Cognitive remediation therapy in schizophrenia: randomised controlled trial.
BACKGROUND
Cognitive difficulties are prevalent in people with a diagnosis of schizophrenia and are associated with poor long-term functioning.


OBJECTIVE
To evaluate the effectiveness of cognitive remediation therapy on cognitive difficulties experienced by people with schizophrenia.


METHODS
Participants with a diagnosis of schizophrenia, a social behaviour problem and a cognitive difficulty (n=85) were randomised to 40 sessions of cognitive remediation or treatment as usual in a single-blind randomised controlled trial. Working memory, cognitive flexibility and planning, were measured at weeks 0,14 and 40.


RESULTS
There were durable improvements in working memory (advantage 1.33 points, 95% CI 0.43-2.16, standardised effect size 0.34) as well as an indication of improvement in cognitive flexibility. Memory improvement predicted improvement in social functioning. Costs were lower in the cognitive remediation group following therapy but rose at follow-up. However, cost-effectiveness analyses showed that improvements in memory were achieved at little additional cost.


CONCLUSIONS
Cognitive remediation therapy is associated with durable improvements in memory, which in turn are associated with social functioning improvements in people with severe mental illness.
Wykes
Til
T
Department of Psychology, Kings College London, Institute of Psychiatry, London, UK. t.wykes@iop.kcl.ac.uk
Reeder
Clare
C
Landau
Sabine
S
Everitt
Brian
B
Knapp
Martin
M
Patel
Anita
A
Romeo
Renee
R
D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000628:therapy*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000628:therapy*; D009788:Occupational Therapy / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011340:Problem Solving; D012153:Retention, Psychology; D012559:Schizophrenia / Q000628:therapy*; D016896:Treatment Outcome