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Tan BL, Tan N, Koh V, Poh L, Medalia A. Integrative Neuro-social cognitive Strategy Programme for Instilling REcovery (INSPIRE): a community-based cognitive remediation trial-study procotol. BMC Psychiatry 2024; 24:621. [PMID: 39300363 PMCID: PMC11414231 DOI: 10.1186/s12888-024-06070-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Adults with schizophrenia experience a range of neurocognitive problems that affect their daily functioning. Evidence for the efficacy of cognitive remediation in schizophrenia has been established, but its implementation in under-resourced community-based settings is less well-studied. In recent years, interventions have also focused on the strategy-learning approach in favor of drill-and-practice. Moreover, there is an increasing recognition to address social cognition and negative symptoms alongside neurocognition. This study attempts to carry out cognitive remediation in a community mental health setting. The Neuropsychological and Educational Approach to Remediation (NEAR) is used as the cognitive remediation intervention. Neurocognitive and social cognitive games will be introduced during the computer-assisted cognitive exercises sessions. In addition, the instructional technique will foster the use of metacognition and cognitive strategies. Moreover, metamotivation training will be the focus of some bridging sessions to enhance motivation to engage in goal-directed learning behaviors. The aims of the study are to 1) investigate the effects of cognitive remediation on neurocognition, social cognition and functional outcomes of participants with schizophrenia/schizoaffective disorders in community mental health settings; and 2) explore the mediators for change (eg: metamotivation, metacognition and negative symptoms) in cognitive performance and functional outcomes. METHODS This randomized controlled trial will be conducted in three Singapore Anglican Community Services (SACS) centers, where standard psychiatric rehabilitation is delivered. Participants who are randomized to the experimental arm will receive cognitive remediation and psychiatric rehabilitation, while those randomized to the control arm will receive standard psychiatric rehabilitation only. Cognitive remediation is carried out three times a week for 12 weeks. It consists of computer-assisted cognitive exercises, as well as bridging groups to aid transfer of learning to daily living. Baseline, post-intervention and eight-week follow-up measurements will be collected. Group by time differences in cognitive performance, negative symptoms, metamotivation, metacognition, functioning and recovery will be analyzed across the three time points. Mediators for improvement in cognitive performance and functioning will also be explored. DISCUSSION Findings of this research will add to the body of knowledge about the key therapeutic ingredients within a strategy-based cognitive remediation program and improve its implementation within under-resourced community settings. TRIAL REGISTRATION This study has been registered with ClinicalTrials.gov (ID: NCT06286202). Date of registration: 29 February 2024. Date of last update: 21 May 2024.
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Affiliation(s)
- Bhing-Leet Tan
- Health and Social Sciences, Singapore Institute of Technology, 10 Dover Drive, Singapore, 138683, Singapore.
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore.
| | - Noel Tan
- Singapore Anglican Community Services, 10 Simei St 3, Singapore, 529897, Singapore
| | - Vanessa Koh
- Singapore Anglican Community Services, 10 Simei St 3, Singapore, 529897, Singapore
| | - Lin Poh
- Singapore Anglican Community Services, 10 Simei St 3, Singapore, 529897, Singapore
| | - Alice Medalia
- New York State Psychiatric Institute, New York, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- New York-Presbyterian, New York, USA
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Lak M, Jafarpour A, Shahrbaf MA, Lak M, Dolatshahi B. The effect of physical exercise on cognitive function in schizophrenia patients: A GRADE assessed systematic review and meta-analysis of controlled clinical trials. Schizophr Res 2024; 271:81-90. [PMID: 39013348 DOI: 10.1016/j.schres.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 05/22/2024] [Accepted: 07/07/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Physical exercise has demonstrated the potential to improve cognitive impairment in schizophrenia, although the results are limited. The objective of this meta-analysis is to synthesize the existing evidence on the impact of physical exercise on cognitive functions in schizophrenia. METHODS A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted. The study included controlled clinical trials on patients with schizophrenia that received physical exercise as the intervention for improving cognition. A meta-analysis was conducted using a random-effects model, and the outcomes were reported using the standardized mean difference (SMD) and a 95 % confidence interval (95 % CI). RESULTS A total of 22 articles, including 1066 patients (565 in the intervention group and 501 in the control group), were included in the final analysis. Physical exercises significantly improved global cognition (SMD: 0.73, 95 % CI (0.46-1.00), P < 0.001), and aerobic exercise was found to have a more significant effect than resistance and mindfulness exercise (SMD: 0.76, 95 % CI (0.45-1.07), P < 0.001). The speed of processing [SMD: 0.88, 95 % CI (0.37-1.38), P = 0.001], attention [SMD: 0.61, 95 % CI (0.20-1.02), P = 0.004], and visual learning memory [SMD: 1.42, 95 % CI (0.14-2.71), P = 0.03] demonstrated significant improvement after physical exercise, while no significant effects were observed on working memory, verbal learning memory, reasoning and problem-solving, and social cognition. CONCLUSIONS Exercise can improve overall cognitive function in people with Schizophrenia. However, it is unclear whether this improvement is significant in specific cognitive domains.
