Successful implementation of a cognitive remediation program in everyday clinical practice for individuals living with schizophrenia.

OBJECTIVE: This article evaluates the feasibility and benefits of implementing cognitive remediation interventions in everyday clinical practice among individuals living with schizophrenia. METHOD: We retrospectively assessed short-term cognitive and occupational outcomes of 89 consecutively admitted people with schizophrenia at a public mental health service. A computerized cognitive remediation program was offered at the facility as an integral component of psychosocial treatments. Data of service recipients who had completed the Brief Assessment of Cognition in Schizophrenia (BACS; Keefe et al., 2004) on admission and discharge were included for evaluating outcomes. RESULTS: Thirty-seven service recipients did not participate (nontrainee), 18 completed less than 20 hr (incomplete trainee), and 34 completed more than 20 hr of cognitive remediation (completed trainee). Whist a variety of factors affected involvement, lack of interest was the predominant reason voiced for nonparticipation. Repeated measures analysis of variance did not reveal significant Group × Time interaction. Exploratory contrasts showed statistically significant improvement within the completed trainee group from baseline to discharge on the BACS composite score, list learning, and token motor task. Logistic regression analysis indicated that although improved cognition predicted enhanced employment outcome, there was no significant difference among the 3 groups. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Cognitive remediation interventions were accepted by a sizable proportion of people with schizophrenia admitted to an inpatient clinical treatment and rehabilitation facility. Promising improvement in cognitive function among those who completed the training suggests the need for methodologically rigorous research exploring the feasibility and benefits of cognitive remediation programs at everyday clinical settings. (PsycINFO Database Record

Successful evaluation of cognitive function and the nature of cognitive deficits among people with schizophrenia in clinical rehabilitation settings.

OBJECTIVES: Despite possessing considerable relevance for planning and delivery of effective rehabilitation interventions, systematic evaluation of cognitive function is often ignored in clinical practice. This paper describes a successful method for measuring cognitive function and the nature of cognitive deficits (CD) in people with schizophrenia admitted to psychiatric rehabilitation services. METHODS: Data on the cognitive functioning of consecutive patients with schizophrenia / schizoaffective disorder admitted during a 5-year period to a public in-patient rehabilitation facility was collated retrospectively and analysed. The Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate cognitive function. RESULTS: It was possible to administer the BACS to 122 of 135 consecutive admissions. The mean composite score on the BACS was 1.8 standard deviations below the norm, and 43% had moderate or severe CD. The BACS sub-tests of list learning and symbol coding revealed more severe deficits. CONCLUSIONS: The study indicates that evaluation of cognitive function using brief instruments is feasible in psychiatric rehabilitation settings. Global and domain-specific CD were prevalent among people with schizophrenia. In view of the strong association of cognitive functioning with community functioning and rehabilitation outcomes, further studies exploring the feasibility and utility of routinely evaluating cognitive function are warranted.