Cognitive remediation in large systems of psychiatric care

Medalia, Alice; Saperstein, Alice M.; Erlich, Matthew D.; Sederer, Lloyd I.

doi:10.1017/s1092852918000822

Cited by 24 publications

(18 citation statements)

References 46 publications

(64 reference statements)

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“…We aim to roll out CR across multiple clinical services and evaluate common and unique aspects of CR programming across settings. While our CR model was well‐aligned with the overall mission and structure of OnTrack, additional development and expansion of this service will involve assessment of implementation measures that are shared and distinct across clinical services (Medalia, Saperstein, et al, 2019), assessment of key aspects of expanded programming across sites such as fidelity and implementation cost, and expanded outcomes assessments including programme maintenance and acceptability to both consumers and providers.…”

Section: Discussionmentioning

confidence: 99%

“…By way of exception, Medalia and colleagues have implemented CR in clinical practice for people with serious mental illness in a large‐scale system of care across New York state. They report strong evidence of feasibility and utilization across geographically diverse clinics, and strong evidence of user satisfaction (Medalia et al, 2019; Medalia, Saperstein, Erlich, & Sederer, 2019; Soumet‐Leman, Medalia, & Erlich, 2018). Here we describe the development of a CR clinical programme at McLean OnTrack, a first episode psychosis and mania clinic at McLean Hospital, and preliminary feasibility and tolerability outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and tolerability of a cognitive remediation clinical service in first episode coordinated specialty care

Lewandowski

2020

Early Intervention Psych

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Aim Cognitive remediation is an evidence‐based intervention targeting the common and disabling cognitive deficits in people with psychosis. Findings from efficacy studies and meta‐analyses show that cognitive remediation produces medium to large effects on cognition in both chronic and first episode patients. However, clinical availability of this treatment remains scarce, reflecting a major gap between science and practice. Here we describe the development of a cognitive remediation programme in an outpatient first episode psychosis clinical service, and preliminary feasibility and acceptability outcomes. Methods Based on evidence from efficacy trials and assessment within the clinic of perceived benefits and barriers, we developed a CR programme that involved both internet‐based computer training exercises and a weekly in‐person therapy group. Outcomes were assessed based on data from three consecutive 12‐week group series. Feasibility outcomes included adoption, fill, cost, and utilization; tolerability outcomes were based on user survey and focus group feedback. Results We found evidence of feasibility including good adoption, fill, utilization, and cost. We also found good tolerability and satisfaction based on feedback from a user survey and focus groups, with more than 80% of respondents reporting high overall satisfaction with the programme and subjective cognitive and functional improvements. Conclusions The present report provides preliminary evidence that cognitive remediation can be translated into real world clinical practice for first episode psychosis. Systematic evaluation of implementation and dissemination of cognitive remediation is needed, and has the potential to improve access to cognitive health interventions for people with psychosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility and tolerability of a cognitive remediation clinical service in first episode coordinated specialty care

Lewandowski

2020

Early Intervention Psych

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“…The difference in the conditions was that only participants in Brain Basics trained auditory psychophysical efficiency and only participants in Brain Training trained abstract reasoning and problem solving. Both conditions entailed 30 separate 75-min group sessions, allotting 60 min for computer exercises, and 15-min for a group "bridging" discussion consistent with the CR treatment model used throughout mental health clinics in New York Office of Mental Health (see Medalia et al, 2018 for a description of the treatment model and treatment fidelity monitors). Cognitive exercise curricula and bridging group content were informed by a preliminary 10-session open trial and focus group feedback which included 12 outpatients and CR clinicians from one psychiatric rehabilitation program in New York City.…”

Section: Participants and Proceduresmentioning

confidence: 99%

Impact of baseline early auditory processing on response to cognitive remediation for schizophrenia