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Affiliation(s)
- Mohammadmahdi Lak
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Psychosis Research Center, University of Social welfare and Rehabilitation Sciences, Tehran, Iran
| | - Atefeh Jafarpour
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Psychosis Research Center, University of Social welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Mohammadyasin Lak
- Department of Exercise Physiology, Sport Sciences Research Institute, Tehran, Iran
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Chang KT, Goh KK, Latthirun K, Yang CT. The effect of exercise on cognition and clinical symptoms of patients with schizophrenia: A systematic review of randomized controlled trial. PROGRESS IN BRAIN RESEARCH 2024; 283:255-304. [PMID: 38538191 DOI: 10.1016/bs.pbr.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Physical activity has been viewed as a potential non-pharmacological therapeutic strategy to improve the clinical symptoms and neurocognitive deficits in patients with schizophrenia. However, there are various types of physical activities, and different exercise prescriptions might produce inconsistent benefits. Thus, this study aimed to conduct a systematic review of exercise interventions for patients with schizophrenia, clarifying the benefits of these interventions on cognitive function and clinical symptoms. This review encompasses six electronic databases, with inclusion criteria including randomized controlled trial designs, participants with schizophrenia, and a comprehensive exercise intervention program. Twenty-seven studies met the inclusion criteria, incorporating data from 1549 patients with schizophrenia. The results highlight that when comparing the exercise intervention group to the non-intervention control group, patients with schizophrenia showed significant improvement in negative symptoms. Structured exercise interventions can help improve the negative symptoms of schizophrenia, filling the gaps where medication falls short. Regarding functional outcomes, exercise interventions aid in enhancing the overall functionality (psychological, social, occupational) of individuals with schizophrenia. The improvement is largely tied to the boost in physical fitness that exercise provides. Based on current findings, exercise interventions assist in enhancing cognitive function in patients with schizophrenia. Notably, significant improvements are observed in higher-order cognitive functions, including processing speed, attention, and working memory. It is recommended to engage in moderate-intensity exercises at least three times a week, with each session lasting a minimum of 30min. Well-structured exercise interventions contribute to enhancing the negative symptoms and cognitive functions in patients with schizophrenia.
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Affiliation(s)
- Kun-Tang Chang
- International Doctoral Program in Principles and Implications of Mind Science, National Cheng Kung University, Tainan, Taiwan
| | - Kah Kheng Goh
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; The Innovative and Translational Research Center for Brain Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Kanthika Latthirun
- International Doctoral Program in Principles and Implications of Mind Science, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Ta Yang
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan; Graduate Institute of Health and Biotechnology Law, Taipei Medical University, Taipei, Taiwan.
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Kunita K, Morimoto T, Kotake R, Sato-Nakamura S, Nakamura-Kukuminato N. Effect of combining motivational interviewing with cognitive remediation on personal recovery in patients with schizophrenia. Hong Kong J Occup Ther 2023; 36:20-30. [PMID: 37332296 PMCID: PMC10273794 DOI: 10.1177/15691861231167504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/18/2023] [Indexed: 09/20/2023] Open
Abstract
Background/objective We have been practising the Neuropsychological and Educational Approach to Remediation (NEAR) as cognitive remediation (CR) in a psychiatric hospital and have implemented it in combination with regular interviews based on Motivational Interviewing (MI) approximately 2 years after launching NEAR. In this study, we investigated whether combining MI with CR affected completion of the programme, cognitive functions, global functioning, and personal recovery of patients with schizophrenia by analysing medical records. Methods In this retrospective observational study, 14 participants were assigned to the NEAR group and 12 participants were assigned to the NEAR + MI group. Fifteen participants in the NEAR group (n = 6) and NEAR + MI group (n = 9) completed the programme. First, the difference in the completion rate between the groups was examined using the chi-squared test. Second, measures of cognitive functions, global functioning, and personal recovery pre-and post-intervention were examined using the Wilcoxon signed-rank tests for those in each group who completed the programme. Third, therapeutic responses for each group were compared using the Mann-Whitney U tests. Results There were no statistically significant differences in completion rates between the groups. In the NEAR group, verbal memory and overall cognition improved after the intervention. On the other hand, not only cognitive functions but also global functioning and personal recovery improved in the NEAR + MI group. Moreover, changes in global functioning and personal recovery were significantly higher in the NEAR + MI group. Conclusion Study findings indicated that combining MI with CR improves cognitive functions, global functioning, and personal recovery in patients with schizophrenia.
