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Cognitive deficits often persist after remission of major depression and schizophrenia; these deficits predict poor functional outcomes. Researchers in Australia examined the effectiveness of a cognitive remediation (CR) program begun early in the course of psychiatric illness.
The participants, 55 stabilized outpatients with depression or psychosis (mean age, 23; 51% male; average education, 12.6 years) were randomized to treatment as usual (TAU) alone or TAU plus CR. Thirty-six participants completed the study (in each group: depression, 7 patients; psychosis, 11 patients). CR consisted of 10 weekly 2-hour sessions including psychoeducation about cognitive deficits, compensatory strategies, drill-and-practice group activities, and individually tailored, computer-assisted cognitive training. TAU included medications, psychiatric monitoring, and case management.
At baseline, psychosis patients performed worse than depressed patients in all cognitive domains tested — processing speed, attention and working memory, immediate learning and memory, delayed learning and memory, and executive functioning. CR+TAU recipients had worse attention and working-memory composite scores at baseline than TAU-only patients. After adjustment for these baseline differences, the CR+TAU group improved significantly more postintervention than the TAU group on immediate learning and memory and psychosocial functioning. Improvements in delayed learning and memory showed a trend (P=0.07) toward prediction of psychosocial gains.
Lee RSC et al. Cognitive remediation improves memory and psychosocial functioning in first-episode psychiatric out-patients. Psychol Med 2012 Dec 14; [e-pub ahead of print]. (http://dx.doi.org/10.1017/S0033291712002127)
Comment
These results suggest that after an initial episode of depression or psychosis, cognitive remediation improves learning and memory and psychosocial functioning. However, this study was small, and interventions and assessments were not blinded. Nevertheless, its findings add support for including CR in the treatment armamentarium for psychiatric disorders, even early in the course of illness. Clinicians should be attentive to signs or patient complaints of cognitive deficits, have a low threshold for neuropsychological assessment, and refer patients for CR when indicated and available.