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Cognitive Remediation

 

More attention has been paid, in recent years, to the cognitive symptoms of psychosis – such handicaps as decreased processing speed and poor attention, concentration and working memory. Cognitive impairment, along with positive, negative and affective symptoms, is a core feature of schizophrenia. The evidence suggests that it is correlated with work functioning, social relations and the capacity for independent living and is an impediment to gaining benefits from psychosocial rehabilitation. Forthcoming editions of the Diagnostic and Statistical Manual for Mental Disorders are expected to direct more attention to cognitive deficits in psychosis.

 

The increased attention to cognitive difficulties has stimulated greater attempts to rectify them. Pharmacological interventions have shown little effect on cognitive deficits but cognitive remediation programs, employing such strategies as repeated practice, teaching to improve cognitive functioning, strategies to compensate for impairments and group discussion have shown some promise. Reviews of cognitive remediation in schizophrenia have suggested that the method produces modest benefits on cognition but has little or no impact on functioning. A recent meta-analysis concludes, however, that cognitive remediation produces moderate improvements in cognitive performance and functioning and that the impact on functioning is greater in studies that provide psychiatric rehabilitation in addition to cognitive remediation. Most remediation programs now employ computer-based training among their methods, but such advances in technology do not appear to have improved outcomes appreciably. Programs that include strategy coaching have greater effects on functioning; this approach targets memory and executive functions by teaching such strategies as problem solving and chunking information to facilitate recall.