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Wykes T, Bowie CR, Cella M. Thinking About the Future of Cognitive Remediation Therapy Revisited: What Is Left to Solve Before Patients Have Access? Schizophr Bull 2024:sbae075. [PMID: 38780191 DOI: 10.1093/schbul/sbae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
In our previous paper on the Future of Cognitive Remediation published more than 10 years ago, we envisaged an imminent and wide implementation of cognitive remediation therapies into mental health services. This optimism was misplaced. Despite evidence of the benefits, costs, and savings of this intervention, access is still sparse. The therapy has made its way into some treatment guidance, but these documents weight the same evidence very differently, causing confusion, and do not consider barriers to implementation. This paper revisits our previous agenda and describes how some challenges were overcome but some remain. The scientific community, with its commitment to Open Science, has produced promising sets of empirical data to explore the mechanisms of treatment action. This same community needs to understand the specific and nonspecific effects of cognitive remediation if we are to provide a formulation-based approach that can be widely implemented. In the last 10 years we have learned that cognitive remediation is not "brain training" but is a holistic therapy that involves an active therapist providing motivation support, and who helps to mitigate the impact of cognitive difficulties through metacognition to develop awareness of cognitive approaches to problems. We conclude that, of course, more research is needed but, in addition and perhaps more importantly at this stage, we need more public and health professionals' understanding of the benefits of this therapy to inform and include this approach as part of treatment regimens.
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Affiliation(s)
- Til Wykes
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Matteo Cella
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Hao J, Tiles-Sar N, Habtewold TD, Liemburg EJ, Bruggeman R, van der Meer L, Alizadeh BZ. Shaping tomorrow's support: baseline clinical characteristics predict later social functioning and quality of life in schizophrenia spectrum disorder. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02630-4. [PMID: 38456932 DOI: 10.1007/s00127-024-02630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/28/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE We aimed to explore the multidimensional nature of social inclusion (mSI) among patients diagnosed with schizophrenia spectrum disorder (SSD), and to identify the predictors of 3-year mSI and the mSI prediction using traditional and data-driven approaches. METHODS We used the baseline and 3-year follow-up data of 1119 patients from the Genetic Risk and Outcome in Psychosis (GROUP) cohort in the Netherlands. The outcome mSI was defined as clusters derived from combined analyses of thirteen subscales from the Social Functioning Scale and the brief version of World Health Organization Quality of Life questionnaires through K-means clustering. Prediction models were built through multinomial logistic regression (ModelMLR) and random forest (ModelRF), internally validated via bootstrapping and compared by accuracy and the discriminability of mSI subgroups. RESULTS We identified five mSI subgroups: "very low (social functioning)/very low (quality of life)" (8.58%), "low/low" (12.87%), "high/low" (49.24%), "medium/high" (18.05%), and "high/high" (11.26%). The mSI was robustly predicted by a genetic predisposition for SSD, premorbid adjustment, positive, negative, and depressive symptoms, number of met needs, and baseline satisfaction with the environment and social life. The ModelRF (61.61% [54.90%, 68.01%]; P =0.013) was cautiously considered outperform the ModelMLR (59.16% [55.75%, 62.58%]; P =0.994). CONCLUSION We introduced and distinguished meaningful subgroups of mSI, which were modestly predictable from baseline clinical characteristics. A possibility for early prediction of mSI at the clinical stage may unlock the potential for faster and more impactful social support that is specifically tailored to the unique characteristics of the mSI subgroup to which a given patient belongs.
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Affiliation(s)
- Jiasi Hao
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Natalia Tiles-Sar
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Psychiatry, University Medical Centre Groningen, University Centre for Psychiatry, Rob Giel Research Centre, University of Groningen, Groningen, The Netherlands
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Edith J Liemburg
- Department of Psychiatry, University Medical Centre Groningen, University Centre for Psychiatry, Rob Giel Research Centre, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, University Medical Centre Groningen, University Centre for Psychiatry, Rob Giel Research Centre, University of Groningen, Groningen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands
| | - Lisette van der Meer
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Psychiatry, University Medical Centre Groningen, University Centre for Psychiatry, Rob Giel Research Centre, University of Groningen, Groningen, The Netherlands.