Medalia

Saperstein

Qian

et al. 2019

Schizophrenia Research

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Background: Early auditory processing (EAP) has increasingly become a focus of efforts to identify biomarkers of treatment response in schizophrenia. EAP deficits lead to poor functional outcome via impaired cognition, and treatments that target EAP may drive downstream cognitive improvements. Assessment of baseline need provides an opportunity for cognitive remediation (CR) programs that give EAP training to personalize treatment and optimize its impact. This initial efficacy study examined the differential benefit of EAP training for those with and without baseline EAP deficits as defined by performance on the Tone Matching Test.Methods: 103 outpatient adults diagnosed with schizophrenia or schizoaffective disorder were classified as having intact (48.5%) or impaired (51.5%) EAP and randomized to a CR program with restorative exercise plans that either included EAP training (N = 49) or did not (N = 54). Cognitive and functional outcomes were measured post-treatment and 3 months later.Results: Only in EAP impaired participants was there a significant benefit from EAP training on verbal learning. Treatment condition did not significantly impact global cognitive or functional outcomes for either EAP group. Cognitive gains partially mediated the relationship between gains in EAP and functional capacity.

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“…There is a wealth of evidence that cognitive impairment (eg, deficits in memory, attention and speed of processing) can emerge early in psychosis, persist throughout the course of illnesses such as schizophrenia, and may impose significant functional limitations such as on the ability to participate in and benefit from psychosocial rehabilitation programs, and to acquire social, vocational and educational skills integral to community integration (Bowie & Harvey, 2006; Mesholam‐Gately, Giuliano, Goff, Faraone, & Seidman, 2009; Nuechterlein et al, 2011). Further, interventions that address cognitive dysfunction are supported by the research literature (Medalia, Saperstein, Erlich, & Sederer, 2019; Vidarsdottir et al, 2019; Wykes, Huddy, Cellard, McGurk, & Czobor, 2011). There is a strong rationale for addressing cognitive health early in the course of illness, to identify and maximize cognitive strengths and reduce the cognitive deficit and its potential negative impact on quality of life and on recovery.…”

Section: Introductionmentioning

confidence: 98%

Addressing cognitive health in coordinated specialty care for early psychosis: Real‐world perspectives

Saperstein

Medalia

Bello

et al. 2020

Early Intervention Psych

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Aim Addressing cognitive health during the early phase of psychosis has the potential to enhance recovery outcomes, yet methods to assess and treat cognitive problems are not a systematic part of Coordinated Specialty Care (CSC) in the United States. We sought to understand how CSC providers perceive cognitive health and gauge the acceptability and appropriateness of cognitive interventions to inform the development and implementation of a cognitive health toolkit for OnTrackNY, a CSC program. Methods Electronic surveys were sent to clinicians from 22 OnTrackNY teams. One unstructured and 10 structured questions assessed knowledge and beliefs about cognition, current cognitive health practices, the likelihood of adopting new practices, perceived facilitators, and barriers to assessing and treating cognitive health. Results Fifty‐three clinicians responded. Clinicians identified a range of terms associated with cognitive impairment with specific neurocognitive deficits cited most frequently. The majority perceived the evidence for cognitive impairment at the time of first episode to be moderate to strong, that specific interventions for cognition are warranted, and that there is a significant link between cognition and community functioning. While current practices vary, 88% indicated a high likelihood of integrating tools to address cognitive problems if provided. Compensatory approaches to aid cognitive functioning were viewed most favourably. Conclusions Results suggest that addressing cognitive health is acceptable and appropriate for OnTrackNY but there is a need for systematic training to integrate empirically supported interventions with existing recovery‐oriented practices. Piloting a cognitive health toolkit will inform the potential uptake of assessment and treatment practices more broadly.

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Cognitive remediation in large systems of psychiatric care

Cited by 24 publications

References 46 publications

Feasibility and tolerability of a cognitive remediation clinical service in first episode coordinated specialty care

Feasibility and tolerability of a cognitive remediation clinical service in first episode coordinated specialty care

Impact of baseline early auditory processing on response to cognitive remediation for schizophrenia

Addressing cognitive health in coordinated specialty care for early psychosis: Real‐world perspectives

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