Olina G Vidarsdottir1,2, Brynja B Magnusdottir2,3, David Roberts4, Elizabeth W Twamley5, Engilbert Sigurdsson1,2, Berglind Gudmundsdottir1,2; 1Landspitali Haskolasjukrahus, 2Landspitali University Hospital, 3Reykjavik University, 4The University of Texas Health Science Center at San Antonio, 5University of California, San Diego and VA San Diego Healthcare System
Introduction: Cognitive remediation, combined with evidence based psychiatric rehabilitation programs, is effective for improving cognitive deficits found in psychosis but generalization to everyday functioning remains a challenge. The objective of this study was to integrate three cognitive remediation approaches: Neuropsychological Educational Approach to Remediation (NEAR), Compensatory Cognitive Training (CCT), and Social Cognition and Interaction Training (SCIT), and evaluate the effects on cognition, functional outcome, and clinical symptoms. Method: We conducted a randomized, wait-list control trial of an Integrative Cognitive Remediation (ICR) in 49 patients with primary psychotic disorder seeking service at an early intervention center in Iceland (mean age: 24; 86% males). Participants were randomized to receive standard treatment (N=24) or standard treatment plus a 12-week group-based ICR (N=25). Neurocognition (verbal memory, reasoning, working memory, processing speed, cognitive flexibility, inhibition, planning), social cognition (theory of mind, emotion recognition and attributional style), functional outcome, and clinical symptoms were assessed at baseline and post-treatment. Results: The ICR group showed significant improvements in verbal memory, cognitive flexibility, theory of mind and a significant reduction in hostile attributional style, compared to those receiving standard treatment alone. No significant ICR associated effects were seen in functional outcomes or clinical symptoms. Post-hoc analyses suggest a dose-response effect. ICR was well tolerated and received high treatment satisfaction ratings. Conclusions: ICR is feasible and effective in improving neurocognition and social cognition in psychosis. Findings will be discussed in context of continuing to improve comprehensive cognitive remediation interventions for early psychosis with discussion on factors associated with treatment response.