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Affiliation(s)
- Koji Kunita
- Department of Rehabilitation, Hayashishita Hospital, Sapporo, Japan
- Forensic Psychiatry Center, Hokkaido University Hospital, Sapporo, Japan
| | - Takafumi Morimoto
- Department of Rehabilitation, Hayashishita Hospital, Sapporo, Japan
- Department of Occupational Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Reiko Kotake
- Department of Rehabilitation, Hayashishita Hospital, Sapporo, Japan
- Hokudai-dori Mental Health Clinic, Sapporo, Japan
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Korman N, Stanton R, Vecchio A, Chapman J, Parker S, Martland R, Siskind D, Firth J. The effect of exercise on global, social, daily living and occupational functioning in people living with schizophrenia: A systematic review and meta-analysis. Schizophr Res 2023; 256:98-111. [PMID: 37209456 DOI: 10.1016/j.schres.2023.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Schizophrenia is associated with high rates of global, social and occupational functional impairments. While prior meta-analyses have extensively examined the impact of exercise on physical and mental health, the impact on functioning in schizophrenia have yet to be fully established. This review aimed to update the evidence base regarding the impact of exercise on functioning in schizophrenia, and explore moderators of effect. METHODS A systematic search was conducted to identify randomized controlled trials (RCTs) of exercise evaluating global functioning versus any comparator in people with schizophrenia; between group meta-analyses of global functioning (and secondary - social, living skills, occupational, adverse events) were computed using a random effects model. Subgroup analyses based on diagnosis and aspects of the intervention were conducted. RESULTS 18 full text articles were included, involving 734 participants. A moderate impact of exercise on global functioning was found (g = 0.40, 95 % C·I. = 0.12 to 0.69, p = 0.006), with a moderate impact of exercise on social (N = 5, g = 0.54 95 % C.I = 0.16 to 0.9 p = 0.005), and daily living functioning (N = 3, g = 0.65, 95 % C.I. = 0.07 to 1.22, p = 0.005). CONCLUSIONS There is good evidence that exercise can improve the global functioning of people with schizophrenia, with preliminary evidence for social and daily living skills; exercise should be considered an important adjunct to usual care. Higher impacts on global functioning were seen in aerobic interventions and of at least moderate to vigorous intensity. More research is required into resistance training, in early psychosis cohorts and to evaluate the comparison of exercise with other established psychosocial therapies.
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Affiliation(s)
- Nicole Korman
- Addiction and Mental Health Services, Metro South Health Services, Australia; School of Medicine, University of Queensland, Brisbane, Australia.
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Anna Vecchio
- Addiction and Mental Health Services, Metro South Health Services, Australia
| | - Justin Chapman
- Addiction and Mental Health Services, Metro South Health Services, Australia; Queensland Institute of Medical Research, Brisbane, Australia
| | - Stephen Parker
- Addiction and Mental Health Services, Metro South Health Services, Australia; School of Medicine, University of Queensland, Brisbane, Australia; The Prince Charles Hospital, Metro North Mental Health Services, Australia
| | - Rebecca Martland
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Dan Siskind
- Addiction and Mental Health Services, Metro South Health Services, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Impact of Physical Exercise Alone or in Combination with Cognitive Remediation on Cognitive Functions in People with Schizophrenia: A Qualitative Critical Review. Brain Sci 2023; 13:brainsci13020320. [PMID: 36831863 PMCID: PMC9954055 DOI: 10.3390/brainsci13020320] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/31/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
Physical exercise and cognitive remediation represent the psychosocial interventions with the largest basis of evidence attesting their effectiveness in improving cognitive performance in people living with schizophrenia according to recent international guidance. The aims of this review are to provide an overview of the literature on physical exercise as a treatment for cognitive impairment in schizophrenia and of the studies that have combined physical exercise and cognitive remediation as an integrated rehabilitation intervention. Nine meta-analyses and systematic reviews on physical exercise alone and seven studies on interventions combining physical exercise and cognitive remediation are discussed. The efficacy of physical exercise in improving cognitive performance in people living with schizophrenia is well documented, but more research focused on identifying moderators of participants response and optimal modalities of delivery is required. Studies investigating the effectiveness of integrated interventions report that combining physical exercise and cognitive remediation provides superior benefits and quicker improvements compared to cognitive remediation alone, but most studies included small samples and did not explore long-term effects. While physical exercise and its combination with cognitive remediation appear to represent effective treatments for cognitive impairment in people living with schizophrenia, more evidence is currently needed to better understand how to implement these treatments in psychiatric rehabilitation practice.
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Xu Y, Cai Z, Fang C, Zheng J, Shan J, Yang Y. Impact of aerobic exercise on cognitive function in patients with schizophrenia during daily care: A meta-analysis. Psychiatry Res 2022; 312:114560. [PMID: 35500333 DOI: 10.1016/j.psychres.2022.114560] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/07/2022] [Accepted: 04/16/2022] [Indexed: 01/06/2023]
Abstract
To assess the effect of aerobic exercise (AZ) on global cognition and different cognition domains in patients with schizophrenia (SZ) in daily care. Selection of the literature was done through the Pubmed, Web of Science, Embase and Cochrane Library databases. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were used to assess the effect of AZ on cognition of SZ patients. All assessment indicators were subjected to sensitivity analysis to test the stability of the result. Subgroup analysis was conducted on study type, follow-up time, supervisor and control method. Totally, 23 articles enrolling 1014 participants were included. The global cognition of SZ patients was improved after 6 months of follow-up. AE guided by an occupational therapist improved the global cognition of SZ patients. AE was associated with improved verbal learning and memory, reasoning and problem solving (SMD: 0.375, 95%CI: 0.009 to 0.741, P = 0.045). However, effects on speed of processing, attention/vigilance, work memory, visual learning and memory, social cognition were not significant. The effect of AE training on global cognition may be maintained over the long-term, and be domain specific. Patients with SZ can do AE guided by professional occupational therapist in their daily lives settings.
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Affiliation(s)
- Yuehui Xu
- Department of Nursing, Wenzhou Seventh People's Hospital, No.158 Xueshiqian Road, Panqiao Town, Ouhai District, Wenzhou 325000, PR China
| | - Ziyao Cai
- Department of Outpatient, Wenzhou Seventh People's Hospital, Wenzhou 325000, PR China
| | - Chunxia Fang
- Department of Prevention & Treatment, Wenzhou Seventh People's Hospital, Wenzhou 325000, PR China
| | - Jie Zheng
- Department of Nursing, Wenzhou Seventh People's Hospital, No.158 Xueshiqian Road, Panqiao Town, Ouhai District, Wenzhou 325000, PR China
| | - Jianmin Shan
- Ward 301, Wenzhou Seventh People's Hospital, Wenzhou 325000, PR China
| | - Yafang Yang
- Department of Nursing, Wenzhou Seventh People's Hospital, No.158 Xueshiqian Road, Panqiao Town, Ouhai District, Wenzhou 325000, PR China.
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Zhu X, Fan H, Zou Y, Tan Y, Yang F, Wang Z, Zhao Y, Fan F, Reeder C, Zhou D, Tan S, Wykes T. Computerized or manual? Long term effects of cognitive remediation on schizophrenia. Schizophr Res 2022; 239:47-54. [PMID: 34839074 DOI: 10.1016/j.schres.2021.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cognitive remediation therapy (CRT) and Computerized CRT (CCRT) improve cognition and functioning, but there is no direct evidence of whether there is an advantage of using a computer. This study fills this gap and extends research evidence to the long-term effect of these two treatments in a large sample of Chinese inpatients with a diagnosis of schizophrenia. METHOD We conducted a randomized single-blind, follow-up study with participants randomized to receive CCRT (n = 144), CRT (n = 72) or Active control (n = 54) for 12 weeks with 4-5 sessions per week. The main outcome was cognition (MATRICS Consensus Cognitive Battery total score, MCCB), and secondary outcomes were cognitive domains, symptoms and functioning assessed at baseline (0 month), post-treatment (3 months) and follow-up (6, 12 and 18 months). RESULTS The primary outcome (MCCB total score) improved in both treatment groups which was maintained at 18 months but did not differ between treatment groups. Post hoc analysis demonstrated that the CRT group had an advantage over CCRT for the Trail Making and Symbol Coding Tests (all p < 0.05), which lasted for almost 18 months. CONCLUSIONS Both CCRT and CRT contribute to general cognitive improvements in schizophrenia and the overall efficacy was similar. The effects were maintained for 18th months. Exploratory analyses revealed few differences except that CRT had a processing speed advantage.
