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Revisiting Cognitive Remediation for Schizophrenia: Facing the Challenges of the Future

  • Caroline CellardEmail author
  • Sasha Whaley
  • Til Wykes
Chapter

Abstract

It is now well established that cognitive impairments are evident in people with a diagnosis of schizophrenia as well as in their unaffected relatives. However, improving cognition is a relatively new interest in schizophrenia research which has developed over the past 15 years with new treatments and rigorous studies of efficacy. This relatively large body of work suggests that cognition can be improved significantly by cognitive remediation therapy and that these changes can impact on everyday functioning including work outcomes. There are a number of challenges for the future; not only to be clearer about the measurement of the success of programmes, but also to improve the delivery of this promising psychological treatment. Identifying mediator and moderator variables may help in the understanding of the active ingredients of therapy as well as the course of the clinical disorder.

Keywords

Schizophrenia Cognitive Training Rehabilitation Methodological 

Abbreviations

CNTRICS

Cognitive neurosciences treatment research to improve cognition in schizophrenia

CREW

Cognitive remediation experts workshop

CRT

Cognitive remediation therapy

MATRICS

Measurement and treatment research to improve cognition in schizophrenia

NICE

National Institute for Health and Clinical Excellence

PORT

Schizophrenia patient outcomes research team

Notes

Acknowledgments

This work was supported by a Fellowship award from the Canadian Institutes of Health Research to Caroline Cellard.

