Effectiveness of Cognitive Remediation in Early Versus Chronic Schizophrenia: A Preliminary Report

Abstract

Background: Many evidences have demonstrated the effectiveness of cognitive remediation on cognition and functioning in patients with schizophrenia. Some researchers speculate that cognitive deficits are more amenable to remediation during earlier phases of illness than in chronicity. Therefore, cognitive rehabilitation should be used as an early intervention, seeking to produce durable functional changes in the early course of schizophrenia. Although there is strong evidence that cognitive remediation is effective in adult schizophrenia, there is little evidence about its efficacy and long-term generalized effectiveness in the early course of the disease. In this paper, we intended to investigate the possibility that cognitive remediation may produce more beneficial effects when applied in the early phase of the illness compared to chronic patients. Materials and methods: Data were gathered from a database used for a previous study performed by our group, in which 56 patients with schizophrenia received a cognitive remediation intervention. In a post hoc analysis, patients with a duration of illness shorter than 5 years were defined as “early course” patients, while patients with a duration of illness longer than 5 years were defined as “chronic.” Clinical, neuropsychological, and functional outcome variables were assessed at baseline and after treatment. Result: Of the 56 patients included in the study, 11 were “early course” and 45 were “chronic.” Both the early course group and the chronic group showed significant improvements in all the clinical, neurocognitive, and functional parameters analyzed. A significantly greater improvement in early course patients compared with chronic patients emerged in clinical and functional measures. No differential change was observed between early course patients and chronic patients in the cognitive composite score. Conclusion: Our study confirms the effectiveness of cognitive remediation in improving clinical, cognitive, and functional parameters in patients with schizophrenia, both in patients in the early course and in chronic patients. However, patients in the early course showed a differential, greater change in clinical and functional parameters compared to chronic patients. Although this study has some limitations, it confirms the effectiveness of cognitive remediation interventions, particularly if applied in the early course of the illness.

Modelling associations between neurocognition and functional course in young people with emerging mental disorders: a longitudinal cohort study

“…Moreover, some preliminary animal modeling suggests that the adolescent brain may be better able to learn from cognitive training 60 as a function of the unique neurobiology of adolescence (e.g., reward hypersensitivity). Further, accumulating evidence suggests that cognitive remediation in early phases of illness may yield greater than when applied in chronic phases 61,62 . Our results suggest that cognitive flexibility may represent a meaningful and transdiagnostic target for cognitive remediation, which may be enhanced when offered to young people early in the course of illness alongside other interventions targeting social and occupational functioning.…”

Characteristics of gray matter alterations in never-treated and treated chronic schizophrenia patients

“…Illness onset was evaluated by the Nottingham Onset Schedule 23 with the information provided by the patients, other family members, and other sources. Patients with a duration of illness longer than 5 years were defined as "chronic" 24,25 . Symptom severity assessment was carried out using the Positive and Negative Syndrome Scale (PANSS) 26 on the same day as MRI scanning.…”

Recent Developments in Treating Cognitive Impairment Associated with Schizophrenia

“…In a recent meta-analysis, effect sizes for global cognitive improvement were somewhat larger for chronic schizophrenia compared to early schizophrenia [511]. Conversely, other studies have reported that younger, less chronic patients receiving lower doses of antipsychotic medication respond best to these types of intervention [512,513].…”