Cognitive Training and Remediation in First-Episode Psychosis: A Literature Review

Research output: Contribution to journalReview articlepeer-review

Abstract

BACKGROUND: Neurocognitive and social cognitive impairments are core characteristics of psychotic disorders, which are present in the first episode of psychosis (FEP) and strongly predict poor social functioning. Addressing cognitive impairments through cognitive training and remediation (CTR) may be a crucial component of recovery-oriented treatment. AIMS: The objectives of this review were to (1) evaluate the CTR theoretical basis and intervention components and (2) examine the effects of CTR on cognition and social functioning in FEP. METHOD: A combined search of Ovid Medline, Embase, and Psych Info databases was conducted using keywords. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quality and risk of bias were assessed using established instruments. RESULTS: Ten randomized controlled trials were included in this review and had an overall fair to poor quality. CTR interventions in FEP utilize a range of theoretical backgrounds, with most including a focus on higher order cognitive processes. Varied doses and intervention components are used. All but one study found improvements in at least one cognitive domain. Global cognition, verbal learning, and memory and executive function were most commonly improved. Three studies found an effect on a range of functional outcomes. CONCLUSIONS: A broad range of CTR interventions have promising effects for addressing cognitive impairments in FEP. Evidence of functional impact is less consistent. Further research is needed in FEP on CTR targeting sensory and perceptual processes, and to identify CTR intervention targets and treatment components that will lead to robust improvements in cognition and functioning.

Original languageEnglish (US)
Pages (from-to)542-554
Number of pages13
JournalJournal of the American Psychiatric Nurses Association
Volume26
Issue number6
DOIs
StatePublished - Oct 4 2019

Bibliographical note

Funding Information:
https://orcid.org/0000-0002-7685-8623 Miley Kathleen 1 Hadidi Niloufar 2 https://orcid.org/0000-0002-3467-8587 Kaas Merrie 3 Yu Fang 4 1 Kathleen Miley, MSN, PMHNP-BC, University of Minnesota, Minneapolis, MN, USA 2 Niloufar Hadidi, PhD, APRN, University of Minnesota, Minneapolis, MN, USA 3 Merrie Kaas, PhD, PMHCNS-BC, University of Minnesota, Minneapolis, MN, USA 4 Fang Yu, PhD, GNP-BC, University of Minnesota, Minneapolis, MN, USA Kathleen Miley, School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 208 Harvard Street SE, Minneapolis, MN 55455, USA. Email: mile0087@umn.edu 10 2019 1078390319877952 © The Author(s) 2019 2019 American Psychiatric Nurses Association BACKGROUND: Neurocognitive and social cognitive impairments are core characteristics of psychotic disorders, which are present in the first episode of psychosis (FEP) and strongly predict poor social functioning. Addressing cognitive impairments through cognitive training and remediation (CTR) may be a crucial component of recovery-oriented treatment. AIMS: The objectives of this review were to (1) evaluate the CTR theoretical basis and intervention components and (2) examine the effects of CTR on cognition and social functioning in FEP. METHOD: A combined search of Ovid Medline, Embase, and Psych Info databases was conducted using keywords. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quality and risk of bias were assessed using established instruments. RESULTS: Ten randomized controlled trials were included in this review and had an overall fair to poor quality. CTR interventions in FEP utilize a range of theoretical backgrounds, with most including a focus on higher order cognitive processes. Varied doses and intervention components are used. All but one study found improvements in at least one cognitive domain. Global cognition, verbal learning, and memory and executive function were most commonly improved. Three studies found an effect on a range of functional outcomes. CONCLUSIONS: A broad range of CTR interventions have promising effects for addressing cognitive impairments in FEP. Evidence of functional impact is less consistent. Further research is needed in FEP on CTR targeting sensory and perceptual processes, and to identify CTR intervention targets and treatment components that will lead to robust improvements in cognition and functioning. neurocognition early intervention recovery functioning national institutes of health https://doi.org/10.13039/100000002 TL1R002493 and UL1TR002494 edited-state corrected-proof Author Roles KM drafted the manuscript and completed the primary analysis. All authors contributed to the conception and design of the research, contributed to analysis and interpretation, critically revised the manuscript, and gave final approval for the manuscript. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grants TL1R002493 and UL1TR002494 (KM). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences. KM receives support as a Jonas Scholar 2018-2020. ORCID iDs Kathleen Miley https://orcid.org/0000-0002-7685-8623 Merrie Kaas https://orcid.org/0000-0002-3467-8587 Supplemental Material Supplemental material for this article is available online.

Keywords

  • early intervention
  • functioning
  • neurocognition
  • recovery

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

Fingerprint Dive into the research topics of 'Cognitive Training and Remediation in First-Episode Psychosis: A Literature Review'. Together they form a unique fingerprint.

Cite this