Cognitive remediation for negative symptoms of schizophrenia: A network meta-analysis

Abstract

Cognitive remediation (CR) is a treatment targeting cognitive difficulties in people with schizophrenia. Recent research suggested that CR may also have a positive effect on negative symptoms. This meta-analysis investigates the effect of CR on negative symptoms. A systematic search was used to identify all randomized-controlled trials of CR in people with schizophrenia reporting negative symptoms outcomes. Levels of negative symptoms at baseline, post-therapy and follow-up, sample demographics and treatment length were extracted. Study methodological quality and heterogeneity were addressed. Negative symptoms standardized mean change was calculated using Hedges's g and used as the main outcome. The search identified 45 studies reporting results for 2511 participants; 15 studies reported follow-up outcomes. CR was associated with a reduction of negative symptoms (most conservative model g=-0.30; 95% CI: -0.36, -0.22) at post-therapy compared with treatment as usual and this effect was larger at follow-up (g=-0.36; 95% CI: -0.51, -0.21). Drop-out rate was comparable between conditions. Network meta-analysis confirmed CR was superior to TAU and TAU plus active control or adjunctive treatment. No evidence of publication bias was found. Studies with more rigorous methodology were associated with larger negative symptom reduction (g=-0.40; 95% CI: -0.51 to -0.30). Although negative symptoms have not been considered a primary target for CR, this intervention can have small to moderate beneficial effects on this symptom cluster. Future research should explore in detail the active mechanisms responsible for negative symptom reduction and the relationship between cognitive and negative symptoms in schizophrenia.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

“…These effects persist after the end of treatment 286 and reduce the probability of transitioning from schizotypal personality disorder to psychotic disorder 291 . Cognitive remediation, a behavioral intervention aimed to improve cognitive processes and not targeting symptoms directly, has been nevertheless found to reduce negative symptoms compared to treatment‐as‐usual, both at the end of treatment and at follow‐up 292 . CBT is efficacious for reducing negative symptoms across psychotic disorders when compared to treatment‐as‐usual, both at the end of treatment and at follow‐up 284,287 .…”

Ist Negativsymptomatik bei Schizophrenie überhaupt behandelbar? Ein systematisches Literaturreview zur Wirksamkeit psychotherapeutischer Interventionen für Negativsymptomatik

“…ihrer medikamentösen Behandlung [Carpenter et al, 1988] [Kurtz und Mueser, 2008], kognitive Verhaltenstherapie (KVT) [Wykes et al, 2008], kognitive Remediation (KR) [Cella et al, 2017], ein kombinierter Ansatz aus KR und SST, dem integrierten psychologischen Therapieprogramm (IPT) [Roder et al, 2011], und Achtsamkeitstrainings [Khoury et al, 2013]. Hierbei ergaben sich jeweils Behandlungseffekte im mittleren Effektstärkenbereich, was in etwa den positiven Effekten der KVT für Positivsymptomatik bei Schizophrenie entspricht [Wykes et al, 2008].…”

Cognitive training improves the disturbed behavioral architecture of schizophrenia-like rats, “Wisket”

“…The fact that from about the seventh day Wisket rats consumed the same amount of rewards as controls may reflect that the learning impairment was greatly overcome by the repetition of the tasks. Since cognitive training also improves cognitive performance in schizophrenic patients, and it can decrease the chance of acute psychiatric admission, too [13][14][15][16][17][18]30], we suggest the predictive validity of this model in this respect. Several brain structures (e.g.…”

“…Unfortunately, the antipsychotic drugs are ineffective in the treatment of negative symptoms and cognitive impairments. Recent data suggest that patients with schizophrenia may regain memory function close to normal after intensive cognitive training for a prolonged period [14][15][16][17][18]. It is well-known that the cognitive functions significantly depend on the behavioral activity, which is impaired in schizophrenic patients, too [19][20][21], and a close relationship was detected between reinforcement learning and general psychosocial functioning in schizophrenia [22].…”