Effectiveness, Core Elements, and Moderators of Response of Cognitive Remediation for Schizophrenia

Abstract

IMPORTANCE Cognitive impairment is a core feature of schizophrenia, with negative consequences on functional outcomes. Although cognitive remediation (CR) is effective and mentioned in treatment guidance for schizophrenia, its active ingredients and ideal candidates are still debated.OBJECTIVE To provide a comprehensive update on CR effectiveness for cognition and functioning in schizophrenia and analyze the core ingredients of efficacy and role of patient characteristics. DATA SOURCESThe reference list of the last comprehensive meta-analysis in 2011 was screened against eligibility criteria. Then, electronic databases (PubMed, Scopus, and PsycInfo) were systematically searched for articles published from January 2011 to February 2020. Reference lists of included articles and relevant reviews were hand searched, and Google Scholar was manually inspected.STUDY SELECTION Eligible studies were randomized clinical trials comparing CR with any other control condition in patients diagnosed with schizophrenia spectrum disorders (with an unrestricted clinical status). Screening was performed by at least 2 independent reviewers. DATA EXTRACTION AND SYNTHESIS The PRISMA guidelines were followed. Study data were independently extracted and pooled using random-effect models. Cohen d was used to measure outcomes. Trial methodological quality was evaluated with the Clinical Trials Assessment Measure. MAIN OUTCOMES AND MEASURESPrimary outcomes were changes in global cognition and overall functioning from baseline to after treatment, subsequently investigated through metaregressions, subgroup, and sensitivity analyses based on prespecified hypotheses, to identify potential moderators of response associated with treatment modality and patient characteristics. RESULTSOf 1815 identified reports, 358 full texts were assessed and 194 reports on 130 studies were included. Based on 130 studies with 8851 participants, CR was effective on cognition (d, 0.29 [95% CI,) and functioning (d, 0.22 [95% CI,). An active and trained therapist (cognition: χ 2 1 , 4.14; P = .04; functioning: χ 2 1 , 4.26; P = .04), structured development of cognitive strategies (cognition: χ 2 1 , 9.34; P = .002; functioning: χ 2 1 , 8.12; P = .004), and integration with psychosocial rehabilitation (cognition: χ 2 1 , 5.66; functioning: χ 2 1 , 12.08) were crucial ingredients of efficacy. Patients with fewer years of education (global cognition:

Digital mental health in China: a systematic review

“…Finally, the methodological quality of the Chinese studies was less rigorous, which may increase the risk of a type 1 statistical error and might be the reason why most of the efficacy studies were positive. For example, all of the included CCRT studies in schizophrenia showed positive effects on improving neurocognitive and functional outcomes, when previous systematic reviews indicated only small to moderate effects and many trials reported negative results (Kambeitz-Ilankovic et al, 2019 ; Vita et al, 2021 ). The current review indicated DHTs may play a role in improving symptom, neurocognitive, and functional outcomes in mental health problems in the Chinese population.…”

Subjective cognitive complaints and relations to objective cognitive performance among Lebanese patients with schizophrenia

“…Four key aspects for cognitive remediation were recognized in a recent expert consensus: the presence of an engaged and qualified therapist, frequent practice of cognitive exercises, organized development of cognitive strategies, and the application of methods to promote the transfer of cognitive gains to the real world [ 58 ]. A recent systematic review and meta-analysis including 130 studies have found that the four core elements of cognitive remediation significantly produced larger benefit on cognitive and functional outcome [ 59 ]. However, treatment duration was directly associated only with functional gain but not with cognitive outcome [ 59 ].…”

“…A recent systematic review and meta-analysis including 130 studies have found that the four core elements of cognitive remediation significantly produced larger benefit on cognitive and functional outcome [ 59 ]. However, treatment duration was directly associated only with functional gain but not with cognitive outcome [ 59 ]. In addition, atypical antipsychotic treatments have been shown to improve objective cognitive impairments and this impact may also translate to subjective cognitive impairments, according to some evidence [ 60 ].…”

An Integrated Account of Expert Perspectives on Functioning in Schizophrenia

“…In this regard, social workers may also contribute to alleviating psychotic symptoms by conducting appropriate assessments and referrals [ 42 ]. Cognitive function is mainly improved through cognitive remediation therapy [ 43 , 44 ], but it has also been proven that it can improve through medical interventions [ 45 ], occupational therapy [ 46 ] and physiotherapeutic interventions [ 16 ]. These are some examples of how interventions carried out from each professional perspective can produce effects in these affected areas.…”