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Effectiveness of a low support, remotely accessible, cognitive remediation training programme for chronic psychosis: cognitive, functional and cortical outcomes from a single blind randomised controlled trial.

Authors
  • Donohoe, G1
  • Dillon, R2
  • Hargreaves, A2
  • Mothersill, O1
  • Castorina, M3
  • Furey, E1
  • Fagan, A J4
  • Meaney, J F4
  • Fitzmaurice, B2
  • Hallahan, B5
  • McDonald, C5
  • Wykes, T6
  • Corvin, A2
  • Robertson, I H3
  • 1 School of Psychology& Center for Neuroimaging and Cognitive Genomics,National University of Ireland Galway,Galway,Ireland. , (Ireland)
  • 2 Department of Psychiatry,Trinity College Dublin,Dublin,Ireland. , (Ireland)
  • 3 Trinity College Institute of Neuroscience,Trinity College Dublin,Ireland,Trinity College Dublin,Ireland. , (Ireland)
  • 4 National Centre for Advanced Medical Imaging (CAMI),St. James's Hospital/School of Medicine,Trinity College Dublin,Dublin,Ireland. , (Ireland)
  • 5 Department of Psychiatry & Center for neuroimaging and Cognitive genomics,National University of Ireland Galway,Ireland. , (Ireland)
  • 6 Institute of Psychiatry,Psychology & Neuroscience,King's College London,London,England.
Type
Published Article
Journal
Psychological Medicine
Publisher
Cambridge University Press
Publication Date
Apr 01, 2018
Volume
48
Issue
5
Pages
751–764
Identifiers
DOI: 10.1017/S0033291717001982
PMID: 28933314
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Cognitive remediation (CR) training has emerged as a promising approach to improving cognitive deficits in schizophrenia and related psychosis. The limited availability of psychological services for psychosis is a major barrier to accessing this intervention however. This study investigated the effectiveness of a low support, remotely accessible, computerised working memory (WM) training programme in patients with psychosis. Ninety patients were enrolled into a single blind randomised controlled trial of CR. Effectiveness of the intervention was assessed in terms of neuropsychological performance, social and occupational function, and functional MRI 2 weeks post-intervention, with neuropsychological and social function again assessed 3-6 months post-treatment. Patients who completed the intervention showed significant gains in both neuropsychological function (measured using both untrained WM and episodic task performance, and a measure of performance IQ), and social function at both 2-week follow-up and 3-6-month follow-up timepoints. Furthermore, patients who completed MRI scanning showed improved resting state functional connectivity relative to patients in the placebo condition. CR training has already been shown to improve cognitive and social function in patient with psychosis. This study demonstrates that, at least for some chronic but stable outpatients, a low support treatment was associated with gains that were comparable with those reported for CR delivered entirely on a 1:1 basis. We conclude that CR has potential to be delivered even in services in which psychological supports for patients with psychosis are limited.

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