Louise B Glenthøj1, Lise S Mariegaard2, Birgitte Fagerlund3, Jens R M Jepsen4, Tina D Kristensen5, Christina Wenneberg6, Kristine Krakauer6, Alice Medalia7, David L Roberts8, Carsten Hjorthøj9, Merete Nordentoft5. 1. Copenhagen Research Centre on Mental Health (CORE), Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark. Electronic address: louise.birkedal.glenthoej@regionh.dk. 2. Copenhagen Research Centre on Mental Health (CORE), Copenhagen University Hospital, DK-2900 Hellerup, Denmark. 3. Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, DK-2600 Glostrup, Denmark; Department of Psychology, Copenhagen University, Denmark. 4. Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, DK-2600 Glostrup, Denmark; Child and Adolescent Mental Health Centre, Mental Health Services Capital Region of Denmark, University of Copenhagen, Denmark. 5. Copenhagen Research Centre on Mental Health (CORE), Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark. 6. Copenhagen Research Centre on Mental Health (CORE), Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Functional Imaging Unit, Department of Diagnostics, Copenhagen University Hospital, DK-2600 Glostrup, Denmark. 7. Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian, New York, NY 10032, USA. 8. Department of Psychiatry, Division of Community Recovery, Research and Training, University of Texas Health Science Center, San Antonio, TX 78229, USA. 9. Copenhagen Research Centre on Mental Health (CORE), Copenhagen University Hospital, DK-2900 Hellerup, Denmark; University of Copenhagen, Department of Public Health, Section of Epidemiology, Denmark.
Abstract
BACKGROUND: Individuals at ultra-high risk (UHR) for psychosis have significant cognitive deficits that can impede functional recovery. Applying cognitive remediation (CR) before the onset of frank psychosis may improve the cognitive and functional prognosis of UHR individuals, however, little is known about the feasibility and efficacy of CR for this population. METHODS: In this randomised, clinical trial 146 individuals at UHR for psychosisaged 18-40 years were randomly assigned to treatment as usual (TAU) or TAU plus cognitive remediation. The CR targeted neurocognitive and social cognitive remediation. Assessments were carried out at 6- and 12-months post baseline. RESULTS: A total of 73 UHR individuals were assigned to TAU and 73 assigned to TAU + cognitive remediation. Compared to the control group, cognitive remediation did not result in significant improvement on the primary outcome; the Brief Assessment of Cognition in Schizophrenia composite score at 6-month follow-up (b = -0.125, 95%CI: -0.23 to 0.172, p = 0.41). Nor did the intervention improve secondary outcomes in clinical symptoms or functioning. Exploratory analyses found emotion recognition latencies to be significantly more reduced in the intervention group at 6-months. At 12-months, the intervention group exhibited significantly better performance on two measures of executive function and visual memory. CONCLUSION: The 20-session treatment protocol was not well received in the UHR group, and unsurprisingly global measures did not improve. The benefit found in isolated neuro- and social cognitive measures after even a few sessions points to a potential for cognitive malleability if people can be engaged sufficiently to practice the skills. Trial registration ClinicalTrial.gov identifier: NCT02098408.
RCT Entities:
BACKGROUND: Individuals at ultra-high risk (UHR) for psychosis have significant cognitive deficits that can impede functional recovery. Applying cognitive remediation (CR) before the onset of frank psychosis may improve the cognitive and functional prognosis of UHR individuals, however, little is known about the feasibility and efficacy of CR for this population. METHODS: In this randomised, clinical trial 146 individuals at UHR for psychosis aged 18-40 years were randomly assigned to treatment as usual (TAU) or TAU plus cognitive remediation. The CR targeted neurocognitive and social cognitive remediation. Assessments were carried out at 6- and 12-months post baseline. RESULTS: A total of 73 UHR individuals were assigned to TAU and 73 assigned to TAU + cognitive remediation. Compared to the control group, cognitive remediation did not result in significant improvement on the primary outcome; the Brief Assessment of Cognition in Schizophrenia composite score at 6-month follow-up (b = -0.125, 95%CI: -0.23 to 0.172, p = 0.41). Nor did the intervention improve secondary outcomes in clinical symptoms or functioning. Exploratory analyses found emotion recognition latencies to be significantly more reduced in the intervention group at 6-months. At 12-months, the intervention group exhibited significantly better performance on two measures of executive function and visual memory. CONCLUSION: The 20-session treatment protocol was not well received in the UHR group, and unsurprisingly global measures did not improve. The benefit found in isolated neuro- and social cognitive measures after even a few sessions points to a potential for cognitive malleability if people can be engaged sufficiently to practice the skills. Trial registration ClinicalTrial.gov identifier: NCT02098408.
Authors: Tina D Kristensen; Bjørn H Ebdrup; Carsten Hjorthøj; René C W Mandl; Jayachandra M Raghava; Jens Richardt M Jepsen; Birgitte Fagerlund; Louise B Glenthøj; Christina Wenneberg; Kristine Krakauer; Christos Pantelis; Birte Y Glenthøj; Merete Nordentoft Journal: Front Psychiatry Date: 2020-08-28 Impact factor: 4.157
Authors: Ana Catalan; Gonzalo Salazar de Pablo; Claudia Aymerich; Stefano Damiani; Veronica Sordi; Joaquim Radua; Dominic Oliver; Philip McGuire; Anthony J Giuliano; William S Stone; Paolo Fusar-Poli Journal: JAMA Psychiatry Date: 2021-06-16 Impact factor: 25.911