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Factors affecting cognitive remediation outcome in schizophrenia: The role of treatment resistance

Published online by Cambridge University Press:  13 August 2021

M. Spangaro ,
M. Bosia ,
F. Martini ,
M. Bechi ,
M. Buonocore  and
R. Cavallaro
M. Spangaro*
Affiliation:
Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, milano, Italy
M. Bosia
Affiliation:
Faculty Of Medicine, Vita-Salute San Raffaele University, Milan, Italy
F. Martini
Affiliation:
Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, milano, Italy
M. Bechi
Affiliation:
Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, milano, Italy
M. Buonocore
Affiliation:
Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, milano, Italy
R. Cavallaro
Affiliation:
Faculty Of Medicine, Vita-Salute San Raffaele University, Milan, Italy
*
*Corresponding author.

Abstract

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Introduction

Treatment-resistant schizophrenia (TRS) represents a major clinical issue, characterized by worse psychopathological outcome, a more disrupted neurobiological substrate and higher healthcare costs. Cognitive impairment is a core feature of schizophrenia, strongly associated with patients’ functional outcome. Different studies showed that TRS patients exhibit poorer neurocognitive performance, particularly on verbal domains. To date Cognitive Remediation Therapy (CRT) represents the best available tool for treating cognitive deficits in schizophrenia. However, CRT outcomes are highly heterogeneous and significant treatment predictors are still lacking.

Objectives

To investigate possible differences of CRT outcome among patients with schizophrenia, stratified according to antipsychotic response (TRSs vs. first-line responders - FLRs).

Methods

150 patients with schizophrenia, (95 FLRs, 55 TRSs) were assessed for neurocognition with BACS and WCST at baseline and after CRT. General Linear Models (GLMs) were performed to investigate possible differences between groups on basal cognition and CRT outcome (Cohen’s d Effect Size).

Results

At baseline, GLMs showed significant differences in Verbal Memory (F=4,66; p=0,03) and WCST–executive functions (F=5,59; p=0,02), both worse in TRS group. Effecr Sizes of CRT outcome resulted significantly different in domains of Verbal Memory (F=4,68; p=0,03) and WCST–executive functions (F=4,62; p=0,03), with greater improvements among TRS patients.

Conclusions

This is the first study to indicate treatment-resistance as a possible predictor of CRT outcome in schizophrenia. Moreover, we observed that CRT resulted able to fill the cognitive gap between treatment groups. Thus, these results further highlight the importance of early cognitive interventions in order to reduce the neuropsychological and functional burden associated with the disease, especially for TRS patients.

Disclosure

No significant relationships.

Keywords

treatment resistancecognitive remediationschizophrénia
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S168
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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