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Cognitive impairment is common in individuals with substance use disorders (SUDs), yet no evidence-based guidelines exist regarding the most appropriate screening measure for use in this population. This systematic review aimed to (1) describe different cognitive screening measures used in adults with SUDs, (2) identify substance use populations and contexts these tools are utilised in, (3) review diagnostic accuracy of these screening measures versus an accepted objective reference standard, and (4) evaluate methodology of included studies for risk of bias. Online databases (PsycINFO, MEDLINE, Embase, and CINAHL) were searched for relevant studies according to pre-determined criteria, and risk of bias and applicability was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). At each review phase, dual screening, extraction, and quality ratings were performed. Fourteen studies met inclusion, identifying 10 unique cognitive screening tools. The Montreal Cognitive Assessment (MoCA) was the most common, and two novel screening tools (Brief Evaluation of Alcohol-Related Neuropsychological Impairments [BEARNI] and Brief Executive Function Assessment Tool [BEAT]) were specifically developed for use within SUD populations. Twelve studies reported on classification accuracy and relevant psychometric parameters (e.g., sensitivity and specificity). While several tools yielded to classification accuracy, there was poor adherence to the Standards for Reporting Diagnostic Accuracy Studies (STARD) across all studies, with high or unclear risk of methodological bias. While some screening tools exhibit promise for use within SUD populations, further evaluation with stronger methodological design and reporting is required. Clinical recommendations and future directions for research are discussed.

ObjectiveCognitive compensatory interventions aim to alleviate psychosocial disability by targeting functioning directly using aids and strategies, thereby minimizing the impact of cognitive impairment. The aim was to conduct a systematic review and meta-analysis of cognitive compensatory interventions for psychosis by examining the effects on functioning and symptoms, and exploring whether intervention factors, study design, and age influenced effect sizes.MethodsElectronic databases (Ovid Medline, PsychINFO) were searched up to October 2018. Records obtained through electronic and manual searches were screened independently by two reviewers according to selection criteria. Data were extracted to calculate estimated effects (Hedge’s g) of treatment on functioning and symptoms at post-intervention and follow-up. Study quality was assessed using Cochrane Collaboration’s risk of bias tool.ResultsTwenty-six studies, from 25 independent randomized controlled trials (RCTs) were included in the meta-analysis (1654 participants, mean age = 38.9 years, 64% male). Meta-analysis revealed a medium effect of compensatory interventions on functioning compared to control conditions (Hedge’s g = 0.46, 95% CI = 0.33, 0.60, P < .001), with evidence of relative durability at follow-up (Hedge’s g = 0.36, 95% CI = 0.19, 0.54, P < .001). Analysis also revealed small significant effects of cognitive compensatory treatment on negative, positive, and general psychiatric symptoms, but not depressive symptoms. Estimated effects did not significantly vary according to treatment factors (ie, compensatory approach, dosage), delivery method (ie, individual/group), age, or risk of bias. Longer treatment length was associated with larger effect sizes for functioning outcomes. No evidence of publication bias was identified.ConclusionCognitive compensatory interventions are associated with robust, durable improvements in functioning in people with psychotic illnesses.

Cognitive screening is an efficient method of detecting cognitive impairment in adults and may signal need for comprehensive assessment. Cognitive screening is not, however, routinely used in youth aged 12-25, limiting clinical recommendations. The aims of this review were to describe performance-based cognitive screening tools used in people aged 12-25 and the contexts of use, review screening accuracy in detecting cognitive impairment relative to an objective reference standard, and evaluate the risk of bias of included studies. Electronic databases (Scopus, Medline, PsychINFO, and ERIC) were searched for relevant studies according to pre-determined criteria. Risk of bias was rated using the Quality Assessment of Diagnostic Accuracy Studies-2. Dual screening, extraction, and quality ratings occurred at each review phase. Twenty studies met the review inclusion criteria. A diverse range of screening tools (length, format) were used in youth aged 12-25 with or without health conditions. Six studies investigating cognitive screening were conducted as primary accuracy studies and reported some relevant psychometric parameters (e.g., sensitivity and specificity). Fourteen studies presented correlational data to investigate the cognitive measure utility. Studies generally presented limited data on classification accuracy, which impacted full screening tool appraisal. Risk of bias was high (or unclear) in most studies with poor adherence to the Standards for Reporting Diagnostic Accuracy Studies (STARD) criteria. Few, high quality studies have investigated the utility of cognitive screening in youth aged 12-25, with no screening measure emerging as superior at detecting cognitive impairment in this age group.

