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Cognitive remediation in large systems of psychiatric care

  • Alice Medalia (a1) (a2), Alice M. Saperstein (a1) (a2), Matthew D. Erlich (a1) (a2) (a3) and Lloyd I. Sederer (a2) (a3) (a4)

Abstract

Introduction

With the increasing enthusiasm to provide cognitive remediation (CR) as an evidence-based practice, questions arise as to what is involved in implementing CR in a large system of care. This article describes the first statewide implementation of CR in the USA, with the goal of documenting the implementation issues that care providers are likely to face when bringing CR services to their patients.

Methods

In 2014, the New York State Office of Mental Health set up a Cognitive Health Service that could be implemented throughout the state-operated system of care. This service was intended to broadly address cognitive health, to assure that the cognitive deficits commonly associated with psychiatric illnesses are recognized and addressed, and that cognitive health is embedded in the vocabulary of wellness. It involved creating a mechanism to train staff to recognize how cognitive health could be prioritized in treatment planning as well as implementing CR in state-operated adult outpatient psychiatry clinics.

Results

By 2017, CR was available at clinics serving people with serious mental illness in 13 of 16 adult Psychiatric Centers, located in rural and urban settings throughout New York state. The embedded quality assurance program evaluation tools indicated that CR was acceptable, sustainable, and effective.

Conclusions

Cognitive remediation can be feasibly implemented in large systems of care that provide a multilevel system of supports, a training program that educates broadly about cognitive health and specifically about the delivery of CR, and embedded, ongoing program evaluation that is linked to staff supervision.

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Copyright

Corresponding author

*Address for correspondence: Alice Medalia, Ph.D., 710 West 168 Street 12th floor, New York, NY 10032, USA. (Email: alice.medalia@columbia.edu)

Footnotes

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We are grateful to the many individuals in OMH central office and at the Psychiatric Centers who facilitated this project. The CR2PR initiative is funded by the New York State Office of Mental Health. The Pibly Fund provided partial support for data analysis and manuscript preparation.

