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Combined cognitive remediation and social cognition training in first episode psychosis
[Thesis]. Manchester, UK: The University of Manchester; 2017.
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Abstract
Introduction: Impaired neurocognition, especially social cognition, predicts disability in schizophrenia. Early intervention to target impairment is theoretically attractive as a means to minimise chronic disability. Many trials confirm that Cognitive Remediation (CR) produces meaningful, durable improvements in cognition and functioning but few interventions remediate social cognition or focus on the early stages of schizophrenia. Methods: A systematic review and meta-analysis of 11 randomised controlled trials (RCTs) of CR in first episode psychosis (FEP) was completed. A randomised controlled pilot trial was then conducted to investigate a combined CR and social cognition training (CR+SCT) intervention in FEP compared to CR alone, assessing cognition, functioning and symptoms at baseline and follow-up. Qualitative feedback was also obtained in a nested feasibility and acceptability study to assess engagement, intervention suitability and attrition.Results: In the systematic review and meta-analysis, random effects models revealed a non-significant effect of CR on global cognition in FEP. However, there was a significant effect on functioning and symptoms, which was larger in trials with adjunctive psychiatric rehabilitation and small group interventions. In the pilot trial, the CR+SCT group had significantly better social functioning scores post-treatment, especially on the interpersonal relationships scale, however there was no significant effect on social cognition. CR+SCT also improved visual learning and set-shifting. There was no specific effect on symptoms.The nested feasibility and acceptability study found CR and CR+SCT to be acceptable and feasible for early intervention in psychosis service users, with high engagement rates and high user-reported satisfaction. Users perceived improvements in neurocognition and reported using strategies learnt during CR in daily life.Conclusions: Meta-analysis suggests that CR is beneficial in FEP. Evidence from the pilot trial shows that a CR intervention enhanced with SCT can improve functioning more than CR alone and that such an intervention is feasible and acceptable. A larger RCT is required to explore the full benefits of a CR+SCT intervention compared to CR and treatment as usual.
Keyword(s)
cognition; cognitive remediation; first episode; psychosis; schizophrenia; social cognition