Cognitive remediation in schizophrenia: efficacy and effectiveness in patients with early versus long-term course of illness

Aim: We examined the efficacy and effectiveness (transfer to functional competence and everyday functioning) of cognitive remediation in early-course (within 5 years of first episode) and long-term (more than 15 years of illness) schizophrenia. Methods: Treatment lasted 12 weeks and included computerized exercises, strategic monitoring and methods to transfer cognition to behaviour. Assessments included a standard battery of neurocognition, performance-based measures of social and adaptive competence, and case manager ratings of real-world functional behaviour. Changes from baseline to post-treatment were examined with repeated measures analysis of variance and estimated premorbid intelligence and total months in hospital as covariates. Results: The early-course group had larger improvements in measures of processing speed and executive functions, as well as larger improvements in adaptive competence and real-world work skills. Duration of illness was inversely associated with improvement in neurocognition and real-world work skills. Conclusions: Treatment of cognitive impairments is feasible in both early-course and chronic schizophrenia, but the clinical meaningfulness and generalization to functioning appear to be more substantial when delivered early. Cognitive remediation should be considered a tool for early intervention in schizophrenia.