Olga Puig1; 1Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, 2014SGR489. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
Early-onset schizophrenia (EOS), defined as the manifestation of psychotic symptoms prior to 18 years of age, is a less common and phenotypically more severe form of the disorder, and implies generalized neurocognitive impairment. Cognitive remediation therapy (CRT) is a strategy-learning approach targeting cognitive deficits with the ultimate goal of improving functional outcome. The height neural plasticity during childhood and adolescence suggests that they may be "sensitive periods" to treatment effects but it is also possible that having EOS may confer damage that reduces the ability of the brain to benefit from CRT. Objetive: To examine the efficacy of CRT in improving cognition and functional outcomes in a sample of symptomatically stable but cognitively disabled adolescents with EOS. Methods: Randomized, controlled trial of individually delivered CRT plus treatment-as-usual (n=25) compared with treatment-as-usual (TAU, n=25). Clinical symptoms and cognitive and functional performance were assessed before and after treatment in both groups and after 3 months in the CRT group. Results: After CRT, significant improvements were found in verbal memory and executive functions. The derived cognitive composite score showed an improvement after the treatment and this change was reliable in more than two-thirds of the treated patients. Improvements were also found after CRT in daily living and adaptive functioning, and in family burden. Cognitive but not functional changes were maintained after 3 months. Conclusion: Cognitive and functional improvements can be achieved through CRT in adolescents with EOS but additional strategies may be needed to enhance the durability of functional gains.
