Interventions to improve real-life functioning

Accurate assessment of neurocognition and social cognition and personalized cognitive training and psychosocial interventions can improve the real-life functioning of patients with schizophrenia, explained experts taking part in a workshop at EPA 2022.

Screening for and assessment of neurocognition and social cognition

"Cognitive impairment is a core symptom of schizophrenia",1 said Professor Silvana Galderisi, University of Campania Luigi Vanvitelli, Caserta, Italy," and impairs real-life functioning".2 The most important cognitive domains to consider when personalizing management of patients are neurocognition and social cognition.3

Cognitive impairment worsens real-life functioning in schizophrenia

"All patients with schizophrenia should therefore be screened for cognitive impairment and undergo a comprehensive assessment of cognitive functioning to develop a personalized care plan", added Professor Armida Mucci, University of Campania Luigi Vanvitelli, Caserta, Italy.

"Screening tools to assess neurocognition include the Brief Assessment of Cognition in Schizophrenia (BACS)4 and the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery",5 said Professor Armida. However, these tools should be complemented with tools to measure social cognition in terms of:

Neurocognition and social cognition are the most important cognitive domains to consider when personalizing patient management

  • Emotion processing – the ability to perceive and use emotions
  • Social perception – the ability to decode and interpret social cues in others
  • Theory of mind — the ability to represent the mental states of others including the inference of intentions or beliefs (also known as cognitive empathy)
  • Attributional style — the way in which an individual explains social events or interactions6

Cognition Assessment in Virtual Reality promises to improve assessment of cognition

"A new sensitive and valid tool for measuring real-life cognitive impairments is the Cognition Assessment in Virtual Reality (CAVIR", said Professor Merete Nordentoft, University of Copenhagen, Copenhagen, Denmark. This new tool assesses verbal memory, processing speed, attention, working memory and planning skills in an interactive virtual reality scenario,7 and the feasibility and efficacy of CAVIR using multiple real-life scenarios is being investigated by Professor Nordentoft and her colleagues.

 

Treatment of cognitive impairment in schizophrenia

Second-generation antipsychotics, exercise, and cognitive remediation can improve cognitive impairment in schizophrenia

Professor Antonio Vita, University of Brescia, Brescia, Italy, provided evidence for the effectiveness of a variety of interventions for improving cognitive impairment. These include:

  • Use of second-generation antipsychotics, which have a favorable cognitive profile compared with first-generation antipsychotics8
  • Integrating physical exercise, which has positive effects on cognition, into rehabilitation programs9
  • Cognitive remediation, which aims to improve cognitive processes through behavioral training-based interventions10

"Systematic reviews and meta-analyses demonstrate not only the efficacy of on cognitive remediation cognition and functioning10 but also a good acceptability profile",11 explained Professor Vita.

EPA : European Psychiatric Association
BACS : Brief Assessment of Cognition in Schizophrenia 
MATRICS : Measurement and Treatment Research to Improve Cognition in Schizophrenia  
CAVIR : Cognition Assessment in Virtual Reality 

BE-NOTPR-0194, approval date : 09.2022

 

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. Reichenberg A, Harvey PD. Neuropsychological impairments in schizophrenia: Integration of performance-based and brain imaging findings. Psychol Bull. 2007;133(5):833–58. Erratum in: Psychol Bull. 2008;134(3):382.
  2. Galderisi S, Rossi A, Rocca P, et al. Italian Network for Research on Psychoses. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry. 2014;13(3):275–87.
  3. Maj M, van Os J, De Hert M, Gaebel W, et al. The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry. 2021;20(1):4–33.
  4. Keefe RS, Goldberg TE, Harvey PD, et al. The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophr Res. 2004;68(2–3):283–97.
  5. Kern RS, Nuechterlein KH, Green MF, et al. The MATRICS Consensus Cognitive Battery, part 2: co-norming and standardization. Am J Psychiatry. 2008;165(2):214–20.
  6. Pinkham AE, Penn DL, Green MF, et al. The social cognition psychometric evaluation study: results of the expert survey and RAND panel. Schizophr Bull. 2014;40(4):813–23.
  7. Miskowiak KW, Jespersen AE, Kessing LV, et al. Cognition Assessment in Virtual Reality: Validity and feasibility of a novel virtual reality test for real-life cognitive functions in mood disorders and psychosis spectrum disorders. J Psychiatr Res. 2021;145:182–9.
  8. Baldez DP, Biazus TB, Rabelo-da-Ponte FD, et al. The effect of antipsychotics on the cognitive performance of individuals with psychotic disorders: network meta-analyses of randomized controlled trials. Neurosci Biobehav Rev. 2021;126:265–75.
  9. Firth J, Stubbs B, Rosenbaum S, et al. Aerobic exercise improves cognitive functioning in people with schizophrenia: A systematic review and meta-analysis. Schizophr Bull. 2017;43(3):546–56.
  10. Vita A, Barlati S, Ceraso A, et al. Effectiveness, core elements, and moderators of response of cognitive remediation for schizophrenia: A systematic review and meta-analysis of randomized clinical trials. JAMA Psychiatry. 2021;78(8):848–58.
  11. Vita A, Barlati S, Ceraso A, et al. Acceptability of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized controlled trials. Psychol Med. 2022:1–11. doi: 10.1017/S0033291722000319.
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