Bruno Biagianti1, Jaisal Merchant2, Paolo Brambilla3, Kathryn E Lewandowski4. 1. Posit Science Inc.,160 Pine Street Suite 200, 94111 San Francisco, CA, USA. Electronic address: bruno.biagianti@positscience.com. 2. Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA. 3. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Psychiatry, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA. 4. Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: Schizophrenia, schizoaffective disorder, and related illnesses are associated with significant impairment in cognitive functioning which is among the strongest predictors of disability and poor quality of life. Cognitive remediation (CR) was developed as a set of behavioral interventions directly targeting cognitive symptoms. Studies have shown that CR produces cognitive improvements in patients with schizophrenia and bipolar disorder that may be associated with improvements in functioning. However, the relative efficacy of CR across diagnoses has not been established. Indirect evidence suggests that CR is effective in patients with affective illness as well as patients with schizophrenia (SZ); however, the one study to evaluate the effects of diagnosis on outcomes directly in patients with SZ versus schizoaffective disorder (SZA) found no differences by diagnosis. METHODS: In this systematic review, we evaluated cognitive and functional outcomes after CR in studies including patients with SZA, and examined specificity of training content to outcomes. RESULTS: Sixteen studies met inclusion criteria: 10 studies that compared CR to a control condition (n = 779) and 6 comparative effectiveness studies. None of the studies explicitly compared patients by diagnosis. Studies included a mixture of patients with SZA or SZ. Of the CR versus control studies, effect sizes for cognitive outcomes were moderate-large (d = .36-.94). Studies comparing CR paradigms targeting different cognitive domains showed specificity of training focus to outcomes. Five of studies reported significant functional improvement after CR as secondary outcomes. CONCLUSIONS: In this review, we found support for the use of CR paradigms in patients with affective psychosis, with evidence that reported treatment effects in mixed affective and non-affective samples are at or above the levels previously reported in SZ. However, lack of availability of data directly comparing patients by diagnosis or examining moderator or mediator effects of diagnosis or diagnosis-related patient characteristics limits our understanding of the relative efficacy of CR across patient group.
BACKGROUND:Schizophrenia, schizoaffective disorder, and related illnesses are associated with significant impairment in cognitive functioning which is among the strongest predictors of disability and poor quality of life. Cognitive remediation (CR) was developed as a set of behavioral interventions directly targeting cognitive symptoms. Studies have shown that CR produces cognitive improvements in patients with schizophrenia and bipolar disorder that may be associated with improvements in functioning. However, the relative efficacy of CR across diagnoses has not been established. Indirect evidence suggests that CR is effective in patients with affective illness as well as patients with schizophrenia (SZ); however, the one study to evaluate the effects of diagnosis on outcomes directly in patients with SZ versus schizoaffective disorder (SZA) found no differences by diagnosis. METHODS: In this systematic review, we evaluated cognitive and functional outcomes after CR in studies including patients with SZA, and examined specificity of training content to outcomes. RESULTS: Sixteen studies met inclusion criteria: 10 studies that compared CR to a control condition (n = 779) and 6 comparative effectiveness studies. None of the studies explicitly compared patients by diagnosis. Studies included a mixture of patients with SZA or SZ. Of the CR versus control studies, effect sizes for cognitive outcomes were moderate-large (d = .36-.94). Studies comparing CR paradigms targeting different cognitive domains showed specificity of training focus to outcomes. Five of studies reported significant functional improvement after CR as secondary outcomes. CONCLUSIONS: In this review, we found support for the use of CR paradigms in patients with affective psychosis, with evidence that reported treatment effects in mixed affective and non-affective samples are at or above the levels previously reported in SZ. However, lack of availability of data directly comparing patients by diagnosis or examining moderator or mediator effects of diagnosis or diagnosis-related patient characteristics limits our understanding of the relative efficacy of CR across patient group.
Authors: Cagri Yüksel; Julie McCarthy; Ann Shinn; Danielle L Pfaff; Justin T Baker; Stephan Heckers; Perry Renshaw; Dost Ongür Journal: Schizophr Res Date: 2012-03-21 Impact factor: 4.939
Authors: Matcheri S Keshavan; Shaun M Eack; Jessica A Wojtalik; Konasale M R Prasad; Alan N Francis; Tejas S Bhojraj; Deborah P Greenwald; Susan S Hogarty Journal: Schizophr Res Date: 2011-06-08 Impact factor: 4.939
Authors: Sophia Vinogradov; Melissa Fisher; Heather Warm; Christine Holland; Margaret A Kirshner; Bruce G Pollock Journal: Am J Psychiatry Date: 2009-07-01 Impact factor: 18.112