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Article of Interest - Schizophrenia

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Bridges4Kids LogoCognitive 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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