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Affiliation(s)
- Xiaolin Zhu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Hongzhen Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Yizhuang Zou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China.
| | - Yunlong Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Yanli Zhao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Fengmei Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China
| | - Clare Reeder
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Dongfeng Zhou
- Institute of Mental Health, Peking University, Beijing 100191, PR China
| | - Shuping Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 100096, PR China.
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
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van Duin D, de Winter L, Oud M, Kroon H, Veling W, van Weeghel J. The effect of rehabilitation combined with cognitive remediation on functioning in persons with severe mental illness: systematic review and meta-analysis. Psychol Med 2019; 49:1414-1425. [PMID: 30696500 DOI: 10.1017/s003329171800418x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychiatric rehabilitation (PR) can improve functioning in people with severe mental illness (SMI), but outcomes are still suboptimal. Cognitive impairments have severe implications for functioning and might reduce the effects of PR. It has been demonstrated that performance in cognitive tests can be improved by cognitive remediation (CR). However, there is no consistent evidence that CR as a stand-alone intervention leads to improvements in real-life functioning. The present study investigated whether a combination of PR and CR enhances the effect of a stand-alone PR or CR intervention on separate domains of functioning. METHOD A meta-analysis of randomized controlled trials of PR combined with CR in people with SMI was conducted, reporting on functioning outcomes. A multivariate meta-regression analysis was carried out to evaluate moderator effects. RESULTS The meta-analysis included 23 studies with 1819 patients. Enhancing PR with CR had significant beneficial effects on vocational outcomes (e.g. employment rate: SMD = 0.41), and social skills (SMD = 0.24). No significant effects were found on relationships and outcomes of community functioning. Effects on vocational outcomes were moderated by years of education, intensity of the intervention, type of CR approach and integration of treatment goals for PR and CR. Type of PR was no significant moderator. CONCLUSIONS Augmenting PR by adding cognitive training can improve vocational and social functioning in patients with SMI more than a stand-alone PR intervention. First indications exist that a synergetic mechanism also works the other way around, with beneficial effects of the combined intervention compared with a stand-alone CR intervention.
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Affiliation(s)
| | | | | | - Hans Kroon
- Trimbos Institute,Utrecht,the Netherlands
| | - Wim Veling
- University of Groningen,Groningen,the Netherlands
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Sauvé G, Lepage M, Corbière M. Impacts de la combinaison de programmes de soutien à l’emploi et de remédiation cognitive sur le maintien en emploi de personnes souffrant de schizophrénie : une méta-analyse. ANNALES MEDICO-PSYCHOLOGIQUES 2019. [DOI: 10.1016/j.amp.2018.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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An efficacy study of a metacognitive group intervention for people with schizophrenia. Psychiatry Res 2018; 270:1150-1156. [PMID: 30482631 DOI: 10.1016/j.psychres.2018.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/23/2018] [Accepted: 10/12/2018] [Indexed: 11/20/2022]
Abstract
Poor cognitive outcomes among people with schizophrenia are associated with poor function in daily life. Cognitive interventions aimed at improving function lead to better cognitive outcomes, but the question of generalization to real-world functioning remains relevant. The ability to generalize or to apply learned skills in the clinic to everyday functioning must include metacognitive components which are the underlying mechanisms of function. To address such generalization, we developed a metacognitive group intervention based on Toglia's (2005) dynamic interactional model, which aims to promote daily activities and participation by focusing on metacognitive components. We assessed 84 participants with schizophrenia (41 in the control group and 43 in the intervention group) before and after completing the intervention and at a 12-week follow-up. Assessments addressed executive function, performance, and participation. The intervention group's performance, participation, and everyday functions significantly increased post-intervention and at follow-up, compared with the control group. Results provide important information about the potential for change in real-world functioning and a basis for the rationale of employing metacognitive interventions in this population.
