A randomized controlled trial of cognitive remediation among inpatients with persistent mental illness.
OBJECTIVE
This study evaluated the feasibility and efficacy of a cognitive remediation program in improving cognitive and work functioning for intermediate- to long-stay psychiatric inpatients.


METHODS
Eighty-five inpatients with predominantly DSM-IV-defined schizophrenia were randomly assigned to cognitive remediation or to a control condition. The cognitive remediation program consisted of 24 hours of computerized practice over a 12-week period and a weekly discussion group to facilitate transfer of cognitive skills to daily activities. A computer control group received similar hours of staff and computer exposure without cognitive training exercises. A comprehensive neuropsychological battery was administered at baseline and posttreatment. Symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) at baseline, midtreatment (six weeks), and posttreatment (12 weeks) and at six- and 12-month follow-ups. Work functioning was tracked during a 12-month follow-up period.


RESULTS
The average number of 45-minute sessions completed was 23. Patients in the cognitive remediation group demonstrated significantly greater improvements over three months than the control group in the composite measure of overall cognitive functioning, psychomotor speed, and verbal learning. In addition, patients who received cognitive remediation worked more weeks than the control group over the 12-month follow-up period. Patients in both groups showed significant and comparable improvements over the follow-up period on the positive, activation, and depression subscales of the PANSS.


CONCLUSIONS
Cognitive remediation was a feasible treatment for this group of inpatients and more effective at improving cognitive functioning than a computer control intervention. Longer-term follow-up indicated that cognitive remediation was associated with better work outcomes, suggesting benefits in psychosocial functioning.
Lindenmayer
Jean-Pierre
JP
Manhattan Psychiatric Center, 600 East 125th St., Wards Island, NY 10035, USA. lindenmayer@nki.rfmh.org
McGurk
Susan Regina
SR
Mueser
Kim T
KT
Khan
Anzalee
A
Wance
Deborah
D
Hoffman
Lisa
L
Wolfe
Rosemarie
R
Xie
Haiyi
H
D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011584:Psychology; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome