Combined Cognitive Remediation and Functional Skills Training for Schizophrenia: Effects on Cognition, Functional Competence, and Real-World Behavior
Abstract
Objective:
Method:
Results:
Conclusions:
Method
Participants
Measures
Cognition.
Clinical symptoms.
Social competence.
Functional competence.
Real-world functional behavior.
Treatment
Data Analysis
Results
Baseline Analyses
Cognitive Remediation (N=36) | Functional Adaptation Skills Training (N=35) | Combined Treatment (N=36) | ||||
---|---|---|---|---|---|---|
Characteristic | Mean | SD | Mean | SD | Mean | SD |
Age (years) | 39.1 | 10.5 | 42.7 | 9.7 | 39.9 | 8.5 |
Education (years) | 13.3 | 1.8 | 13.1 | 1.7 | 12.9 | 1.1 |
Wide-Range Achievement Test reading score | 44.5 | 4.3 | 44.6 | 4.7 | 46.1 | 5.2 |
Age at first hospitalization (years) | 21.4 | 3.9 | 19.8 | 8.4 | 19.9 | 6.7 |
Total time institutionalized (months) | 38.5 | 40.8 | 31.2 | 57.2 | 43.7 | 46.7 |
Time since last hospitalization (months) | 50.8 | 57.0 | 61.9 | 64.0 | 39.7 | 51.0 |
Time in current outpatient treatment (months) | 80.6 | 84.0 | 72.9 | 74.0 | 87.6 | 89.0 |
Case management visits per monthb | 2.9 | 2.5 | 3.3 | 3.0 | 3.2 | 2.9 |
Cognitive Remediation | Functional Adaptation Skills Training | Combined Treatment | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Baseline (N=36) | Endpoint (N=29) | Baseline (N=35) | Endpoint (N=28) | Baseline (N=36) | Endpoint (N=26) | |||||||
Medication Class | N | % | N | % | N | % | N | % | N | % | N | % |
Atypical antipsychotic | 33 | 92 | 29 | 100 | 32 | 91 | 25 | 89 | 32 | 89 | 23 | 90 |
Conventional antipsychotic | 3 | 8 | 0 | 0 | 5 | 14 | 3 | 11 | 4 | 11 | 3 | 10 |
Benzodiazepine | 5 | 14 | 3 | 10 | 3 | 8 | 2 | 7 | 4 | 11 | 2 | 8 |
SSRI | 10 | 28 | 5 | 17 | 5 | 14 | 3 | 11 | 4 | 11 | 2 | 8 |
Lithium | 2 | 5 | 1 | 3 | 2 | 6 | 1 | 4 | 1 | 3 | 1 | 4 |
Intent-to-Treat Analysis
Baseline | End of Active Treatment | 12 Weeks After End of Active Treatment | ||||||
---|---|---|---|---|---|---|---|---|
Measurea and Treatment Group | EMMb | SE | EMMb | SE | Cohen's dc | EMMb | SE | Cohen's dd |
Brief Assessment of Cognition in Schizophrenia | ||||||||
Composite score (z-score) | ||||||||
Cognitive remediation | –1.60 | 0.15 | –0.90 | 0.15 | 0.77 | –0.88 | 0.15 | 0.72 |
Functional skills training | –1.54 | 0.15 | –1.45 | 0.15 | 0.05 | –1.43 | 0.15 | 0.12 |
Combined treatment | –1.70 | 0.15 | –1.01 | 0.15 | 0.73 | –1.12 | 0.14 | 0.71 |
Adaptive composite (% of total) | ||||||||
Cognitive remediation | 60.0 | 2.9 | 65.5 | 2.9 | 0.25 | 63.9 | 3.0 | 0.13 |
Functional skills training | 60.8 | 2.9 | 68.5 | 2.9 | 0.51 | 65.9 | 3.0 | 0.41 |
Combined treatment | 57.3 | 2.8 | 69.6 | 2.8 | 0.63 | 71.8 | 3.0 | 0.71 |
Social Skills Performance Assessment total score (% of total) | ||||||||
Cognitive remediation | 68.4 | 2.1 | 71.2 | 2.0 | 0.16 | 69.6 | 2.1 | 0.07 |
Functional skills training | 69.2 | 2.2 | 76.9 | 2.0 | 0.52 | 76.1 | 2.1 | 0.60 |
Combined treatment | 68.9 | 2.1 | 76.2 | 2.0 | 0.67 | 76.5 | 2.1 | 0.59 |
Specific Levels of Functioning Scale | ||||||||
Interpersonal subscale (% of total) | ||||||||
Cognitive remediation | 57.3 | 2.4 | 58.5 | 2.4 | 0.12 | 55.5 | 2.3 | –0.08 |
Functional skills training | 55.3 | 2.4 | 57.1 | 2.3 | 0.22 | 57.4 | 2.2 | 0.25 |
Combined treatment | 53.5 | 2.2 | 55.5 | 2.2 | 0.21 | 54.9 | 2.4 | 0.15 |
Community activities subscale (% of total) | ||||||||
Cognitive remediation | 77.3 | 1.7 | 79.4 | 1.8 | 0.13 | 80.3 | 1.8 | 0.18 |
Functional skills training | 78.8 | 1.7 | 81.1 | 1.7 | 0.21 | 81.0 | 1.7 | 0.17 |
Combined treatment | 75.9 | 1.7 | 78.7 | 1.7 | 0.36 | 81.1 | 1.7 | 0.46 |
Work skills subscale (% of total) | ||||||||
Cognitive remediation | 73.8 | 2.3 | 75.8 | 2.4 | 0.19 | 75.0 | 2.4 | 0.14 |
Functional skills training | 67.4 | 2.2 | 71.1 | 2.2 | 0.25 | 71.4 | 2.2 | 0.29 |
Combined treatment | 71.7 | 2.2 | 79.1 | 2.3 | 0.44 | 85.8 | 2.3 | 0.92 |
Positive and Negative Syndrome Scale | ||||||||
Negative symptoms (mean item score) | ||||||||
Cognitive remediation | 2.7 | 0.13 | 2.7 | 0.13 | 0.05 | 2.8 | 0.13 | 0.08 |
Functional skills training | 2.4 | 0.13 | 2.3 | 0.13 | –0.03 | 2.2 | 0.13 | –0.11 |
Combined treatment | 2.7 | 0.13 | 2.6 | 0.12 | –0.14 | 2.6 | 0.12 | –0.13 |
Positive symptoms (mean item score) | ||||||||
Cognitive remediation | 2.3 | 0.13 | 2.2 | 0.16 | –0.10 | 2.3 | 0.14 | –0.04 |
Functional skills training | 2.6 | 0.12 | 2.8 | 0.14 | 0.12 | 2.6 | 0.12 | 0.02 |
Combined treatment | 2.4 | 0.12 | 2.3 | 0.15 | –0.08 | 2.3 | 0.13 | –0.07 |
Discussion
Acknowledgments
Footnotes
References
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Funding Information
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