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Noyes S, Sokolow H, Arbesman M. Evidence for Occupational Therapy Intervention With Employment and Education for Adults With Serious Mental Illness: A Systematic Review. Am J Occup Ther 2018; 72:7205190010p1-7205190010p10. [PMID: 30157005 DOI: 10.5014/ajot.2018.033068] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Many of the estimated 9.8 million American adults with serious mental illness (SMI) want to engage in employment and education, yet the majority report a need for more skills training. This review presents evidence for the effectiveness of interventions that occupational therapy practitioners can provide to help people with SMI improve and maintain performance and participation in employment and education. METHOD Citations, abstracts, and full-text articles in databases including MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were reviewed for inclusion and analysis. RESULTS Fifty-seven articles met criteria for inclusion. For employment, strong evidence was found for the Individual Placement and Support (IPS) model and cognitive interventions. For education, moderate evidence was found for supported education interventions. CONCLUSION This systematic review supports the role of occupational therapy practitioners in promoting the implementation of IPS, cognitive-based, and social skills programs to improve vocational and educational outcomes for adults with SMI.
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Affiliation(s)
- Susan Noyes
- Susan Noyes, PhD, OTR/L, is Assistant Professor, Occupational Therapy Program, University of Southern Maine, Lewiston;
| | - Helena Sokolow
- Helena Sokolow, MOT, OTR, is Adjunct Instructor, Occupational Therapy Program, University of Southern Maine, Lewiston
| | - Marian Arbesman
- Marian Arbesman, PhD, OTR/L, FAOTA, is Adjunct Associate Professor, Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, and President, ArbesIdeas, Inc., Williamsville, NY
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Garrido G, Penadés R, Barrios M, Aragay N, Ramos I, Vallès V, Faixa C, Vendrell JM. Computer-assisted cognitive remediation therapy in schizophrenia: Durability of the effects and cost-utility analysis. Psychiatry Res 2017; 254:198-204. [PMID: 28463718 DOI: 10.1016/j.psychres.2017.04.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/24/2017] [Accepted: 04/27/2017] [Indexed: 12/16/2022]
Abstract
The durability of computer-assisted cognitive remediation (CACR) therapy over time and the cost-effectiveness of treatment remains unclear. The aim of the current study is to investigate the effectiveness of CACR and to examine the use and cost of acute psychiatric admissions before and after of CACR. Sixty-seven participants were initially recruited. For the follow-up study a total of 33 participants were enrolled, 20 to the CACR condition group and 13 to the active control condition group. All participants were assessed at baseline, post-therapy and 12 months post-therapy on neuropsychology, QoL and self-esteem measurements. The use and cost of acute psychiatric admissions were collected retrospectively at four assessment points: baseline, 12 months post-therapy, 24 months post-therapy, and 36 months post-therapy. The results indicated that treatment effectiveness persisted in the CACR group one year post-therapy on neuropsychological and well-being outcomes. The CACR group showed a clear decrease in the use of acute psychiatric admissions at 12, 24 and 36 months post-therapy, which lowered the global costs the acute psychiatric admissions at 12, 24 and 36 months post-therapy. The CACR is durable over at least a 12-month period, and CACR may be helping to reduce health care costs for schizophrenia patients.
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Affiliation(s)
- Gemma Garrido
- Department of Mental Health, Consorci Sanitari de Terrassa (CST), Martí Díez 5, 08224 Terrassa, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Rafael Penadés
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Clinical Institute of Neurosciences (ICN), Hospital Clínic, Barcelona, Spain.
| | - Maite Barrios
- Department of Behavioral Sciences Methods, University of Barcelona, Spain; Institute of Neuroscience, University of Barcelona, Spain.
| | - Núria Aragay
- Department of Mental Health, Consorci Sanitari de Terrassa (CST), Martí Díez 5, 08224 Terrassa, Barcelona, Spain.
| | - Irene Ramos
- Department of Mental Health, Consorci Sanitari de Terrassa (CST), Martí Díez 5, 08224 Terrassa, Barcelona, Spain; Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain.
| | - Vicenç Vallès
- Department of Mental Health, Consorci Sanitari de Terrassa (CST), Martí Díez 5, 08224 Terrassa, Barcelona, Spain.
