title: Executive function needs to be targeted to improve social functioning with Cognitive Remediation Therapy (CRT) in schizophrenia.
abstract: While the role of impaired cognition in accounting for functional outcome in schizophrenia is generally established, the relationship between cognitive and functional change in the context of treatments is far from clear. The current paper tries to identify which cognitive changes lead to improvements in daily functioning among persons with chronic schizophrenia who had current negative symptoms and evidenced neuropsychological impairments. In a previous work, Cognitive Remediation Therapy (CRT) was compared with a control therapy, involving similar length of therapist contact but different targets. At the end of treatment, CRT conferred a benefit to people with schizophrenia in cognition and functioning [Schizophrenia Research, 87 (2006) 323-331]. Subsequently, analyses of covariance (ANCOVA) were conducted with baseline and cognitive change scores as covariates to test whether cognitive change predicted change in functioning. Additionally, statistical tests to establish the mediation path with significant variables were performed. Although verbal memory, but not executive functioning, was associated with functioning at baseline, it was the improvement in executive functioning that predicted improved daily functioning. Verbal memory played a mediator role in the change process. Consequently, in order to improve daily functioning with CRT, executive function still needs to be targeted in despite of multiple cognitive impairments being present.
authors.affiliation: Clinical Psychology Department, Clinical Institute of Neurosciences, Hospital Clinic Barcelona, Spain. rpenades@clinic.ub.es
authors.forename: Rafael
authors.initials: R
authors.lastname: Penadés
authors.forename: Rosa
authors.initials: R
authors.lastname: Catalán
authors.forename: Olga
authors.initials: O
authors.lastname: Puig
authors.forename: Guillem
authors.initials: G
authors.lastname: Masana
authors.forename: Núria
authors.initials: N
authors.lastname: Pujol
authors.forename: Víctor
authors.initials: V
authors.lastname: Navarro
authors.forename: Joana
authors.initials: J
authors.lastname: Guarch
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Gastó
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000339:Affect / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003430:Cross-Sectional Studies; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D008954:Models, Biological; D009483:Neuropsychological Tests; D012559:Schizophrenia / Q000150:complications / Q000628:therapy*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D014706:Verbal Learning / Q000502:physiology