title: Cognitive remediation therapy (CRT) for young early onset patients with schizophrenia: an exploratory randomized controlled trial.
abstract: BACKGROUND
  Schizophrenia with an onset in adolescence is known to be associated with a poorer outcome and cognitive difficulties. These impairments have an impact on quality of life and represent treatment targets. Cognitive remediation therapy (CRT) attempts to improve cognitive deficits by teaching information processing strategies through guided mental exercises. The objective of this study is to evaluate the efficacy of CRT in alleviating cognitive deficits compared to treatment as usual and explore the mediating and moderating effects of cognitive improvement.
  
  
  METHODS
  Single-blind randomized controlled trial with two groups, one receiving CRT (N21) and the other standard care (N19) assessed at baseline, 3 months (post therapy) and follow-up (3 months post therapy). Participants were recruited from specialist inpatient and community mental health services and were young patients with recent onset schizophrenia (average age of 18) and evidence of cognitive and social behavioural difficulties. The intervention was individual cognitive remediation therapy delivered over a period of 3 months with at least three sessions per week. The main outcome measures were cognition (memory, cognitive flexibility and planning) and secondary outcomes (symptoms, social contacts and self-esteem).
  
  
  RESULTS
  Compared to standard care, CRT produced significant additional improvements in cognitive flexibility as measured by the Wisconsin Card Sort Test (WCST). Therapy moderated the effects of improved planning ability on symptoms such that improvements only had a beneficial effect when they were achieved in the context of CRT. Improvements in cognition in all domains had a direct effect on social functioning and improvements in WCST had a direct effect on overall symptom improvement.
  
  
  CONCLUSIONS
  Cognitive remediation therapy can contribute to the improvement in WCST even in adolescents. The changes in cognitive outcomes also contributed to improvements in functioning either directly or solely in the context of CRT. Evidence of the mediator and moderator effects of cognitive changes should lead to more effective therapy development.
authors.affiliation: Institute of Psychiatry, Kings College London, De Crespigny Park, London, SE5 8AF, UK. t.wykes@iop.kcl.ac.uk
authors.forename: Til
authors.initials: T
authors.lastname: Wykes
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Newton
authors.forename: Sabine
authors.initials: S
authors.lastname: Landau
authors.forename: Christopher
authors.initials: C
authors.lastname: Rice
authors.forename: Neil
authors.initials: N
authors.lastname: Thompson
authors.forename: Sophia
authors.initials: S
authors.lastname: Frangou
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D010054:Brief Psychiatric Rating Scale; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011788:Quality of Life / Q000523:psychology; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012919:Social Behavior; D011795:Surveys and Questionnaires