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 Cognitive
Rehabilitation Shows Robust Benefits For Schizophrenics
Psychiatry News Online, September 10, 2004
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The cognitive
deficits and related behaviors seen in patients with stable
schizophrenia can be improved with sufficient exposure to
cognitive rehabilitation, say researchers.
"Cognitive enhancement therapy is a recovery-phase intervention
for symptomatically stable schizophrenic outpatients with
reduced relapse risk, who nevertheless remain socially and
cognitively disabled, an increasing population in the modern era
of atypical antipsychotic medications," explains the team from
the University of Pittsburgh Medical Center in Pennsylvania,
USA.
Led by Gerard Hogarty, the team explored the cognitive benefits
of two such enhancement therapies in 121 symptomatically stable,
but chronically ill patients with schizophrenia or
schizoaffective disorder.
The participants were randomly assigned to receive either
cognitive enhancement therapy (CET), which is a
multidimensional, developmental approach that integrates
computer-assisted training in neurocognition with social
cognitive group exercises, or enriched supportive therapy (EST),
which focuses on illness management through applied coping
strategies and education.
After 12 months, a robust effect of CET was seen on processing
speed and neurocognition, with marginal improvement evident for
the behavioral domains of cognitive style, social cognition, and
social adjustment. No effect was seen on residual symptoms, as
was expected, given the clinical stability of the patients.
Further improvement in these composites was seen after 24
months. Overall, the CET effects were superior to those seen
with EST, although patients receiving the latter therapy still
experienced substantive neurocognitive and behavioral gains.
Processing speed was a primary mediator candidate for
improvement, and the effects of CET on neurocognition were
mainly due to better verbal memory, with some evidence of
improved cognitive flexibility and problem solving. Enhanced
psychomotor speed and vigilance also made some contribution.
The researchers conclude in the Archives of General Psychiatry:
"The cognitive disabilities of schizophrenia do not need to be
the persistent deficits described in numerous naturalistic,
longitudinal studies.
"Instead, many of these disabilities are capable of improvement
after adequate exposure to cognitive rehabilitation."
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