Occupational Goal Intervention Method for the Management of Executive Dysfunction in People With Treatment-Resistant Schizophrenia: A Randomized Controlled Trial

Abstract

Importance: The occupational goal intervention (OGI) method has been proven effective in improving executive function (EF) in people with schizophrenia, but it has not yet been tested with those with treatment-resistant schizophrenia (TRS). Objective: To test the efficacy of the OGI in people with TRS. Design: Single-blind randomized controlled trial. Setting: The Schizophrenia Program, Institute of Psychiatry, University of São Paulo General Hospital, Brazil. Participants: People with TRS according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria, ages 18 to 55. Outcomes and Measures: Primary outcome: improvement in EF as measured by the Behavioural Assessment of the Dysexecutive Syndrome (BADS). Secondary outcomes: improvement of functionality, as measured by the Direct Assessment of Functional Status–Revised (DAFS–BR), and improvement in autonomy in activities of daily living (ADLs), as measured by the Independent Living Skills Survey (ILSS–BR), administered to caregivers. The outcomes were measured at baseline, posttreatment, and follow-up. Intervention: Participants were divided into two groups: OGI and craft activities (control). Each group participated in 30 sessions during 15 wk, with follow-up at 6 mo postintervention. Results: The OGI group improved significantly compared with the control group, with medium to large effect sizes in posttreatment scores on the BADS and DAFS–BR. The ILSS–BR showed the highest effect sizes at posttreatment and follow-up. Conclusions and Relevance: The OGI method is effective for improving EF, occupational performance and ADLs in people with TRS. What This Article Adds: The OGI method is an important therapeutic tool for use in the occupational therapy clinic.

A randomized controlled trial of Goal Management Training for executive functioning in schizophrenia spectrum disorders or psychosis risk syndromes

“…It is therefore somewhat uncertain if the results may be generalized to older adults who have been living with schizophrenia for a longer period of time. However, a recent study using the GMT protocol in combination with occupational therapy among adults with treatmentresistant schizophrenia and a higher mean age found similar results [35].…”

“…Combining GMT with restorative drill training and vocational rehabilitation may offer the most promise for achieving functional gains among people with psychosis and EF impairments [33,[102][103][104]. In a study by Vizzotto and colleagues GMT was combined with occupational therapy where participants with treatment-resistant schizophrenia practiced real-life tasks during sessions lasting a total of 45 h [35]. In that context, GMT improved performance on observed real-life tasks and informant reports of independent living.…”

“…The RCT that combined GMT with occupational therapy was aimed at adults with treatment resistant schizophrenia. The participants in the treatment group showed greater improvements in activities of daily living scored by observers [35].…”

“…The extensive assessment protocol with a multimodal approach to the measurement of EF is also a strength of the study. However, the protocol lacked observational measures of real-life situations and community functioning and was a missed opportunity of capturing potential beneficial effects of GMT on functioning [35,36,116]. The primary outcome measure that showed the largest treatment effect of GMT was self-reported EF, which may be vulnerable to cognitive deficits in self-evaluation, demand characteristics and social desirability bias [117].…”

“…GMT has been introduced for people with schizophrenia with promising results in one case-study and a recent randomized controlled trial (RCT) that combined GMT with occupational therapy [35,36]. The individual from the case study showed better performance of familiar and novel real-life tasks after intervention.…”