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Gjerdalen OS, Lystad JU, Bull H, Ringen PA, Røssberg JI, Martinsen EW, Ueland T, Falkum E, Evensen S. Vocational rehabilitation augmented with cognitive behavioral therapy or cognitive remediation for individuals with schizophrenia: a 5-year follow-up study. Nord J Psychiatry 2023; 77:23-30. [PMID: 35209785 DOI: 10.1080/08039488.2022.2042598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Although employment is an important part of recovery for individuals with schizophrenia spectrum disorders, the employment rate for this group remains low. Increasing evidence supports the use of augmented vocational rehabilitation (VR) programs to improve occupational outcome. The aim of this study is to explore 5-year follow-up registry data from the JUMP study, a VR program for individuals with schizophrenia spectrum disorders, specifically with regard to competitive employment outcome and predictors of competitive employment. The VR was augmented with either cognitive remediation (CR) or elements from cognitive behavior therapy (CBT). METHODS One hundred and forty eight participants with schizophrenia spectrum disorders from six Norwegian counties received 10 months VR augmented with either CR (n = 64) or CBT (n = 84). Both competitive and sheltered workplaces were used. Assessments were conducted at baseline, at post intervention and at 2-year follow-up. Data on employment status at 5-year follow-up was obtained by registry. RESULTS At 5-year follow-up 55.4% were engaged in working activity, of which 22.3% had obtained competitive employment. A further 18.2% had work placements in competitive workplaces. Number of received intervention hours and competitive employment at 2-year follow-up emerged as significant predictors of competitive employment. IQ and intervention type in marginal favor of CBT were predictors on trend level. CONCLUSION To the best of our knowledge, this is the first study investigating competitive employment at 5-year follow-up for individuals with schizophrenia spectrum disorders. The results add to existing evidence that competitive employment is attainable for this group.
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Affiliation(s)
| | - June Ullevoldsaeter Lystad
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helen Bull
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of health science, Oslo Metropolitan University, Oslo, Norway
| | | | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Egil W Martinsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo
| | - Erik Falkum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stig Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo
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Ringbom I, Suvisaari J, Kääriälä A, Sourander A, Gissler M, Kelleher I, Gyllenberg D. Psychotic Disorders in Adolescence and Later Long-term Exclusion From Education and Employment. Schizophr Bull 2022; 49:90-98. [PMID: 36305161 PMCID: PMC9810018 DOI: 10.1093/schbul/sbac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND HYPOTHESIS Psychotic disorders have been associated with not being in education, employment, and training (NEET). There is a lack of knowledge on the importance of risk markers for NEET among people with psychotic disorders and what rehabilitation they receive. STUDY DESIGN We based our research on the register-based 1987 Finnish Birth Cohort study, which included all live births in Finland during that year. The study cohort were 288 people who had been diagnosed with psychotic disorders during 2004-2007, when they were 16-20 year old, and 55 883 who had not. We looked at the national register data for those subjects in 2008-2015, when they were 20-28 year old, and compared any associations between sociodemographic factors and NEET status. STUDY RESULTS NEET for more than 5 year affected 2.2% of those without psychosis, 35.8% of those with any nonaffective psychotic disorder, and 57.0% of those with schizophrenia or schizoaffective disorders. Family-related risk factors were weaker predictors of long-term NEET in subjects with psychotic disorders than other cohort members. Having a psychotic disorder plus long-term NEET was associated with not applying for upper secondary education, not finishing upper secondary education, parents receiving welfare benefits, being diagnosed with schizophrenia or schizoaffective disorders and being hospitalized for psychosis. Only 24.3% with psychotic disorders had participated in vocational rehabilitation. CONCLUSIONS A diagnosis of psychosis in adolescence is independently associated with serious long term functional disability. Among those with psychotic disorders, educational problems are markers for adverse labor market outcomes. Despite this, vocational rehabilitation is seldom provided.
