Cognitive remediation in schizophrenia: efficacy and effectiveness in patients with early versus long-term course of illness.
OBJECTIVE
We examined the efficacy and effectiveness (transfer to functional competence and everyday functioning) of cognitive remediation in early-course (within 5 years of first episode) and long-term (more than 15 years of illness) schizophrenia.


METHODS
Treatment lasted 12 weeks and included computerized exercises, strategic monitoring and methods to transfer cognition to behaviour. Assessments included a standard battery of neurocognition, performance-based measures of social and adaptive competence, and case manager ratings of real-world functional behaviour. Changes from baseline to post-treatment were examined with repeated measures analysis of variance and estimated premorbid intelligence and total months in hospital as covariates.


RESULTS
The early-course group had larger improvements in measures of processing speed and executive functions, as well as larger improvements in adaptive competence and real-world work skills. Duration of illness was inversely associated with improvement in neurocognition and real-world work skills.


CONCLUSIONS
Treatment of cognitive impairments is feasible in both early-course and chronic schizophrenia, but the clinical meaningfulness and generalization to functioning appear to be more substantial when delivered early. Cognitive remediation should be considered a tool for early intervention in schizophrenia.
Department of Psychology, Queen's University, Kingston, Ontario, Canada; Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.
Christopher R
CR
Bowie
Michael
M
Grossman
Maya
M
Gupta
L Kola
LK
Oyewumi
Philip D
PD
Harvey
D000293:Adolescent; D000368:Aged; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011597:Psychomotor Performance; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
cognition; cognitive remediation; first-episode; functioning; schizophrenia