Pharmacological Augmentation of Psychosocial and Remediation Training Efforts in Schizophrenia

Abstract

Pharmacological approaches to cognitive enhancement have received considerable attention but have not had considerable success in improving their cognitive and functional targets. Other intervention strategies, such as cognitive remediation therapy (CRT), have been shown to enhance cognitive performance but have not been found to improve functional outcomes without additional psychosocial interventions. Recently, several studies have attempted to enhance the effects of CRT by adding pharmacological interventions to the CRT treatments. In addition, as CRT has been shown to synergistically improve the effects of psychosocial interventions, the combination of pharmacological therapies aimed at cognition and psychosocial interventions may itself provide a promising strategy for improving functional outcomes. This review and commentary examines the current state of interventions combining CRT and psychosocial treatments with pharmacological augmentation. Our focus is on the specific level of effect of the pharmacological intervention, which could be enhancing motivation, training efficiency, or the consolidation of therapeutic gains. Different pharmacological strategies (e.g., stimulants, plasticity-inducing agents, or attentional or alertness enhancers) may have the potential to lead to different types of gains when combined with CRT or psychosocial interventions. The relative potential of these different mechanisms for immediate and durable effects is considered.

Social Cognition and Neurocognition in Schizophrenia and Healthy Controls: Intercorrelations of Performance and Effects of Manipulations Aimed at Increasing Task Difficulty

“…As previously reported by Lindenmayer et al ( 10 , 11 ), training neurocognitive skills may speed the path to social cognitive gains elsewhere. This may also suggest, consistent with our earlier arguments, Harvey and Sand ( 30 ) that augmentation of social cognitive training with pharmacological strategies aimed at neurocognitive abilities may be a feasible way forward as well.…”

Does Cognitive Dysfunction in Bipolar Disorder Qualify as a Diagnostic Intermediate Phenotype?—A Perspective Paper

“…Among the most promising pharmacological treatments for cognitive dysfunction across bipolar disorder and unipolar disorder is erythropoietin, but the evidence is still preliminary ( 62 , 64 ). These findings are partly in accordance with findings within unipolar disorder and schizophrenia with only a few studies have shown benefit for pharmacological treatments ( 64 – 66 ) and with a lack of successful replication of these data ( 64 , 66 , 67 ). However, psychological treatment programs involving intensive cognitive remediation have revealed more consistent positive effects on cognition in schizophrenia ( 68 , 69 ) and emerging evidence in mood disorders ( 64 , 70 ).…”

Nonsocial and social cognition in schizophrenia: current evidence and future directions

“…One possible path forward is to examine whether the impact of integrated cognitive remediation is boosted when combined with pharmacological therapies. This is an active area of investigation, though preliminary findings have been mixed.…”