Non-pharmacological interventions in early schizophrenia: focus on cognitive remediation

Objectives There is a growing body of evidence suggesting that barriers to functional recovery are associated with a host of neurocognitive impairments in both the early and later course of schizophrenia. Given the significant influence of cognitive functions on daily functioning, several cognitive training approaches have been developed to improve cognitive deficits in schizophrenia. Increasing amounts of data suggest that cognitive remediation leads to improvements not only in cognition, but also in functional outcomes of schizophrenia. Some researchers speculate that deficits in cognition are more amenable to remediation during earlier phases of the illness, rather than when chronicity has developed. Despite the widely cited benefits of cognitive remediation in long-term course patients, fewer studies have examined the extent to which cognitive remediation has practical implications in the early stages of schizophrenia. The aim of this paper is to review the available literature on cognitive remediation in the prodromal phase and the early course of schizophrenia. Methods This review summarizes findings of cognitive changes induced in the early course and the prodromal phases of schizophrenia by different cognitive remediation approaches. Electronic searches were performed in the PubMed database, and all the studies published until January 2013 have been taken in account. Controlled studies of cognitive training are discussed in more detail. Results Few studies on the effects of cognitive training programs have been conducted in first episode or in early schizophrenia, and only three studies have been conducted in the prodromal phase of the disease or in subjects at risk for psychosis. The studies available support the usefulness of cognitive remediation when applied in the early course of schizophrenia and in subjects at risk for the disease. Conclusions Although preliminary positive results have been achieved, more empirical research is needed to confirm the efficacy of cognitive remediation in the early course of schizophrenia, and future studies should address the issue of the usefulness of cognitive remediation in the prodromal phases of schizophrenia or in subjects at risk for psychosis.