Cognitive Remediation in Middle-Aged or Older Inpatients with Chronic Schizophrenia: A Randomized Controlled Trial in Korea

Abstract

Background: Accumulating evidence indicates that cognitive remediation (CR) is effective for improving various cognitive deficits in adult patients with schizophrenia. Although reports of brain plasticity in older adults and the service needs for chronic patients with schizophrenia are increasing, very few randomized controlled trials of CR have been conducted in middle-aged or older inpatients with chronic schizophrenia. We investigated the efficacy of individualized CR on the cognitive impairments of middle-aged or older inpatients with chronic schizophrenia within the context of comprehensive psychiatric rehabilitation (PR) by comparing the results obtained with PR only and treatment as usual (TAU).Method: Fifty-seven middle-aged and older individuals with chronic schizophrenia and mild to moderate cognitive deficits were enrolled. Thirty-eight who were undergoing PR were randomly assigned to CR + PR (N = 19) or PR-only (N = 19) groups. Nineteen participants who were undergoing TAU without CR or PR were evaluated pre- and post-treatment.Results: CR was easily provided and well received (drop-out rates = 5.3%) by middle-aged or older psychiatric inpatients. Compared to the PR-Only or TAU patients, patients in the CR + PR group showed greater improvement in executive functioning. Compared to TAU patients, CR + PR and PR-only patients showed greater improvement in logical memory. More patients in the CR + PR group improved clinically significantly in executive functioning and logical memory, compared with the PR-only and TAU patients.Conclusions: These results suggested that CR improved some cognitive deficits in middle-aged or older inpatients with chronic schizophrenia and that it was effective as an adjunctive treatment to the usual PR services provided in inpatient settings.Clinical Registration: KCT0002609

Current Status of Cognitive Remediation for Psychiatric Disorders: A Review

“…Since the study by Revell et al ( 84 ) is the only meta-analysis on CR with early psychosis, more research is needed to support or refute the results of this study. Although the majority of studies have been conducted in the United States or European countries, recently CR RCTs have been reported in Asian countries ( 88 – 90 ).…”

The Recovery Process for Individuals With Schizophrenia in the Context of Evidence-Based Psychotherapy and Rehabilitation

“…Thirty-two RCTs displayed positive results regarding the recovery process: CR improved neurocognition, depression, positive and negative symptoms, vocational outcomes, insight, self esteem, functioning, and quality of life and reduced relapse rate, disorganization, and emotional distress (Bowie, McGurk, Mausbach, Patterson, & Harvey, 2012; Byrne et al, 2013; Choi et al, 2018; Garrido et al, 2013; Gharaeipour & Scott, 2012; Iwata et al., 2017; Man, Law, & Chung, 2012; Ojeda et al, 2012; Pena et al., 2016; Poletti et al., 2010; Sanchez et al., 2014; Subramaniam et al, 2014; Tao et al., 2015; Thomas et al., 2018). The effectiveness of CR in schizophrenia persists after 1 year (Deste et al, 2015).…”

“…Naeem et al (2015) and Vohs et al (2018) fulfilled the fidelity criteria but included no follow-up; thus, the improvement of Enactment of Treatment Skills was not very clear.Rehabilitation (RCTs): All included RCTs, which contain a rehabilitation program, fulfill the fidelity criteria. The RCTs include only a post-treatment evaluation but not a follow-up evaluation (Table 1) could have a better impact on the improvement of Enactment of Treatment Skills (Bechi et al, 2013; Bio & Gattaz, 2011; Byrne et al, 2013; Choi et al, 2018; Garrido et al, 2013; Gaudelus et al, 2016; Gharaeipour & Scott, 2012; Gil-Sanz et al, 2013; Gomar et al, 2015; Iwata et al, 2017; Kurtz et al, 2015; Ojeda et al, 2012; Palumbo et al, 2017; Pena et al., 2016; Rocha & Queiros, 2013; Sanchez et al, 2014; Sevos et al, 2018; Souto et al, 2018; Taylor et al, 2016; Thomas et al, 2018; Veltro et al, 2011). Case studies (CBT, MCT, MCTR, MERIT, and Rehabilitation): Balzan and Galletly (2015), Peyroux and Franck (2016), and Grant et al (2014) followed the fidelity criteria thoroughly.…”

“…Rehabilitation (RCTs): All included RCTs, which contain a rehabilitation program, fulfill the fidelity criteria. The RCTs include only a post-treatment evaluation but not a follow-up evaluation (Table 1) could have a better impact on the improvement of Enactment of Treatment Skills (Bechi et al, 2013; Bio & Gattaz, 2011; Byrne et al, 2013; Choi et al, 2018; Garrido et al, 2013; Gaudelus et al, 2016; Gharaeipour & Scott, 2012; Gil-Sanz et al, 2013; Gomar et al, 2015; Iwata et al, 2017; Kurtz et al, 2015; Ojeda et al, 2012; Palumbo et al, 2017; Pena et al., 2016; Rocha & Queiros, 2013; Sanchez et al, 2014; Sevos et al, 2018; Souto et al, 2018; Taylor et al, 2016; Thomas et al, 2018; Veltro et al, 2011).…”

A Future Research Agenda for Digital Geriatric Mental Healthcare

“…Digital geriatric mental health has a similar challenge that is being experienced by the whole discipline of digital psychiatry-the need for additional methodologically rigorous proof-ofconcept studies. Most studies that focus on older adults have included small, proof-ofconcept pre/postdesigns that are not powered to test effectiveness [40][41][42][43][44] or case studies that examine usability and feasibility. 23 Additional proof-of-concept studies are needed.…”