Improvements in Negative Symptoms and Functional Outcome After a New Generation Cognitive Remediation Program: A Randomized Controlled Trial

Abstract

Cognitive remediation improves cognition in patients with schizophrenia, but its effect on other relevant factors such as negative symptoms and functional outcome has not been extensively studied. In this hospital-based study, 84 inpatients with chronic schizophrenia were recruited from Alava Hospital (Spain). All of the subjects underwent a baseline and a 3-month assessment that examined neurocognition, clinical symptoms, insight, and functional outcome according to the Global Assessment of Functioning (GAF) scale and Disability Assessment Schedule from World Health Organization (DAS-WHO). In addition to receiving standard treatment, patients were randomly assigned either to receive neuropsychological rehabilitation (REHACOP) or to a control group. REHACOP is an integrative program that taps all basic cognitive functions. The program included experts' latest suggestions about positive feedback and activities of daily living in the patients' environment. The REHACOP group showed significantly greater improvements at 3 months in the areas of neurocognition, negative symptoms, disorganization, and emotional distress compared with the control group (Cohen's effect size for these changes ranged from d = 0.47 for emotional distress to d = 0.58 for disorganization symptoms). The REHACOP group also improved significantly in both the GAF (d = 0.61) and DAS-WHO total scores (d = 0.57). Specifically, the patients showed significant improvement in vocational outcomes (d = 0.47), family contact (d = 0.50), and social competence (d = 0.56). In conclusion, neuropsychological rehabilitation may be useful for the reduction of negative symptoms and functional disability in schizophrenia. These findings support the integration of neuropsychological rehabilitation into standard treatment programs for patients with schizophrenia.

The association of neurocognitive impairment with diminished expression and apathy in schizophrenia

“…In addition to cognitive behavioral therapy to address apathy in schizophrenia, cognitive remediation therapy could be applied to target diminished expression. Until now, cognitive remediation has been found in some but not all studies to improve overall negative symptoms (Dickinson et al, 2010;Sánchez et al, 2014). Our findings clearly suggest that apathy and diminished expression need to be addressed as separate outcomes in order to clarify the effect of cognitive remediation on negative symptoms.…”

Motivational and neurocognitive deficits are central to the prediction of longitudinal functional outcome in schizophrenia

“…That said, treatments that are aimed at enhancing one domain, say cognition, should concurrently assess the effects on amotivation/negative symptoms. There is some evidence, for example, that interventions aimed at enhancing cognitive function improve functional outcome, which is more closely related to secondary improvement in negative symptoms rather than cognition per se (62,63). It will be an important area of research to examine whether either amotivation or neurocognitive deficits are necessary or sufficient for poor functioning among individuals with schizophrenia.…”

Working Memory Deficit as a Risk Factor for Severe Apathy in Schizophrenia: A 1-Year Longitudinal Study

“…27 From a clinical perspective, our results support the use of cognitive remediation (CR) as an effective psychological intervention for treating apathy in schizophrenia patients. However if some studies have shown the effectiveness of CR to reduce negative symptoms, 63,64 most of the therapies designed to enhance cognition do not seem to be effective in improving negative symptoms. 65 This apparent contradiction can be partly explained by differences in study design.…”