| | - Carlota Faixa
- Section of Neuropsychology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Josep M Vendrell
- Section of Neuropsychology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Lanfredi M, Deste G, Ferrari C, Barlati S, Magni LR, Rossi R, de Peri L, Bonomi M, Rossi G, Vita A. Effects of cognitive remediation therapy on neurocognition and negative symptoms in schizophrenia: an Italian naturalistic study. Cogn Neuropsychiatry 2017; 22:53-68. [PMID: 27921860 DOI: 10.1080/13546805.2016.1260537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cognitive remediation therapy (CRT) has been reported to positively affect neurocognitive processes among patients with schizophrenia; however, the degree to which changes in cognition is linked to improved clinical symptoms, remains poorly understood. The current study aimed to investigate whether cognitive gains were associated to improvements in negative symptoms' severity in patients with schizophrenia living in two Italian psychiatric facilities. METHODS Patients with a diagnosis of schizophrenia were consecutively assigned to CRT (n = 33) and compared with an historical control group (n = 28). Assessments were performed at baseline and post-treatment using a neuropsychological battery (Trail Making Test A and B, Self-Ordered Pointing Task, California Verbal Learning Test), along with clinical and functioning measures. RESULTS Visual attention (TMT-A score change) was found as the only significant predictor of improvement in negative symptoms subscale of the Positive and Negative Syndrome Scale. Furthermore, a mediation path analysis confirmed that better performance in visual attention acts as mediator of the positive association between CRT intervention and lower post-treatment negative symptoms score. CONCLUSIONS CRT can have a positive impact on a measure of visual attention in patients with schizophrenia and on negative symptoms reduction that is mediated by this significant intervention effect.
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Affiliation(s)
- Mariangela Lanfredi
- a Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli , Brescia , Italy
| | - Giacomo Deste
- b Department of Psychiatry , Spedali Civili Hospital , Brescia , Italy
| | - Clarissa Ferrari
- c cService of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli , Brescia , Italy
| | - Stefano Barlati
- b Department of Psychiatry , Spedali Civili Hospital , Brescia , Italy
| | - Laura Rosa Magni
- a Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli , Brescia , Italy
| | - Roberta Rossi
- a Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli , Brescia , Italy
| | - Luca de Peri
- b Department of Psychiatry , Spedali Civili Hospital , Brescia , Italy
| | - Marco Bonomi
- b Department of Psychiatry , Spedali Civili Hospital , Brescia , Italy
| | - Giuseppe Rossi
- a Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli , Brescia , Italy
| | - Antonio Vita
- b Department of Psychiatry , Spedali Civili Hospital , Brescia , Italy
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Subramaniam M, Zheng H, Soh P, Poon LY, Vaingankar JA, Chong SA, Verma S. Typology of people with first-episode psychosis. Early Interv Psychiatry 2016; 10:346-54. [PMID: 25175055 DOI: 10.1111/eip.12178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/22/2014] [Indexed: 11/27/2022]
Abstract
AIMS The aim of the current study was to create a typology of patients with first-episode psychosis based on sociodemographic and clinical characteristics, service use and outcomes using cluster analysis. METHODS Data from all respondents who were accepted into the Early Psychosis Intervention Programme (EPIP), Singapore from 2007 to 2011 were analysed. A two-step clustering method was carried out to classify the patients into distinct clusters. RESULTS Two clusters were identified. Cluster 1 comprised largely of younger people with mean age of 25.5 (6.0) years at treatment contact, who were predominantly male (55.3%), single (98.3%) and living with parents (86.3%). Cluster 1 had a higher proportion of people diagnosed with the schizophrenia spectrum disorder (71.4%) and with a positive family history of psychiatric illness. Patients in cluster 2 were generally older with a mean age of 33.6 (4.7) years and the majority were women (74.2%). Cluster 1 had people with higher Positive and Negative Syndrome Scale (PANSS) scores at baseline as compared with cluster 2. After a 1-year follow up, their scores were still poorer than their counterparts in cluster 2, especially for PANSS negative score. The functioning level of people in cluster 1 showed less improvement than the people in cluster 2 after a year of treatment. CONCLUSIONS There is a compelling need to develop new therapies and intensively treat young people presenting with psychosis as this group tends to have poorer outcomes even after 1 year of treatment.