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Affiliation(s)
- Ida Ringbom
- To whom correspondence should be addressed; Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd floor, 20014 Turku, Finland, e-mail:
| | | | | | - Andre Sourander
- Department of Child Psychiatry and Invest Flagship, University of Turku, Finland,Turku University Central Hospital, Department of Child Psychiatry, Finland
| | - Mika Gissler
- Department of Child Psychiatry and Invest Flagship, University of Turku, Finland,Finnish Institute for Health and Welfare, Finland,Karolinska Institute, Department of Molecular Medicine and Surgery, Sweden and Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
| | - Ian Kelleher
- School of Medicine, University College Dublin, Ireland
| | - David Gyllenberg
- Department of Child Psychiatry and Invest Flagship, University of Turku, Finland,Finnish Institute for Health and Welfare, Finland,Helsinki University Hospital, Department of Adolescent Psychiatry, Finland
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Okada H. Identifying subgroups based on self-assessment of ability in patients with schizophrenia and its relationship with vocational outcomes. Hong Kong J Occup Ther 2022; 35:35-43. [PMID: 35847185 PMCID: PMC9279875 DOI: 10.1177/15691861221075715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background/Objectives People with schizophrenia have defective self-assessment of ability (i.e., loss of introspective accuracy [IA]). Although previous studies grouped people according to the degree of IA, the clinical features of these subgroups have not been clarified. Additionally, the determinants of outcomes depending on self-assessment remain unknown. We aimed to identify the clinical features that can help distinguish these subgroups and whether the determinants of vocational outcomes differed between the groups. Methods The self-assessment ability of 100 people with schizophrenia was examined and categorized as accurate, over-, or under-estimators. Multiple discriminant analysis was also performed. After demonstrating statistical validity, the relative effects of positive and negative symptoms, cognitive function, and level of IA on vocational outcomes were also examined for each subgroup. Results The symptoms that particularly explained the differences between these subgroups were positive and negative (expressing factors) symptoms: p < .001. Using the determinants of vocational outcomes in each subgroup, the over-estimator subgroup was characterized by positive symptoms: p = .025, the under-estimator group, by the underestimation of their own ability: p = .042, and the accurate estimator group, by cognitive function: p = .006. Conclusion Reduced IA can be a core mediator of various symptoms. Thus, tailoring the target and strategy of interventions for vocational outcomes according to the accuracy and quality of IA is important in clinical settings.
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Affiliation(s)
- Hiroki Okada
- Department of Rehabilitation of Sciences, Hokkaido University, Sapporo, Japan
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Cowman M, Holleran L, Lonergan E, O’Connor K, Birchwood M, Donohoe G. Cognitive Predictors of Social and Occupational Functioning in Early Psychosis: A Systematic Review and Meta-analysis of Cross-Sectional and Longitudinal Data. Schizophr Bull 2021; 47:1243-1253. [PMID: 33761534 PMCID: PMC8379554 DOI: 10.1093/schbul/sbab033] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Many individuals with early psychosis experience impairments in social and occupational function. Identification of modifiable predictors of function such as cognitive performance has the potential to inform effective treatments. Our aim was to estimate the strength of the relationship between psychosocial function in early psychosis and different domains of cognitive and social cognitive performance. We conducted a systematic review and meta-analysis of peer-reviewed, cross-sectional, and longitudinal studies examining cognitive predictors of psychosocial function. Literature searches were conducted in PsycINFO, PubMed, and reference lists of relevant articles to identify studies for inclusion. Of the 2565 identified, 46 studies comprising 3767 participants met inclusion criteria. Separate meta-analyses were conducted for 9 cognitive domains. Pearson correlation values between cognitive variables and function were extracted. All cognitive domains were related to psychosocial function both cross-sectionally and longitudinally. Importantly, these associations remained significant even after the effects of symptom severity, duration of untreated psychosis, and length of illness were accounted for. Overall, general cognitive ability and social cognition were most strongly associated with both concurrent and long-term function. Associations demonstrated medium effect sizes. These findings suggest that treatments targeting cognitive deficits, in particular those focusing on social cognition, are likely to be important for improving functional outcomes in early psychosis.
