Cognitive Remediation for Schizophrenia

Status: Strong Research Support

Description

Cognitive functions such as executive function, learning & memory, processing speed, and sustained attention are frequently impaired and play an important role in the functional impairments seen in schizophrenia. Cognitive remediation (CR) or cognitive rehabilitation interventions are designed to improve cognitive function through repeated practice of cognitive tasks and / or strategy training. CR interventions are typically time-limited. They can be conducted individually or in groups. Some involve extensive use of computers while others focus primarily on paper-and-pencil tasks. Most CR interventions take into account the motivational and emotional deficits that are often present in schizophrenia as well. The goal of CR is to improve cognitive function. Research has shown small to medium effects of CR on neuropsychological measures of cognition, but whether these improvements are sustained or whether they translate into improved functioning remains unclear.

Key References (in reverse chronological order)

• Wexler BE, Hawkins KA, Rounsaville B, Anderson M, Sernyak MJ, Green MF: Normal neurocognitive performance after extended practice in patients with schizophrenia. Schizophr Res 1997; 26(2-3):173-80.
• Spaulding W, Reed D, Strozbach D, Sullivan M, Weiler M, Richardson C: The effects of a remediational approach to cognitive therapy for schizophrenia, in Outcome and Innovation in Psychological Treatment of Schizophrenia. Edited by Wykes T, Tarrier N, Lewis S. Chichester, England, Wiley, 1998, pp 145-160
• Medalia A, Revheim N: Computer assisted learning in psychiatric rehabilitation. Psychiatr Rehab 1999; 3:77-98
• Wykes T, Reeder C, Corner J, Williams C, Everitt B: The effects of neurocognitive remediation on executive processing in patients with schizophrenia. Schizophr Bull 1999; 25:291-307
• Bell M, Bryson G, Greig T, Corcoran C, Wexler BE: Neurocognitive enhancement therapy with work therapy: effects on neuropsychological test performance. Arch Gen Psychiatry 2001; 58(8):763-8.
• Medalia A, Revheim N, Casey M: The remediation of problem-solving skills in schizophrenia. Schizophr Bull 2001; 27(2):259-67
• Medalia A, Revheim N, Casey M: Remediation of problem-solving skills in schizophrenia: evidence of a persistent effect. Schizophr Res 2002; 57(2-3):165-71
• Twamley, Elizabeth W; Jeste, Dilip V; Bellack, Alan S. A review of cognitive training in schizophrenia. Schizophrenia Bulletin. Vol 29(2) 2003, 359-382.
• Medalia A, Richardson R (2005). What Predicts a Good Response to Cognitive Remediation Interventions?Schizophrenia Bulletin, 31: 942-53
• Wykes, T., Reeder, C., Landau, S., Everitt, B, Knapp, M, Patel, A. & Romeo, R. (2007) Cognitive remediation therapy in schizophrenia: Randomised controlled trial. British Journal of Psychiatry, 190, 421-427.

Clinical Resources

• Delahunty A, Morice R: A Training Programme for the Remediation of Cognitive Deficits in Schizophrenia. Albury, New South Wales, Department of Health, 1993
• Brenner H, Roder V, Hodel B, Kienzle N, Reed D, Liberman R: Integrated psychological therapy for schizophrenia patients. Seattle, Hogrefe & Huber, 1994
• Medalia A, Revheim N, Herlands T : Remediation of Cognitive Deficits in Psychiatric Patients: A Clinician’s Manual,  Alliance for the Study of Cognitive Disorders,  New York,  NC,  USA,  2002
• Revheim N, Medalia A (2004). How to Help Psychiatric Patients with Cognitive Deficits: A Guide for Families and Friends.  Journal of Psychiatric Practice,10: 73-76
• Bellack, A.S., Dickinson, D., Morris, S.E., & Tenhula, W.N. (2005). The development of a computer-assisted cognitive remediation program for patients with schizophrenia. Israel Journal of Psychiatry and Related Sciences, 42 (1): 5-14
• Wykes, T. & Reeder, R. (2005). Cognitive Remediation Therapy for Schizophrenia: Theory and Practice. New York, NY: Brunner-Routledge.

Training Opportunities