Abstract Background Cognitive impairment is a core feature of schizophrenia that contributes to functional disability. Pharmacological treatments have little to no effect on cognitive deficits. Cognitive remediation therapy (CRT) has emerged as a moderately effective treatment in ameliorating cognitive deficits. However, a number of limitations have been identified in the literature which have impacted the strength of recommendations for clinical translation. These include, but are not limited to: reported variability in response to CRT with some patients not realising any benefit; it is unknown to what extent there is functional generalisation; it is unknown what the role of intrinsic motivation on treatment engagement and response is; and finally, there has been limited previous research to examine the lived experience of participants as they engage with CRT programs. This presentation will review a compendium of recent studies conducted by this research group to address these issues. Methods Study 1 completed a systematic review of the empirical research examining the possible mediators, moderators and predictors of cognitive outcome following CRT. Study 2 completed a single arm CRT intervention in a group of schizophrenia patients with the aim to investigate whether there were different responder groups and what factors might influence response. Study 3 was an assessor-blinded randomized controlled CRT versus computer game control study, which as well as examining impact on cognition and independent living skills also explored the role of intrinsic motivation on cognitive improvement. Study 4 and 5 qualitatively examined how schizophrenia patients experienced participation in CRT. Results Study 1 identified premorbid IQ, baseline cognition, and learning potential as possible predictors of an individual’s capacity to benefit from CRT. Study 2 demonstrated that fifty-five percent of this sample realised reliable change across at least one cognitive domain. Baseline attention/vigilance and verbal learning potential differentiated the CRT responders from non-responders. Study 3 demonstrated improvements in cognition but not independent living skills in the CRT group relative to the controls. It also reported that early perceptions of intervention value predicted session attendance, and positive changes in interest and value during the intervention increased the odds of reliable cognitive improvement. Throughout study 4 and 5 participants qualitatively reported positive experiences during CRT, including greater memory and community functioning, having learned new skills, and opportunities to overcome challenges which enhanced beliefs about capability. Discussion The data presented addresses some of the important limitations identified in CRT research. However, there remains a critical need for large-scale investigations to further scrutinize critical mechanisms influential in CRT outcomes. In conjunction, there is a need for novel analytic techniques to aid a better formulation to influence treatment guidelines. Large-scale international consortia are needed to make substantial advances within this field.

BackgroundSchizophrenia spectrum disorder (SSD) typically presents with a diverse range of cognitive impairments, with the effective treatment of which is advocated as an important future focus for the field. Currently, cognitive remediation therapy (CRT) is the most widely administered form of cognition enhancing treatment, however individual responses to CRT are highly variable in SSD, warranting examination of whether alternative approaches can also enhance cognition. Mindfulness-based interventions (MBI) have shown potential in alleviating the negative impact of clinical SSD symptoms and show promising pro-cognitive treatment effects. The aim of the current study was to retrospectively compare cognitive improvements following two different CRT programs (multi-domain drill and strategy; visually intensive drill and practice) an MBI targeting persistent auditory verbal hallucinations, and a video game-based active control.MethodsData was retrospectively pooled for participants who completed measures of perceptual processing speed, sustained and switching attention, and inhibitory control. Twelve SSD participants completed four weekly one-hour individual sessions of the Individual Mindfulness Program for Voices, 22 completed a minimum of ten one-hour group-/computed-based sessions of the multi-domain drill and strategy intervention COGPACK, 22 completed a minimum of 24 one-hour group-/computer-based sessions of BrainHQ’s (Posit Science) VISUAL Intensive drill and practice intervention, and 17 participants completed a minimum of 10 one-hour group-/computed-based sessions of games putatively similar to exercises common to CRT (active control). Baseline/Post-treatment change effects were calculated for each intervention across specified cognitive variables and converted to standardised Z-scores based on the performance of the active control group.ResultsUnique and overlapping pro-cognitive effects were identified for each of the three intervention types compared to the active control. MBI produced moderate standardized pro-cognitive effects above the active control in perceptual processing speed (z-score□: 0.62) and switching attention (z-score: 0.45). This somewhat overlapped with the change effects calculated for the visually intensive drill and practice (z-score□: 0.57) CRT program. Both the visually intensive drill and practice (z-score: 0.47) and the multi-domain drill and strategy (z-score: 0.52) CRT programs resulted in moderate-to-large improvements v. control in sustained attention, whilst the MBI had no such effect (z-score: 0.10). The video-gamed based active control produced moderate improvements in inhibitory control in comparison to all three interventions (z-score□: -0.37).DiscussionOverall, these preliminary findings suggest that a brief MBI can produce similar performance enhancing effects to that of the lengthier CRT programs in a discrete subset of cognitive tests. More extensive examinations of the cognitive benefits and their translation to real world functional improvements in SSD are needed.

Background Research suggests that young people with major depressive disorder (MDD) experience neurocognitive deficits and that these are associated with poorer functional and clinical outcomes. However, we are yet to understand how young people experience such difficulties. The aim of the current study was to explore the subjective experiences of neurocognitive functioning among young people with MDD. Methods Semi-structured qualitative interviews were conducted with 11 young people (aged 17–24 years) attending a specialist clinic for youth experiencing moderate-severe depression. Interview transcripts were analysed via Thematic Analysis to identify patterns and themes representing how young people with MDD subjectively experience neurocognitive deficits. Results Five main themes were identified: (1) experience of neurocognitive complaints; (2) relationship between neurocognitive complaints and depression; (3) impact on functioning; (4) strategies and supports; and (5) neurocognitive complaints and treatment. Overall, young people with MDD commonly experienced a range of subjective neurocognitive complaints. These appeared to have a bidirectional relationship with depressive symptomatology and significantly disrupted vocational, social and independent functioning, and aspects of psychological well-being including self-esteem. Neurocognitive difficulties represented an experiential barrier to psychological therapeutic engagement and were perceived as variably responsive to psychotropic medications, highlighting the need for targeted intervention. Discussion Neurocognitive difficulties are a common and pervasive experience for young people with MDD, with perceived impacts on depressive symptoms, attitudinal beliefs, everyday functioning and therapeutic engagement. Subjective neurocognitive complaints may therefore contribute to or exacerbate personal challenges faced by young people with MDD and thus, require early identification, consideration in psychological formulation, and treatment. Further research into the mechanisms of neurocognitive impairment in MDD is also needed.

Abstract Background Cognitive remediation (CR) therapies are upheld as promising methods of reducing cognitive impairment in schizophrenia. However, controlled trials with blind assessors and active comparison conditions are lacking, along with evidence of generalization of CR to everyday function and self-efficacy. In addition, the role of patient-specific factors such as motivation in predicting adherence and training outcomes has not been investigated. This assessor-blinded, randomized controlled trial compared the impact of ‘drill-and-strategy’ CR with a computer game (CG) control delivered in a group-setting on cognitive function, independent living skills and self-efficacy, and examined the impact of intrinsic motivation on group attendance and treatment response. Methods Fifty-six people with schizophrenia or schizoaffective disorder were randomized into CR or CG, and offered 20 one-hour sessions over 10 weeks. Measures of cognition (MATRICS consensus cognitive battery), psychopathology (Positive and Negative Syndrome Scale), self-efficacy (Revised Self Efficacy Scale) and independent living skills (Independent Living Skills Survey) were administered at baseline, end-group and three-months post-group. Intrinsic motivation (Intrinsic Motivation Inventory-Schizophrenia Research) was measured in-session at baseline and end-group. Results Primary analysis was conducted for participants who completed end-therapy assessment (CR=22; Control=21). Linear mixed-effect analysis found a significant interaction effect for cognition (p=.028). Pairwise comparisons revealed that cognition was better at end-group and three-month follow-up than baseline for CR completers, with no differences between timepoints for controls. Three-quarters (77%) of CR completers showed a reliable improvement in at least one cognitive domain. A significant time effect was also evident for self-efficacy (p=.028), with the combined groups showing higher self-efficacy at end-group than baseline. No changes in independent living skills were observed. Early reports of program value predicted session attendance above baseline cognitive and clinical symptoms. Enhanced program interest and value over time increased the likelihood of reliable cognitive improvement. Discussion Drill-and-strategy CR, delivered as a stand-alone treatment in a group setting, may improve cognition in schizophrenia when compared to active controls. Enhancing motivation may increase the likelihood of achieving meaningful cognitive improvements. This type of CR, however, may not translate to independent living domains, even if enhanced cognition and confidence in completing everyday behaviors is achieved. Independent living skills may need to be targeted directly to achieve meaningful changes in this domain.

Background Cognitive deficits are associated with poor functional outcomes in individuals recovering from a first episode of psychosis (FEP). Existing treatments that target cognitive deficits in FEP may enhance cognitive function, but improvements to real-world functioning are less consistent. Furthermore, these treatments may not adequately address the personal recovery goals of young people attending FEP services. A novel cognitive strengths-based approach may overcome these shortcomings. Methods This qualitative study used semi-structured interviews to explore clinicians’ ( N =  12) perspectives toward the potential development of a cognitive strengths-based assessment or treatment in FEP. The interviews were analysed using thematic analysis. Results Five higher-order themes emerged: (1) pro-strengths attitude despite unfamiliarity and minimal use, (2) default to a cognitive deficit lens, (3) potential benefits of a cognitive strengths approach, (4) potential risks and barriers, and (5) considerations for successful implementation. While clinicians acknowledged their current deficit approach, they supported implementing a cognitive strengths assessment or treatment and highlighted their potential benefits for the personal recovery needs of young people with FEP. Conclusions These findings suggest that a deficit-focused approach to cognitive function amongst clinicians may be common practice in FEP services. Nevertheless, a cognitive strengths approach was viewed favourably by clinicians and may represent a novel method of supporting personal recovery. Thus, the design and implementation of a cognitive strengths approach may be worthwhile. Future exploration of other stakeholder perspectives, such as young people with FEP, is essential.

