The effect of cognitive remediation in individuals at ultra-high risk for psychosis: a systematic review

Abstract

Cognitive deficits are prominent features of the ultra-high risk state for psychosis that are known to impact functioning and course of illness. Cognitive remediation appears to be the most promising treatment approach to alleviate the cognitive deficits, which may translate into functional improvements. This study systematically reviewed the evidence on the effectiveness of cognitive remediation in the ultra-high risk population. The electronic databases MEDLINE, PsycINFO, and Embase were searched using keywords related to cognitive remediation and the UHR state. Studies were included if they were peer-reviewed, written in English, and included a population meeting standardized ultra-high risk criteria. Six original research articles were identified. All the studies provided computerized, bottom-up-based cognitive remediation, predominantly targeting neurocognitive function. Four out of five studies that reported a cognitive outcome found cognitive remediation to improve cognition in the domains of verbal memory, attention, and processing speed. Two out of four studies that reported on functional outcome found cognitive remediation to improve the functional outcome in the domains of social functioning and social adjustment. Zero out of the five studies that reported such an outcome found cognitive remediation to affect the magnitude of clinical symptoms. Research on the effect of cognitive remediation in the ultra-high risk state is still scarce. The current state of evidence indicates an effect of cognitive remediation on cognition and functioning in ultra-high risk individuals. More research on cognitive remediation in ultra-high risk is needed, notably in large-scale trials assessing the effect of neurocognitive and/or social cognitive remediation on multiple outcomes.npj Schizophrenia (2017) 3:20 ; doi:10.1038/s41537-017-0021-9 INTRODUCTIONDuring the last two decades there have been a surge of studies into the putative prodromal phase of psychosis commonly termed "the ultra-high risk state for psychosis" (UHR) or "the clinical high risk state". This way of prospectively identifying individuals at heightened risk for psychosis serves as the foundation for intervention studies aimed at avoiding, ameliorating, or delaying progression to psychosis. Furthermore, initiating appropriate treatment as early as possible has the potential of improving both the clinical and functional heterogeneous outcome 1 of UHR individuals. 2 Cognitive deficits are prominent features of the UHR state that have received increased attention in the research field. The most recent meta-analysis on the subject found an overall impairment in neurocognition compared with healthy controls to have an effect size of Hedges' g = −0.34, 95% CI: −0.43 to −0.26, with the greatest impairments found in the domains of visual and verbal memory. 3 Moreover, evidence indicates that neurocognitive functioning can be predictive of transition to psychosis, as poorer neurocognitive functioning in the domains of verbal fluency, verbal and visual memory, an...

Pilot study of cognitive remediation and motivational interviewing in youth at risk of serious mental illness

“…Although attrition was moderate, adherence to the treatment was poor with an average of only 33% of the sessions being completed. This was despite the offering of MI although in line with other similar studies with at‐risk populations that reported moderate and high attrition rates (Glenthøj et al, ). Anecdotally, participants overall reported that they found most of the MBS training games easy and unchallenging compared to the commercial video games that a few of them regularly played.…”

“…MDD, major depressive disorder; QIDS, Quick Inventory of Depressive Symptomatology; SCID 5, Structured Clinical Interview for similar studies with at-risk populations that reported moderate and high attrition rates (Glenthøj et al, 2017). Anecdotally, participants overall reported that they found most of the MBS training games easy and unchallenging compared to the commercial video games that a few of them regularly played.…”

“…However, support for CRT in mood disorders is limited as it is based on a few very small and heterogeneous studies (Porter, Bowie, Jordan, & Malhi, ). With respect to those at risk, results from 6 published studies of CRT in CHR samples are inconclusive and tend to suffer from low treatment adherence (Glenthøj, Hjorthøj, Kristensen, Davidson, & Nordentoft, ). Given motivational impairments in CHR youth (Schlosser et al, ), strategies such as motivational interviewing (MI) to increase motivation and readiness to participate in treatment have been suggested as an adjunct to CRT (Fiszdon, Kurtz, Choi, Bell, & Martino, ; Harvey & Bowie, ).…”

Negative symptoms in the clinical high‐risk state for psychosis: Connection with cognition and primacy in impacting functioning

“…These have produced more consistent results. Both Meyer et al () and Glenthøj, Hjorthøj, Kristensen, Davidson, and Nordentoft () found predictive relationships between cognitive variables and functioning on the GF:R and GF:S, with partial mediation through negative symptoms, mirroring the findings of Gard et al () in schizophrenia. Carrión et al () likewise observed an impact of cognition on GF:R and GF:S scores, which was unmediated by positive symptoms (these authors did not examine negative symptoms).…”

Multimodal prevention of first psychotic episode through N‐acetyl‐l‐cysteine and integrated preventive psychological intervention in individuals clinically at high risk for psychosis: Protocol of a randomized, placebo‐controlled, parallel‐group trial

“…These domains are already impaired in CHR subjects (Lee et al, 2015;Van Donkersgoed, Wunderink, Nieboer, Aleman, & Pijnenborg, 2015). Although the need of social-cognitive remediation for CHR subjects has been highlighted in recent reviews (Glenthøj, Hjorthøj, Kristensen, Davidson, & Nordentoft, 2017;Statucka & Walder, 2013), there is still a lack of such evaluation studies.…”