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Affiliation(s)
- Megan Cowman
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Laurena Holleran
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Edgar Lonergan
- First Episode Psychosis Service, South Lee Mental Health Service, Cork, Ireland
| | - Karen O’Connor
- First Episode Psychosis Service, South Lee Mental Health Service, Cork, Ireland
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gary Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
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Lysaker PH, Cheli S, Dimaggio G, Buck B, Bonfils KA, Huling K, Wiesepape C, Lysaker JT. Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs? BMC Psychiatry 2021; 21:329. [PMID: 34215225 PMCID: PMC8254212 DOI: 10.1186/s12888-021-03338-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/21/2021] [Indexed: 02/01/2023] Open
Abstract
Research using the integrated model of metacognition has suggested that the construct of metacognition could quantify the spectrum of activities that, if impaired, might cause many of the subjective disturbances found in psychosis. Research on social cognition and mentalizing in psychosis, however, has also pointed to underlying deficits in how persons make sense of their experience of themselves and others. To explore the question of whether metacognitive research in psychosis offers unique insight in the midst of these other two emerging fields, we have offered a review of the constructs and research from each field. Following that summary, we discuss ways in which research on metacognition may be distinguished from research on social cognition and mentalizing in three broad categories: (1) experimental procedures, (2) theoretical advances, and (3) clinical applications or indicated interventions. In terms of its research methods, we will describe how metacognition makes a unique contribution to understanding disturbances in how persons make sense of and interpret their own experiences within the flow of life. We will next discuss how metacognitive research in psychosis uniquely describes an architecture which when compromised - as often occurs in psychosis - results in the loss of persons' sense of purpose, possibilities, place in the world and cohesiveness of self. Turning to clinical issues, we explore how metacognitive research offers an operational model of the architecture which if repaired or restored should promote the recovery of a coherent sense of self and others in psychosis. Finally, we discuss the concrete implications of this for recovery-oriented treatment for psychosis as well as the need for further research on the commonalities of these approaches.
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Affiliation(s)
- P H Lysaker
- Richard L Roudebush VA Medical Center, Department of Psychiatry, 1481 W. 10th St., Indianapolis, IN, 46202, USA. .,Department of Psychiatry, Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN, 46202, USA.
| | - S Cheli
- University of Florence, School of Human Health Sciences, Piazza di San Marco, 4, 50121, Florence, FI, Italy
| | - G Dimaggio
- Terzocentro di Psicoterapia Cognitiva, Associazione di Psicologia Cognitiva, Via Ravenna, 9, 00161, Rome, RM, Italy
| | - B Buck
- Department of Psychiatry and Behavioral Sciences, University of Washington, Behavioral Research in Technology and Engineering (BRiTE) Center, 1851 NE Grant Ln., Seattle, WA, 98185, USA
| | - K A Bonfils
- University of Southern Mississippi, School of Psychology, 118 College Dr., Hattiesbury, MS, 39406, USA
| | - K Huling
- University of Indianapolis, School of Psychological Sciences, 1400 E. Hanna Ave., Indianapolis, IN, 46277, USA
| | - C Wiesepape
- Indiana State University, Department of Psychology, 200 N. 7th St., Terre Haute, IN, 47809, USA
| | - J T Lysaker
- Department of Philosophy, Emory University, 201 Dowman Dr., Atlanta, GA, 30322, USA
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