Footnotes

References

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1. Nuechterlein, KH, Barch, DM, Gold, JM, Goldberg, TE, Green, MF, Heaton, RK. Identification of separable cognitive factors in schizophrenia. Schizophr Res. 2004; 72(1): 2939.
2. Bowie, CR, Harvey, PD. Cognition in schizophrenia: impairments, determinants, and functional importance. Psychiatr Clin North Am. 2005; 28(3): 613633.
3. Keefe, RS, Harvey, PD. Cognitive impairment in schizophrenia. Handb Exp Pharmacol. 2012; 213: 1137.
4. Bowie, CR, Leung, WW, Reichenberg, A, et al. Predicting schizophrenia patients’ real-world behavior with specific neuropsychological and functional capacity measures. Biol Psychiatry. 2008; 63(5): 505511.
5. Green, MF. Impact of cognitive and social cognitive impairment on functional outcomes in patients with schizophrenia. J Clin Psychiatry. 2016; 77(Suppl 2): 811.
6. Harvey, PD, Sabbag, S, Prestia, D, Durand, D, Twamley, EW, Patterson, TL. Functional milestones and clinician ratings of everyday functioning in people with schizophrenia: overlap between milestones and specificity of ratings. J Psychiatr Res. 2012; 46(12): 15461552.
7. Kurtz, MM. Neurocognition as a predictor of response to evidence-based psychosocial interventions in schizophrenia: what is the state of the evidence? Clin Psychol Rev. 2011; 31(4): 663672.
8. Spaulding, WD, Fleming, SK, Reed, D, Sullivan, M, Storzbach, D, Lam, M. Cognitive functioning in schizophrenia: implications for psychiatric rehabilitation. Schizophr Bull. 1999; 25(2): 275289.
9. Wykes, T, Reeder, C. Cognitive Remediation Therapy for Schizophrenia: Theory and Practice. London: Taylor & Francis; 2005.
10. Patel, A, Knapp, M, Romeo, R, et al. Cognitive remediation therapy in schizophrenia: cost-effectiveness analysis. Schizophr Res. 2010; 120(1–3): 217224.
11. Fiszdon, JM, Bryson, GJ, Wexler, BE, Bell, MD. Durability of cognitive remediation training in schizophrenia: performance on two memory tasks at 6-month and 12-month follow-up. Psychiatry Res. 2004; 125(1): 17.
12. Krabbendam, L, Aleman, A. Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled studies. Psychopharmacology. 2003; 169(3–4): 376382.
13. Kurtz, MM, Moberg, PJ, Gur, RC, Gur, RE. Approaches to cognitive remediation of neuropsychological deficits in schizophrenia: a review and meta-analysis. Neuropsychol Rev. 2001; 11(4): 197210.
14. McGurk, SR, Twamley, EW, Sitzer, DI, McHugo, GJ, Mueser, KT. A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry. 2007; 164(12): 17911802.
15. Wykes, T, Huddy, V, Cellard, C, McGurk, SR, Czobor, P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry. 011 2; 168(5): 472485.
16. Wykes, T, Reeder, C, Williams, C, Corner, J, Rice, C, Everitt, B. Are the effects of cognitive remediation therapy (CRT) durable? Results from an exploratory trial in schizophrenia. Schizophr Res. 2003; 61(2–3): 163174.
17. Garrido, G, Barrios, M, Penadés, R, et al. Computer-assisted cognitive remediation therapy: cognition, self-esteem and quality of life in schizophrenia. Schizophr Res. 2013; 150(2–3): 563569.
18. Bell, MD, Choi, KH, Dyer, C, Wexler, BE. Benefits of cognitive remediation and supported employment for schizophrenia patients with poor community functioning. Psychiatr Serv. 2014; 65(4): 469475.
19. Bell, MD, Zito, W, Greig, T, Wexler, BE. Neurocognitive enhancement therapy with vocational services: work outcomes at two-year follow-up. Schizophr Res. 2008; 105(1–3): 1829.
20. Bowie, CR, McGurk, SR, Mausbach, B, Patterson, TL, Harvey, PD. Combined cognitive remediation and functional skills training for schizophrenia: effects on cognition, functional competence, and real-world behavior. Am J Psychiatry. 2012; 169(7): 710718.
21. Chan, JY, Hirai, HW, Tsoi, KK. Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials. J Psychiatr Res. 2015; 68: 293300.
22. Hodge, MA, Siciliano, D, Withey, P, et al. A randomized controlled trial of cognitive remediation in schizophrenia. Schizophr Bull. 2010; 36(2): 419427.
23. Breitborde, NJ, Bell, EK, Dawley, D, et al. The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service. BMC Psychiatry. 2015; 15: 266.
24. Lewandowsk, KE. Cognitive remediation for the treatment of cognitive dysfunction in the early course of psychosis. Harv Rev Psychiatry. 2016; 24(2): 164172.
25. Revell, ER, Neill, JC, Harte, M, Khan, Z, Drake, RJ. A systematic review and meta-analysis of cognitive remediation in early schizophrenia. Schizophr Res. 2015; 168(1–2): 213222.
26. Bowie, CR, Gupta, M, Holshausen, K. Cognitive remediation therapy for mood disorders: rationale, early evidence, and future directions. Can J Psychiatry. 2013; 58(6): 319325.
27. Contreras, NA, Lee, S, Tan, EJ, Castle, DJ, Rossell, SL. How is cognitive remediation training perceived by people with schizophrenia? A qualitative study examining personal experiences. J Ment Health. 2016; 25(3): 260266.
28. Medalia, A, Herlands, T, Saperstein, A, Revheim, N. Cognitive Remediation for Psychological Disorders. New York: Oxford University Press; 2017.
29. Cella, M, Reeder, C, Wykes, T. Group cognitive remediation for schizophrenia: exploring the role of therapist support and metacognition. Psychol Psychother Theory Res Pract. 2016; 89(1): 114.
30. Reeder, C, Pile, V, Crawford, P, et al. The feasibility and acceptability to service users of CIRCuiTS, a computerized cognitive remediation therapy programme for schizophrenia. Behav Cogn Psychother. 2016; 44(3): 288305.
31. Biagianti, B, Fisher, M, Howard, L, Rowlands, A, Vinogradov, S, Woolley, J. Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets. Schizophr Res Cogn. 2017; 10: 714.
32. Medalia, A, Erlich, M. Why cognitive health matters. Am J Public Health. 2017; 107(1): 4547.
33. Medalia, A, Saperstein, AM. Does cognitive remediation for schizophrenia improve functional outcomes? Curr Opin Psychiatry. 2013; 26(2): 151157.
34. Foussias, G, Remington, G. Negative symptoms in schizophrenia: avolition and Occam’s razor. Schizophr Bull. 2010; 36(2): 359369.
35. Strauss, GP, Horan, WP, Kirkpatrick, B, et al. Deconstructing negative symptoms of schizophrenia: avolition-apathy and diminished expression clusters predict clinical presentation and functional outcome. J Psychiatr Res. 2013; 47(6): 783790.
36. Medalia, A, Saperstein, A. The role of motivation for treatment success. Schizophr Bull. 2011; 37(Suppl 2): S122S128.
37. Saperstein, AM, Medalia, A. The role of motivation in cognitive remediation for people with schizophrenia. Curr Top Behav Neurosci. 2016; 27: 533546.
38. Amado, I, Sederer, LI. Implementing cognitive remediation programs in France: the “secret sauce”. Psychiatr Serv. 2016; 67(7): 707709.
39. Keefe, RS, Goldberg, TE, Harvey, PD, Gold, JM, Poe, MP, Coughenour, L. The brief assessment of cognition in schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophr Res. 2004; 68(2–3): 283297.
40. Nuechterlein, KH, Green, MF, Kern, RS, et al. The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability, and validity. Am J Psychiatry. 2008; 165(2): 203213.
41. Corrigan, PW, Lickey, SE, Campion, J, Rashid, F. Mental health team leadership and consumers satisfaction and quality of life. Psychiatr Serv. 2000; 51(6): 781785.
42. Goodman, D, Ogrinc, G, Davies, L, et al. Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature. BMJ Qual Saf. 2016; 25(12): e7.
43. Medalia, A, Erlich, MD, Soumet-Leman, C, Saperstein, AM. Translating cognitive behavioral interventions from bench to bedside: the feasibility and acceptability of cognitive remediation in research as compared to clinical settings. Schizophr Res. Jul 30. pii: S0920-9964(17)30455-3. doi: 10.1016/j.schres.2017.07.044.
44. Soumet-Lehman, C, Erlich, M, Medalia, A. Acceptability and perceived effectiveness of cognitive remediation in real-world clinical practice. Psychiatr Serv. 2018; 69(4): 493494.

Keywords

Cognitive remediation in large systems of psychiatric care

  • Alice Medalia (a1) (a2), Alice M. Saperstein (a1) (a2), Matthew D. Erlich (a1) (a2) (a3) and Lloyd I. Sederer (a2) (a3) (a4)

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