Schizophrenia is a severe and disabling mental health condition that exacts considerable burden on the individuals who live with the disorder, their family members, and society. Impairments in social and non- social cognition are leading contributors to disability in schizophrenia, and while these deficits are currently untreated by antipsychotic medication, evidence has supported the efficacy of psychosocial cognitive rehabilitation interventions in treating cognitive impairments in the disorder. The early application of these treatments soon after individuals develop the illness has shown particular promise for producing cognitive and functional improvements that stand to alter the long-term trajectory of schizophrenia by preventing chronic disability and capitalizing on early neuroplasticity reserves. Cognitive Enhancement Therapy (CET) is one such approach to cognitive rehabilitation that uniquely targets deficits in neurocognitive and social-cognitive function, and has been shown to lead to considerable improvements in social and vocational functioning, and to exert a neuroprotective effect against gray matter loss, when applied early in schizophrenia. Despite the promise of early intervention with cognitive rehabilitation, no evidence is available on the long-term durability of its effects in either chronic or early course schizophrenia patients, and thus the ability of cognitive rehabilitation treatments, such as CET, to alter the neurobiologic and functional trajectory of the illness is not known. This project proposes to conduct a 10-year follow-up study of the 58 patients who participated in a randomized- controlled trial of CET for early course schizophrenia, in order to provide evidence on the potential long-term benefits of early intervention with cognitive rehabilitation in the disorder. Early course participants in this trial were randomized to CET or an active Enriched Supportive Therapy (EST) and treated for up to two years, with annual cognitive, functional outcome, and neuroimaging assessments. Individuals are now approaching 10- years since completing this trial, and many have remained in the Pittsburgh area and connected with known treatment systems, providing the unique opportunity to examine the long-term impact of CET on the disorder. All available patients who were randomized and received some exposure to their psychosocial treatment condition will be recruited back for this study. Comprehensive cognitive and behavioral data will be collected on neuropsychological function, social cognition, psychopathology, and functional outcome to examine the durability of the previously observed benefits of CET in this sample of early course patients with schizophrenia. In addition, structural neuroimaging assessments will be conducted to examine whether the neuroprotective effects of CET compared to EST found at the end of active treatment have been maintained. Together, this project will provide the first comprehensive evidence of the long-term durability of early cognitive rehabilitation in schizophrenia, and will generate critical information on the ability of CET to alter the long-term disability trajectory of the illness, which could have a profound impact on patients with schizophrenia and society.
This project proposes to conduct the first comprehensive study of the long-term benefits of cognitive rehabilitation when applied in the early course of schizophrenia. The information gathered from this project is of significant public health relevance, in that it will provide information on the potential of cognitive rehabilitation to alte the disability and neurobiologic trajectories of the disorder. Such information is critical to understanding the best approaches to schizophrenia treatment, and will help policymakers decided where to invest scarce public resources to reduce the public health burden of schizophrenia.