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Affiliation(s)
| | - Huili Zheng
- Saw Swee Hock School of Public Health, Singapore
| | - Pauline Soh
- Research Division, Institute of Mental Health, Singapore
| | - Lye Yin Poon
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore.,Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Swapna Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
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16
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Tan BL, Li Z, Tan CHM. Evaluation of a national supported employment programme for people with psychiatric conditions. Br J Occup Ther 2016. [DOI: 10.1177/0308022615615891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Statement of context Job Club is a National Mental Health Blueprint programme funded by the Ministry of Health in Singapore, to provide supported employment for people recovering from psychiatric conditions. Critical reflection on practice Professional staff such as occupational therapists were re-designated as vocational specialists in this programme. Between financial years 2009 and 2014, a total of 1449 job placements were carried out. Fifty-six per cent of all job placements lasted more than two months and 47% of them lasted more than three months. From 2012, the service was integrated with an existing occupational therapy psychiatric rehabilitation service, resulting in an improved job placement rate from 19% to 63%. Linear regression analyses found that only prior vocational training predicted job tenure. Implications for practice Overall, occupational therapists found that our training in activity analyses enabled us to conduct job task analyses, employer education as well as worksite support and modifications competently.
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Affiliation(s)
- Bhing-Leet Tan
- Head of Occupational Therapy Department, Institute of Mental Health and Assistant Professor, Singapore Institute of Technology
| | - Zhongying Li
- Senior Occupational Therapist, Institute of Mental Health, Singapore, Singapore
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Baandrup L, Østrup Rasmussen J, Klokker L, Austin S, Bjørnshave T, Fuglsang Bliksted V, Fink-Jensen A, Hedegaard Fohlmann A, Peter Hansen J, Kristine Nielsen M, Sandsten KE, Schultz V, Voss-Knude S, Nordentoft M. Treatment of adult patients with schizophrenia and complex mental health needs - A national clinical guideline. Nord J Psychiatry 2016; 70:231-40. [PMID: 26328910 DOI: 10.3109/08039488.2015.1074285] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM The Danish Health and Medicines Authority assembled a group of experts to develop a national clinical guideline for patients with schizophrenia and complex mental health needs. Within this context, ten explicit review questions were formulated, covering several identified key issues. METHODS Systematic literature searches were performed stepwise for each review question to identify relevant guidelines, systematic reviews/meta-analyses, and randomized controlled trials. The quality of the body of evidence for each review question was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Clinical recommendations were developed on the basis of the evidence, assessment of the risk-benefit ratio, and perceived patient preferences. RESULTS Based on the identified evidence, a guideline development group (GDG) recommended that the following interventions should be offered routinely: antipsychotic maintenance therapy, family intervention and assertive community treatment. The following interventions should be considered: long-acting injectable antipsychotics, neurocognitive training, social cognitive training, cognitive behavioural therapy for persistent positive and/or negative symptoms, and the combination of cognitive behavioural therapy and motivational interviewing for cannabis and/or central stimulant abuse. SSRI or SNRI add-on treatment for persistent negative symptoms should be used only cautiously. Where no evidence was available, the GDG agreed on a good practice recommendation. CONCLUSIONS The implementation of this guideline in daily clinical practice can facilitate good treatment outcomes within the population of patients with schizophrenia and complex mental health needs. The guideline does not cover all available interventions and should be used in conjunction with other relevant guidelines.
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Affiliation(s)
- Lone Baandrup
- a Danish Health and Medicines Authority and Mental Health Centre Glostrup , Denmark
| | | | - Louise Klokker
- c Danish Health and Medicines Authority and the Parker Institute, Bispebjerg and Frederiksberg Hospital , Denmark
| | | | | | | | | | | | - Jens Peter Hansen
- i Mental Health Services, Region of Southern Denmark and Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark
| | | | | | | | | | - Merete Nordentoft
- l Danish Health and Medicines Authority, Mental Health Centre Copenhagen and Institute of Clinical Medicine, Faculty of Health Science, University of Copenhagen , Denmark
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Mulder R. Does methodology influence the outcome of psychotherapy randomised controlled trials: A look at Australian and New Zealand Studies. Aust N Z J Psychiatry 2015; 49:963-4. [PMID: 26450941 DOI: 10.1177/0004867415609428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Roger Mulder
- Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand
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Katsumi A, Hoshino H, Fujimoto S, Niwa SI. Efficacy of Cognitive Remediation in Schizophrenia: A Short Review of Its Variable Effects According to Cognitive Domain. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojpsych.2015.52019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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