title: Cognitive Enhancement Therapy in substance misusing schizophrenia: results of an 18-month feasibility trial.
abstract: Substance use is a frequent problem in schizophrenia, and although many substance misusing patients with the disorder also experience considerable cognitive impairments, such individuals have been routinely excluded from clinical trials of cognitive remediation that could support their functional and addiction recoveries. This study conducted a small-scale feasibility trial of Cognitive Enhancement Therapy (CET) in substance misusing schizophrenia patients to assess the feasibility and efficacy of implementing comprehensive neurocognitive and social-cognitive remediation in this population. A total of 31 schizophrenia outpatients meeting addiction severity criteria for alcohol and/or cannabis use were randomized to 18months of CET or usual care. Feasibility findings indicated high degrees of satisfaction with CET, but also presented significant challenges in the recruitment and retention of substance misusing patients, with high levels of attrition (50%) over the study period, primarily due to positive symptom exacerbation. Intent-to-treat efficacy analyses showed large and significant improvements in neurocognition (d=.86), social cognition (d=1.13), and social adjustment (d=.92) favoring CET. Further, individuals treated with CET were more likely to reduce alcohol use (67% in CET vs. 25% in usual care) during treatment (p=.021). These results suggest that once engaged and stabilized, CET is a feasible and potentially effective treatment for cognitive impairments in patients with schizophrenia who misuse alcohol and/or cannabis. Substance misusing patients who are able to engage in treatment may be able to benefit from cognitive remediation, and the treatment of cognitive impairments may help improve substance use outcomes among this underserved population.
authors.affiliation: School of Social Work, University of Pittsburgh, United States; Department of Psychiatry, University of Pittsburgh School of Medicine, United States. Electronic address: sme12@pitt.edu.
authors.forename: Shaun M
authors.initials: SM
authors.lastname: Eack
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, United States.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Hogarty
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, United States.
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Greenwald
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, United States.
authors.forename: Maralee Y
authors.initials: MY
authors.lastname: Litschge
authors.affiliation: School of Social Work, University of Pittsburgh, United States; Department of Psychiatry, University of Pittsburgh School of Medicine, United States.
authors.forename: Summer A F
authors.initials: SA
authors.lastname: McKnight
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, United States.
authors.forename: Srihari S
authors.initials: SS
authors.lastname: Bangalore
authors.affiliation: Department of Psychology, University of Pittsburgh, United States.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Pogue-Geile
authors.affiliation: Department of Psychiatry, Harvard Medical School, United States.
authors.forename: Matcheri S
authors.initials: MS
authors.lastname: Keshavan
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, United States.
authors.forename: Jack R
authors.initials: JR
authors.lastname: Cornelius
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000523:psychology / Q000628:therapy; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000150:complications* / Q000523:psychology / Q000628:therapy; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D012559:Schizophrenia / Q000150:complications / Q000628:therapy*; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D012938:Social Perception; D016896:Treatment Outcome
keywords: Cognitive rehabilitation; Cognitive remediation; Drug use; Social cognition; Substance use