References

  1. 1.
    Heinrichs RW, Zakzanis KK (1998) Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12(3):426–445PubMedCrossRefGoogle Scholar
  2. 2.
    Wykes T, Katz R, Sturt E et al (1992) Abnormalities of response processing in a chronic psychiatric group. A possible predictor of failure in rehabilitation programmes? Br J Psychiatry 160:244–252PubMedCrossRefGoogle Scholar
  3. 3.
    Green MF (1996) What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry 153(3):321–330PubMedGoogle Scholar
  4. 4.
    Wykes T (1994) Predicting symptomatic and behavioural outcomes of community care. Br J Psychiatry 165(4):486–492PubMedCrossRefGoogle Scholar
  5. 5.
    Green MF, Kern RS, Braff DL et al (2000) Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the right stuff? Schizophr Bull 26(1):119–136PubMedGoogle Scholar
  6. 6.
    Keefe RS, Bilder RM, Davis SM et al (2007) Neurocognitive effects of antipsychotic medications in patients with chronic schizophrenia in the CATIE trial. Arch Gen Psychiatry 64(6):633–647CrossRefGoogle Scholar
  7. 7.
    Davidson G, Shannon C, Mulholland C et al (2009) A longitudinal study of the effects of childhood trauma on symptoms and functioning of people with severe mental health problems. J Trauma Dissociation 10(1):57–68PubMedCrossRefGoogle Scholar
  8. 8.
    Green MF, Nuechterlein KH, Gold JM et al (2004) Approaching a consensus cognitive battery for clinical trials in schizophrenia: the NIMH-MATRICS conference to select cognitive domains and test criteria. Biol Psychiatry 56(5):301–307PubMedCrossRefGoogle Scholar
  9. 9.
    Carter CS, Barch DM, Buchanan RW et al (2008) Identifying cognitive mechanisms targeted for treatment development in schizophrenia: an overview of the first meeting of the cognitive neuroscience treatment research to improve cognition in schizophrenia initiative. Biol Psychiatry 64(1):4–10CrossRefGoogle Scholar
  10. 10.
    Tandon R, Keshavan MS, Nasrallah HA (2008) Schizophrenia, just the facts: what we know in 2008 part 1: overview. Schizophr Res 100(1–3):4–19PubMedCrossRefGoogle Scholar
  11. 11.
    Fioravanti M, Carlone O, Vitale B et al (2005) A meta-analysis of cognitive deficits in adults with a diagnosis of schizophrenia. Neuropsychol Rev 15(2):73–95PubMedCrossRefGoogle Scholar
  12. 12.
    Dickinson D, Ramsey ME, Gold JM (2007) Overlooking the obvious: a meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Arch Gen Psychiatry 64(5):532–542PubMedCrossRefGoogle Scholar
  13. 13.
    Maziade M, Rouleau N, Gingras N et al (2009) Shared neurocognitive dysfunctions in young offspring at extreme risk for schizophrenia or bipolar disorder in eastern quebec multigenerational families. Schizophr Bull 35(5):919–930PubMedCrossRefGoogle Scholar
  14. 14.
    Cellard C, Lefebvre AA, Maziade M et al (2010) An examination of the relative contribution of saturation and selective attention to memory deficits in patients with recent-onset schizophrenia and their unaffected parents. J Abnorm Psychol 119(1):60–70PubMedCrossRefGoogle Scholar
  15. 15.
    Reichenberg A, Caspi A, Harrington H et al (2010) Static and dynamic cognitive deficits in childhood preceding adult schizophrenia: a 30-year study. Am J Psychiatry 167(2):160–169PubMedCrossRefGoogle Scholar
  16. 16.
    Lefebvre AA, Cellard C, Tremblay S et al (2010) Familiarity and recollection processes in patients with recent-onset schizophrenia and their unaffected parents. Psychiatry Res 175(1–2):15–21PubMedCrossRefGoogle Scholar
  17. 17.
    Wykes T, Dunn G (1992) Cognitive deficit and the prediction of rehabilitation success in a chronic psychiatric group. Psychol Med 22(2):389–398PubMedCrossRefGoogle Scholar
  18. 18.
    Gur RE, Calkins ME, Gur RC et al (2007) The Consortium on the genetics of schizophrenia: neurocognitive endophenotypes. Schizophr Bull 33(1):49–68PubMedCrossRefGoogle Scholar
  19. 19.
    Gottesman II, Gould TD (2003) The endophenotype concept in psychiatry: etymology and strategic intentions. Am J Psychiatry 160(4):636–645PubMedCrossRefGoogle Scholar
  20. 20.
    Barch DM, Keefe RS (2010) Anticipating DSM-V: opportunities and challenges for cognition and psychosis. Schizophr Bull 36(1):43–47PubMedCrossRefGoogle Scholar
  21. 21.
    Keefe RS, Vinogradov S, Medalia A et al (2010) Report from the working group conference on multisite trial design for cognitive remediation in schizophrenia. Schizophr Bull doi:10.1093/schbul/sbq010Google Scholar
  22. 22.
    Wykes T, van der Gaag M (2001) Is it time to develop a new cognitive therapy for psychosis – cognitive remediation therapy (CRT)? Clin Psychol Rev 21(8):1227–1256PubMedCrossRefGoogle Scholar
  23. 23.
    Krabbendam L, Aleman A (2003) Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled studies. Psychopharmacology 169(3–4):376–382PubMedCrossRefGoogle Scholar
  24. 24.
    Kurtz MM, Moberg PJ, Gur RC et al (2001) Approaches to cognitive remediation of neuropsychological deficits in schizophrenia: a review and meta-analysis. Neuropsychol Rev 11(4):197–210PubMedCrossRefGoogle Scholar
  25. 25.
    McGurk SR, Twamley EW, Sitzer DI et al (2007) A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry 164(12):1791–1802PubMedCrossRefGoogle Scholar
  26. 26.
    Twamley EW, Jeste DV, Bellack AS (2003) A review of cognitive training in schizophrenia. Schizophr Bull 29(2):359–382PubMedGoogle Scholar
  27. 27.
    McGurk SR, Mueser KT, Feldman K et al (2007) Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial [see comment]. Am J Psychiatry 164(3):437–441PubMedCrossRefGoogle Scholar
  28. 28.
    Bell M, Fiszdon J, Greig T et al (2007) Neurocognitive enhancement therapy with work therapy in schizophrenia: 6-month follow-up of neuropsychological performance. J Rehabil Res Dev 44(5):761–770PubMedCrossRefGoogle Scholar
