How Cognitive Remediation in Schizophrenia Brings Us Back to Systemic Therapies: a Viewpoint
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MEDICINE
How Cognitive Remediation in Schizophrenia Brings Us Back to Systemic Therapies: a Viewpoint Arthur Trognon 1,2
&
Frédéric Verhaegen 1
Accepted: 21 August 2020 # Springer Nature Switzerland AG 2020
Abstract Almost a decade has passed since (Wykes et al. 2011) released a famous meta-analysis of cognitive remediation for schizophrenia. They concluded that stronger effects of the functional outcome of cognitive training occur when the remediation is coprovided with psychiatric rehabilitation. By analysing six recent research papers, we re-evaluated this hypothesis by comparing cognitive-oriented and multidimensional strategies. Consistent with (Wykes et al. 2011), the latest studies have shown that benefits from cognitive remediation are increased when associated with psychosocial intervention and focused on daily life implementation, although we were not able to formally conclude on these improvements related to psychosocial rehabilitation because the reviewed studies were not uniform in their control experiments. Keywords Schizophrenia . Therapy . Cognitive . Training . Remediation
Introduction Schizophrenia is a debilitating neurodevelopmental psychiatric disorder characterised by psychotic and nonpsychotic symptoms that affects nearly 0.5% of the world’s total population [1]. Almost 80% of these individuals present moderate to high cognitive impairments [2], in addition to social deficits, impacted rates of employment and impaired ability to live without around-the-clock care [3–5]. As current pharmaceutical approaches have limited effects on cognitive functioning in schizophrenia [6], cognitive remediation therapies (CRTs) could represent an interesting therapeutic tool [7]. CRTs are classified as nonpharmacological therapeutic tools and defined as interventions targeting cognitive deficit and using scientific principles related to learning to increase functional benefits by compensating for cognitive perturbation. In fact, CRTs
focus on the rehabilitation of a given psychological function by establishing alternative cognitive strategies [8]. Actually, CRTs are provided in a wide range of ways, depending on the treatment goals, the programme (paper and pencil, computerised, etc.), the therapist and the patient. Their effects might be evaluated based on two aspects: first, based on their psychological target (i.e. by amelioration of the targeted function), and second, based on the repercussion in ecological situations (e.g. in daily or professional life). First, we will analyse the effectiveness of cognitivedirected strategies, which focus only on isolated cognitive functions, and then compare them to integrative strategies that combine cognitive training and psychosocial accompaniment. Finally, we will conclude by integrating these findings into recent works on ecological approaches and experimental animal research as well.
Cognitive-Directed Strategies This article is part of the Topical Collection on Medicine * Arthur Trognon [email protected] 1
Communications Research Group, GRC - INTE
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