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A Journal on Psychiatry, Psychology and Psychopharmacology
Official Journal of the Italian Society of Social Psychiatry
Indexed/Abstracted in: EMBASE, e-psyche, PsycINFO, Scopus, Emerging Sources Citation Index
SCHIZOPHRENIA: A CLOSER LOOK
Minerva Psichiatrica 2012 September;53(3):185-96
Cognitive remediation therapy for schizophrenia
Cella M., Huddy V., Reeder C., Wykes T.
Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
Research has consistently documented cognitive deficits across different domains in people with a diagnosis of schizophrenia. Cognitive remediation therapy (CRT) programs based on a number of psychological and learning principles were developed with the aim of improving cognitive and social cognitive deficits. Evidence across at least 40 studies shows that CRT can produce small to medium effects on cognition with this estimate unaffected by studies’ methodological rigour. Domains where positive outcomes should be expected after CRT include memory, planning, reasoning, problem solving, attention and social cognition but also general functioning. Therapeutic mechanisms have rarely been examined but increasing evidence points at the role of brain plasticity and learning dependent reorganization as potential biological mechanisms responsible for change. Recent evidence has also begun to reveal mediators and moderators of successful treatment and these include age, symptoms at intake, premorbid executive skills but also relationship with the therapist. Given that there is now a large amount of evidence of success (and relatively few studies showing failure) increasing research efforts are considering pragmatic issues that may affect CRT service delivery such as cost effectiveness, therapy delivery format and patient acceptability. Despite evidence of efficacy there is still more research required to determine the best methods of delivery. We consider that the future research priorities should be: clarifying the translational pathway of CRT from basic science to service implementation, understand the contribution of non-specific factors such as the role of therapist to outcomes, identify which factors contribute to maximize the response to therapy and how therapy can be adapted to different clients presentations.