Objectives: The aim of this study was to evaluate the impact of computer-assisted “drill-and-strategy” cognitive remediation (CR) for community-dwelling individuals with schizophrenia on cognition, everyday self-efficacy, and independent living skills. Methods: Fifty-six people with schizophrenia or schizoaffective disorder were randomized into CR or computer game (CG) playing (control), and offered twenty 1-hr individual sessions in a group setting over 10 weeks. Measures of cognition, psychopathology, self-efficacy, quality of life, and independent living skills were conducted at baseline, end-group and 3 months following intervention completion. Results: Forty-three participants completed at least 10 sessions and the end-group assessment. Linear mixed-effect analyses among completers demonstrated a significant interaction effect for global cognition favoring CR (p=.028). CR-related cognitive improvement was sustained at 3-months follow-up. At end-group, 17 (77%) CR completers showed a reliable improvement in at least one cognitive domain. A significant time effect was evident for self-efficacy (p=.028) with both groups improving over time, but no significant interaction effect was observed. No significant effects were found for other study outcomes, including the functional measure. Conclusions: Computer-assisted drill-and-strategy CR in schizophrenia improved cognitive test performance, while participation in both CR and CG playing promoted enhancements in everyday self-efficacy. Changes in independent living skills did not appear to result from CR, however. Adjunctive psychosocial rehabilitation is likely necessary for improvements in real-world community functioning to be achieved. (JINS, 2018, 24, 549–562)

Abstract Background Cognitive impairments in domains such as attention, memory, processing speed and executive functions are a central feature of psychotic disorders that have significant negative consequences for daily functioning, including activities of daily living, social and vocational roles. Compensatory approaches aim to minimise the impact of cognitive impairment on daily functioning through the use of aids or strategies to reduce cognitive load, in much the same way as glasses reduce the impact of vision impairment. The primary treatment target is real world community functioning and functional capacity, rather than cognition. There is now a need to synthesise the available evidence in this field so that treatment recommendations and future research directions can be better informed. A large body of research into compensatory approaches to cognition in psychosis exists, but this has never been comprehensively synthesised. The aim of this systematic review and meta-analysis is to examine the effects of compensatory approaches for cognitive deficits in psychotic disorders on i) functional outcomes and ii) other outcomes such as symptoms and quality of life. Methods A systematic review and meta-analysis was conducted according to PRISMA guidelines. PsycINFO and MEDLINE electronic databases were searched from inception to October 2017 using multiple terms for ‘psychosis’, ‘cognition’ and ‘compensatory’. All papers retrieved from this search were double-screened and final inclusion/exclusion was determine by consensus. Data were double-extracted and risk of bias rated by two independent authors. Meta-analysis only included randomised-controlled trials. Standardised Mean Differences (SMD) were calculated to produce a single summary estimate using the random-effects model with 95% Confidence Intervals using Comprehensive Meta-Analysis (CMA) software. When means or standard deviations were not reported in the original articles, SMDs were calculated from data provided by the study authors. Results 2192 articles were identified via electronic and manual searches. Forty-two papers describing 40 independent studies were included in the review: case studies (n=4), case series (n=2), uncontrolled single arm pilot studies (n=5), within-subjects designs (n=1), quasi-randomised trials (n=2), and randomised controlled trials (n=26). The types of compensatory interventions included environmental adaptation and supports, internal and external self-management strategies, and errorless learning. Compensatory interventions were associated with improvements in global functioning post intervention (N=1,449; SMD=0.506; 95%CI=0.347, 0.665; p<.001). Improvements in global symptoms (N=849; SMD=-0.297; 95%CI=-0.484, -0.111; p=.002) and positive symptoms (N=784; SMD=-0.227; 95%CI=-0.416, -0.038; p=.018) were also found. Compensatory interventions were not associated with improvements in negative symptoms (N=736; SMD=-0.162; 95%CI=-0.382, 0.058; p=.150). The heterogeneity of findings was low. Discussion Compensatory approaches are effective for improving functioning in psychosis, with a medium effect size. General symptoms and positive symptoms appear to benefit from compensatory approaches, but compensatory approaches are not effective for improving negative symptoms. Future analyses will examine the durability of effects, effects of study quality and moderating factors such as pure vs. partially compensatory, treatment intensity/length, mode of delivery (group vs. individual), baseline functioning level and age of participants.