Journal Article

A randomized controlled trial of cognitive remediation for a national cohort of forensic patients with schizophrenia or schizoaffective disorder

Galligan, Toni, Kennedy, Harry G., Coyle, Ciaran, Corvin, Aiden, O’Reilly, Ken, Donohoe, Gary, O’Flynn, Padraic, O’Donnell, Muireann, O’Sullivan, Danny, O’Connell, Paul

2019

Overview

Background Evidence is accumulating that Cognitive Remediation Training (CRT) is effective for ameliorating cognitive deficits experienced by patients with schizophrenia and accompanying functional impairment. There has been no randomized controlled trial of CRT using a nationally representative population of forensic patients, despite the significant cognitive deficits frequently present within this group. Methods Sixty-five patients with schizophrenia or schizoaffective disorder were enrolled in a single blind randomized controlled trial of CRT versus treatment as usual (TAU); representing 94% of those eligible within a national forensic cohort. The primary outcome measure was the composite score of the MATRICS Consensus Cognitive Battery (MCCB). Secondary outcome measures included neurocognitive and social cognitive domains, symptoms, and ‘real world’ functioning. Patient satisfaction was examined using an exit interview. Participants were reassessed at 8 months follow up. All data were analyzed using an intention to treat design (ITT). Results For the primary outcome measure, the MCCB composite score, there were significant differences between those who participated in CRT and those receiving TAU at both end of treatment and 8 months follow up (Cohen’s d = 0.34. Significant improvements were observed in visual and working memory. Mediation analysis found that those who cognitively benefited from CRT had corresponding improved functioning, and more net positive therapeutic moves i.e. moves to units with lower security within the hospital. Ninety-six percent believed their cognitive gains positively affected their daily lives. Conclusions CRT may be an acceptable and efficacious intervention for forensic patients with schizophrenia or schizoaffective disorder. Trial registration ClinicalTrials.gov Identifier: NCT02360813 . Trial registered Feb 4th 2015, last updated May 1st 2015.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Care and treatment / Clinical trials / Cognition / Cognition & reasoning / Cognitive ability / Cognitive Remediation - methods / Cognitive remediation training / Cognitive therapy / Cohort Studies / Criminal investigation / CRT / Data processing / Effectiveness / Evidence-based medicine / Female / Follow-Up Studies / Forensic mental health / Forensic psychiatry / Forensic Psychiatry - methods / Forensic science / Humans / Male / Mediation / Medicine / Medicine & Public Health / Memory / Mental disorders / Mental health / Mental health care / Middle Aged / Neurocognition / Patient Satisfaction / Patients / Psychiatry / Psychotherapy / Psychotic Disorders - psychology / Psychotic Disorders - therapy / Research Article / Schizoaffective disorder / Schizophrenia / Schizophrenia - therapy / Schizophrenic Psychology / Short term memory / Single-Blind Method / Tau protein / Treatment Outcome / Violence / Young Adult