  29. 29.
    Wykes T, Reeder C, Corner J et al (1999) The effects of neurocognitive remediation on executive processing in patients with schizophrenia. Schizophr Bull 25(2):291–307PubMedGoogle Scholar
  30. 30.
    Reeder C, Shivji R, Wood H et al (2007) Cognitive remediation – does it work? Adv Schizophr Clin Psychiatr 3(2):40–47Google Scholar
  31. 31.
    Matthews DG, Harley JP, Malec JF (1991) Guidelines for computer-assisted neuropsychological rehabilitation and cognitive remediation. Clin Neuropsychol 5(1):3–19CrossRefGoogle Scholar
  32. 32.
    Grynszpan O, Perbal S, Pelissolo A et al (2010) Efficacy and specificity of computer-assisted cognitive remediation in schizophrenia: a meta-analytical study. Psychol Med 1–11Google Scholar
  33. 33.
    Lehoux C, Everett J, Laplante L et al (2003) Fine motor dexterity is correlated to social functioning in schizophrenia. Schizophr Res 62(3):269–273PubMedCrossRefGoogle Scholar
  34. 34.
    Ventura J, Hellemann GS, Thames AD et al (2009) Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: a meta-analysis. Schizophr Res 113(2–3):189–199PubMedCrossRefGoogle Scholar
  35. 35.
    Silverstein SM, Hatashita-Wong M, Solak BA et al (2005) Effectiveness of a two-phase cognitive rehabilitation intervention for severely impaired schizophrenia patients. Psychol Med 35(6):829–837PubMedCrossRefGoogle Scholar
  36. 36.
    Wykes T, Huddy V (2009) Cognitive remediation for schizophrenia: it is even more complicated. Curr Opin Psychiatr 22(2):161–167CrossRefGoogle Scholar
  37. 37.
    Bellack AS, Green MF, Cook JA et al (2007) Assessment of community functioning in people with schizophrenia and other severe mental illnesses: a white paper based on an NIMH-sponsored workshop. Schizophr Bull 33(3):805–822PubMedCrossRefGoogle Scholar
  38. 38.
    Brebion G, Gorman JM, Malaspina D et al (2005) A model of verbal memory impairments in schizophrenia: two systems and their associations with underlying cognitive processes and clinical symptoms. Psychol Med 35(1):133–142PubMedCrossRefGoogle Scholar
  39. 39.
    Reeder C, Newton E, Frangou S et al (2004) Which executive skills should we target to affect social functioning and symptom change? A study of a cognitive remediation therapy program. Schizophr Bull 30(1):87–100PubMedGoogle Scholar
  40. 40.
    Goodarzi MA, Wykes T, Hemsley DR (2000) Cerebral lateralization of global-local processing in people with schizotypy. Schizophr Res 45(1–2):115–121PubMedCrossRefGoogle Scholar
  41. 41.
    Knight RA, Silverstein SM (2001) A process-oriented approach for averting confounds resulting from general performance deficiencies in schizophrenia. J Abnorm Psychol 110(1):15–30PubMedCrossRefGoogle Scholar
  42. 42.
    Medalia A, Thysen J, Freilich B (2008) Do people with schizophrenia who have objective cognitive impairment identify cognitive deficits on a self report measure? Schizophr Res 105(1–3):156–164PubMedCrossRefGoogle Scholar
  43. 43.
    Dickinson D, Tenhula W, Morris S et al (2010) A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia. Am J Psychiatry 167(2):170–180PubMedCrossRefGoogle Scholar
  44. 44.
    Wykes T, Huddy V, Cellard C et al (in press) A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J PsychiatryGoogle Scholar
  45. 45.
    Tarrier N, Wykes T (2004) Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? Behav Res Ther 42(12):1377–1401PubMedCrossRefGoogle Scholar
  46. 46.
    Guralnick MJ (1993) Second generation research on the effectiveness of early intervention. Early Edu Dev 4(4):366–378CrossRefGoogle Scholar
  47. 47.
    Roth A, Fonagy P (eds) (2005) What works for whom? A critical review of psychotherapy research, 2nd edn. The Guilford Press, New York, NY, p 661Google Scholar
  48. 48.
    Breitborde NJ, Srihari VH, Pollard JM et al (2010) Mediators and moderators in early intervention research. Early Intervent Psychiatry 4(2):143–152CrossRefGoogle Scholar
  49. 49.
    Kazdin AE (2003) Research design in clinical psychology, 4th edn. Allyn, Boston, MAGoogle Scholar
  50. 50.
    Tandon R, Nasrallah HA, Keshavan MS (2009) Schizophrenia, just the facts 4. Clinical features and conceptualization. Schizophr Res 110(1–3):1–23PubMedCrossRefGoogle Scholar
  51. 51.
    Longenecker J, Dickinson D, Weinberger DR et al (2010) Cognitive differences between men and women: a comparison of patients with schizophrenia and healthy volunteers. Schizophr Res 120(1–3):234–235PubMedCrossRefGoogle Scholar
  52. 52.
    Wykes T, Reeder C, Landau S et al (2009) Does age matter? Effects of cognitive rehabilitation across the age span. Schizophr Res 113(2–3):252–258PubMedCrossRefGoogle Scholar
  53. 53.
    McGurk S, Mueser KT (2008) Response to cognitive rehabilitation in older versus younger persons with severe mental illness. Am J Psychiatr Rehabil 11(1):90–105CrossRefGoogle Scholar
  54. 54.
    Dixon LB, Dickerson F, Bellack AS et al (2010) The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull 36(1):48–70PubMedCrossRefGoogle Scholar
  55. 55.
    Wykes T, Reeder C, Landau S et al (2007) Cognitive remediation therapy in schizophrenia: randomised controlled trial. Br J Psychiatry 190:421–427PubMedCrossRefGoogle Scholar
  56. 56.
    Patel A, Knapp M, Romeo R et al (2010) Cognitive remediation therapy in schizophrenia: cost-effectiveness analysis. Schizophr Res 120(1–3):217–224PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Centre de recherche Université Laval Robert-GiffardQuébec CityCanada
  2. 2.Department of PsychologyInstitute of PsychiatryLondonUK

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