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Improving outcome of treatment-resistant schizophrenia: effects of cognitive remediation therapy

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Abstract

Treatment-Resistant Schizophrenia (TRS) represents a main clinical issue, associated with worse psychopathological outcomes, a more disrupted neurobiological substrate, and poorer neurocognitive performance across several domains, especially in verbal abilities. If cognitive impairment is a major determinant of patients’ functional outcomes and quality of life, targeting cognitive dysfunction becomes even more crucial in TRS patients in order to minimize cognitive and functional deterioration. However, although Cognitive Remediation Therapy (CRT) represents the best available tool to treat cognitive dysfunction in schizophrenia, specific evidence of its efficacy in TRS is lacking. Based on these premises, our study aimed at investigating possible differences in CRT outcomes in a sample of 150 patients with schizophrenia, stratified according to antipsychotic response (TRS vs. non-TRS). Subjects were assessed for neurocognition through Brief Assessment of Cognition in Schizophrenia (BACS) and the Wisconsin Card Sorting Test (WCST) at baseline and after CRT. As expected, we observed greater baseline impairment among TRS patients in BACS-Verbal Memory and WCST-Executive Functions. Repeated measures ANCOVAs showed significant within-group pre-/post-CRT differences in the above-mentioned domains, both among non-TRS and TRS subjects. However, after CRT, no differences were observed between groups. This is the first study to indicate that CRT represents a highly valuable resource for TRS patients, since it may be able to fill the cognitive gap between treatment response groups. Our finding further highlights the importance of early implementation of CRT in addition to pharmacotherapy to reduce the cognitive and functional burden associated with the disease, especially for TRS patients.

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Data availability

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.

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Author notes

  1. Francesca Martini and Marco Spangaro contributed to this work equally.

  2. Roberto Cavallaro and Marta Bosia contributed to this work equally.

Authors and Affiliations

  1. Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Francesca Martini, Marco Spangaro, Margherita Bechi, Giulia Agostoni, Mariachiara Buonocore, Jacopo Sapienza, Federica Cocchi, Roberto Cavallaro & Marta Bosia

  2. Vita-Salute San Raffaele University, Milan, Italy

    Daniela Nocera, Chiara Ave, Roberto Cavallaro & Marta Bosia

  3. Department of Humanities and Life Sciences, University School for Advanced Studies IUSS, Pavia, Italy

    Jacopo Sapienza

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Contributions

All the authors contributed to the study conception and design. Material preparation, and data collection and analysis were performed by MS, FM, MB, MB, MB, GA, FC, JS, and RC. The first draft of the manuscript was written by MS and FM and all the authors commented on previous versions of the manuscript. CA and DN assisted in revising the Manuscript and data implementation. All the authors read and approved the final manuscript.

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Correspondence to Marco Spangaro.

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All subjects provided informed consent to a protocol approved by the local Ethical Committee following the principles of the Declaration of Helsinki.

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Martini, F., Spangaro, M., Bechi, M. et al. Improving outcome of treatment-resistant schizophrenia: effects of cognitive remediation therapy. Eur Arch Psychiatry Clin Neurosci (2023). https://doi.org/10.1007/s00406-023-01731-6

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