Joseph Ventura1, Kenneth Subotnik1, Denise Gretchen-Doorly1, Laurie Casaus1, Michael , Boucher1, Gerhard Hellemann1, Keith Nuechterlein1,2; 1Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 2Department of Psychology, University of California, Los Angeles
Background: Meta-analyses have reported that the effects of cognitive remediation might go beyond improvement in cognition to include additional benefits for schizophrenia patients such as negative and positive symptom reduction and improvements in functioning. Method: A RCT compared Cognitive Remediation (CR) to Healthy Behaviors Training (HBT) in 80 patients (78% male) with a mean age of 21.9 years and mean education of 12.3 years who had a first psychotic episode within two years of study entry. Participants were trained using CR programs or received HBT involving 50 sessions over 6 months and then booster sessions over the next 6 months. The SANS and BPRS were used to assess symptoms. The UCLA Social Attainment Survey assessed social functioning. Results: Using GLMM, improvements over 12 months were found favoring CR for SANS Expressive Symptoms (p<.01), which was composed of Affective Flattening (p<.01) and Alogia (p=.04), and for SANS Experiential Symptoms (p<.01), composed of Avolition /Apathy (p=.04) and Anhedonia / Asociality (p<.01). Improvements were also found for the BPRS Positive Symptom Factor (p=.04) composed mostly of reality distortion (p<.01). CR was associated with improvements in social functioning (p=.05) as compared to HBT. Discussion: We confirmed that the beneficial effects of CR appear to extend beyond cognition to improvements in negative and positive symptoms, and social functioning in early course schizophrenia patients. These results suggest that cognitive remediation might have an impact at an early point in the illness when the reduction of risk factors for chronicity is most critical for promoting recovery.
