Psy-Q: How do I know if my patient is a good candidate for cognitive remediation for schizophrenia?

Antonio Vita MD PhD

Antonio Vita MD PhD

Answer: “We encourage clinicians to consider cognitive function and a cognitive assessment in the clinical practice approach to people with schizophrenia. This can help to identify not only candidates for cognitive remediation (CR) but also critical targets for more personalized rehabilitative interventions,” says Antonio Vita, MD, PhD, lead author of a recent JAMA Psychiatry article.

The study, Effectiveness, Core Elements, and Moderators of Response of Cognitive Remediation for Schizophrenia, is a systematic review and meta-analysis of randomized clinical trials looking at CR, a behavioral training-based approach to improving cognitive function, for people with schizophrenia. Dr. Vita’s team found that CR may benefit most patients with schizophrenia and should be implemented more widely, instead of the current practice of targeting certain individuals for CR therapy.

Dr. Vita is a professor and chair of psychiatry, in the Department of Clinical and Experimental Sciences at the University of Brescia. He also serves as head of the Department of Mental Health and Addiction Services at Spedali Civili Hospital, in Brescia, Italy, and he recently shared more about his team’s research on schizophrenia and cognitive remediation with Psycom Pro.

Psycom Pro: Your study concludes that cognitive remediation could be a “game-changer” for treating people with schizophrenia. Why isn’t its use more widespread?

Dr. Vita: Even if the notion of the effectiveness of cognitive remediation is established, there’s still a lag between the scientific findings and their implementation in the “real world.” This may be due to the gap existing between research and clinical practice but may also rely on mental health services’ latency in implementing new routine activities.

Psycom Pro: What will it take for cognitive remediation to become part of the standard of care for people with schizophrenia?

Dr. Vita: First of all, it needs to be acknowledged as a valid treatment in order to be embedded in the standard of care. This is slowly happening through its inclusion in some international guidelines, but there is still a way to go. Second, cognitive remediation needs funding, both to train professionals to apply it, to develop new solutions, and to allow reimbursement from their health service or health insurance companies.

Psycom Pro: What advice would you give to clinicians using or considering using CR therapy to help treat schizophrenia in their patients?

Dr. Vita: Cognitive remediation does its best when applied in a more comprehensive rehabilitative context, with the direct intervention of a trained therapist and when strategies are used. This approach is strongly advised, in addition to a careful evaluation of patients’ subjective attitudes toward the intervention since their commitment and motivation are key ingredients for a successful treatment.

 

See more on recent cognitive remediation studies. and our full Clinician’s Guide to treating schizophrenia.

Last Updated: Jun 2, 2021