Cognitive remediation for inpatients with psychosis: a systematic review and meta-analysis

Abstract

Cognitive difficulties are common in people with psychosis and associated with considerable disability. Cognitive remediation (CR) can reduce the burden of cognitive difficulties and improve functioning. While mental health care has predominantly shifted to the community, people with greater illness severity and complexity, and those with poor response to treatment and concomitant greater cognitive difficulties, continue to receive inpatient care. The aim of this study is to review and evaluate the acceptability and efficacy of CR for inpatients with psychosis. A systematic search was used to identify randomized controlled trials of CR for inpatients with psychosis. Demographic and clinical information was extracted by independent raters together with therapy outcomes. Study quality was assessed using the Cochrane Collaboration Risk of Bias Assessment tool. Standardized mean change for cognitive and functional outcomes was calculated using Hedges's g and used to infer therapy effects with meta-analysis. Twenty studies were identified considering 1509 participants. Results from random-effect models suggested that CR was effective in improving processing speed (g = 0.48), memory (g = 0.48) and working memory (g = 0.56). While there was an indication of improvements in the levels of vocational, social and global functioning, these were less reliable. On average, 7% of participants dropped-out of treatment. Studies methodological quality was moderate. CR is an acceptable intervention for inpatients with psychosis and can lead to significant cognitive improvements. Evidence for improvement in functioning requires more robust and converging evidence. Future research should extend the evaluation of inpatient CR to subsequent post-discharge community functioning and further need for care.

Computerized Cognitive Training in People with Depression: A Systematic Review and Meta-analysis of Randomized Clinical Trials

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Advanced glycation end products and cognitive impairment in schizophrenia

“…This evidence emphasizes that processing speed deficits are a potential intervention target to obtain better functional outcomes in patients with schizophrenia. Indeed, previous studies have demonstrated that cognitive intervention is effective for improving processing speed [ 22 ], even for inpatients with schizophrenia [ 34 ]. Taken together, these findings have important clinical implications.…”

Cognitive Remediation in Virtual Environments for Patients with Schizophrenia and Major Depressive Disorder: A Feasibility Study

“…Although previous meta-analyses revealed significant improvement in different cognitive domains in schizophrenia after cognitive remediation [24][25][26] the meta-analysis by Revell et al [51] investigating CR efficacy in early schizophrenia showed a significant effect on verbal memory and learning, but only a non-significant small effect of CR on global cognition and other cognitive domains. Similarly, some randomized clinical trials also failed to report significant improvement [52][53][54], arguing the potential inefficacy of the cognitive remediation approach in schizophrenia patients in general [53] Both treatments in this study used a drill-practice approach.…”

“…The drill practice was reported as a beneficial intervention for increasing cognitive performance [22]; strategy learning was argued to lead to larger functional outcome performance [23]. Meta-analyses focusing on the effect of CR show more promising results than the treatment with antipsychotic medication [22,[24][25][26]. A large meta-analysis (n = 2401) conducted by Wykes et al [24], pointed to a moderate effect of CR on global cognitive functioning (ES = 0.45), and almost all cognitive domains showed significant improvement.…”