Cognitive remediation in schizophrenia: efficacy and effectiveness in patients with early versus long-term course of illness

Authors

  • Christopher R. Bowie,

    Corresponding author
    1. Department of Psychology, Queen's University, Kingston, Ontario, Canada
    2. Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
    3. Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
    • Corresponding author: Dr Christopher R. Bowie, Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON, Canada K0H 1S0. Email: bowiec@queensu.ca

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  • Michael Grossman,

    1. Department of Psychology, Queen's University, Kingston, Ontario, Canada
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  • Maya Gupta,

    1. Department of Psychology, Queen's University, Kingston, Ontario, Canada
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  • L. Kola Oyewumi,

    1. Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
    2. Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
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  • Philip D. Harvey

    1. Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
    2. Research Service, Miami VA Medical Center, Miami, Florida, USA
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  • Funding sources: Funding for the study presented in this manuscript was provided by a NARSAD Young Investigator award to Dr. Bowie.
  • Disclosures: Dr. Bowie has served as a consultant for Abbott Pharmaceuticals in the past year. Dr. Harvey has served as a consultant to Abbott Labs, Boehinger Ingelheim, Genentech, Johnson and Johnson, PharmaNeuro Boost, Roche Pharma, Shire and Sunovion Pharma in the past year. Dr. Oyewumi has served on the advisory board for Pfizer, Sunovion, Bristol Myers Squibb and Lundbeck in the past year. All other authors report no financial relationships with commercial interests.

Abstract

Aim

We examined the efficacy and effectiveness (transfer to functional competence and everyday functioning) of cognitive remediation in early-course (within 5 years of first episode) and long-term (more than 15 years of illness) schizophrenia.

Methods

Treatment lasted 12 weeks and included computerized exercises, strategic monitoring and methods to transfer cognition to behaviour. Assessments included a standard battery of neurocognition, performance-based measures of social and adaptive competence, and case manager ratings of real-world functional behaviour. Changes from baseline to post-treatment were examined with repeated measures analysis of variance and estimated premorbid intelligence and total months in hospital as covariates.

Results

The early-course group had larger improvements in measures of processing speed and executive functions, as well as larger improvements in adaptive competence and real-world work skills. Duration of illness was inversely associated with improvement in neurocognition and real-world work skills.

Conclusions

Treatment of cognitive impairments is feasible in both early-course and chronic schizophrenia, but the clinical meaningfulness and generalization to functioning appear to be more substantial when delivered early. Cognitive remediation should be considered a tool for early intervention in schizophrenia.

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