Planning and problem-solving training for patients with schizophrenia: a randomized controlled trial

Katlehn Rodewald, Mirjam Rentrop, Daniel V Holt, Daniela Roesch-Ely, Matthias Backenstrass, Joachim Funke, Matthias Weisbrod, Stefan Kaiser, Katlehn Rodewald, Mirjam Rentrop, Daniel V Holt, Daniela Roesch-Ely, Matthias Backenstrass, Joachim Funke, Matthias Weisbrod, Stefan Kaiser

Abstract

Background: The purpose of this study was to assess whether planning and problem-solving training is more effective in improving functional capacity in patients with schizophrenia than a training program addressing basic cognitive functions.

Methods: Eighty-nine patients with schizophrenia were randomly assigned either to a computer assisted training of planning and problem-solving or a training of basic cognition. Outcome variables included planning and problem-solving ability as well as functional capacity, which represents a proxy measure for functional outcome.

Results: Planning and problem-solving training improved one measure of planning and problem-solving more strongly than basic cognition training, while two other measures of planning did not show a differential effect. Participants in both groups improved over time in functional capacity. There was no differential effect of the interventions on functional capacity.

Conclusion: A differential effect of targeting specific cognitive functions on functional capacity could not be established. Small differences on cognitive outcome variables indicate a potential for differential effects. This will have to be addressed in further research including longer treatment programs and other settings.

Trial registration: ClinicalTrials.gov NCT00507988.

Figures

Figure 1
Figure 1
Plan-a-Day interface.
Figure 2
Figure 2
CONSORT study flow chart.

References

    1. Green MF, Kern RS, Heaton RK. Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophr Res. 2004;72(1):41–51. doi: 10.1016/j.schres.2004.09.009.
    1. Bowie CR, Reichenberg A, Patterson TL, Heaton RK, Harvey PD. Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. Am J Psychiatry. 2006;163(3):418–425. doi: 10.1176/appi.ajp.163.3.418.
    1. Medalia A, Choi J. Cognitive remediation in schizophrenia. Neuropsychol Rev. 2009;19(3):353–364. doi: 10.1007/s11065-009-9097-y.
    1. McGurk SR, Twamley EW, Sitzer DI, McHugo GJ, Mueser KT. A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry. 2007;164(12):1791–1802. doi: 10.1176/appi.ajp.2007.07060906.
    1. Bell M, Bryson G, Greig T, Corcoran C, Wexler BE. Neurocognitive enhancement therapy with work therapy: effects on neuropsychological test performance. Arch Gen Psychiatry. 2001;58(8):763–768. doi: 10.1001/archpsyc.58.8.763.
    1. Cavallaro R, Anselmetti S, Poletti S, Bechi M, Ermoli E, Cocchi F, Stratta P, Vita A, Rossi A, Smeraldi E. Computer-aided neurocognitive remediation as an enhancing strategy for schizophrenia rehabilitation. Psychiatry Res. 2009;169(3):191–196. doi: 10.1016/j.psychres.2008.06.027.
    1. McGurk SR, Mueser KT, Pascaris A. Cognitive training and supported employment for persons with severe mental illness: one-year results from a randomized controlled trial. Schizophr Bull. 2005;31(4):898–909. doi: 10.1093/schbul/sbi037.
    1. Vauth R, Corrigan PW, Clauss M, Dietl M, Dreher-Rudolph M, Stieglitz RD, Vater R. Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation. Schizophr Bull. 2005;31(1):55–66. doi: 10.1093/schbul/sbi013.
    1. Goldberg TE, Weinberger DR, Berman KF, Pliskin NH, Podd MH. Further evidence for dementia of the prefrontal type in schizophrenia? A controlled study of teaching the Wisconsin Card Sorting Test. Arch Gen Psychiatry. 1987;44(11):1008–1014.
    1. Benedict RH, Harris AE, Markow T, McCormick JA, Nuechterlein KH, Asarnow RF. Effects of attention training on information processing in schizophrenia. Schizophr Bull. 1994;20(3):537–546.
    1. Hogarty GE, Flesher S, Ulrich R, Carter M, Greenwald D, Pogue-Geile M, Kechavan M, Cooley S, DiBarry AL, Garrett A, Parepally H, Zoretich R. Cognitive enhancement therapy for schizophrenia. Effects of a 2-year randomized trial on cognition and behavior. Arch Gen Psychiatry. 2004;61(9):866–876. doi: 10.1001/archpsyc.61.9.866.
    1. Krabbendam L, Aleman A. Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled studies. Psychopharmacology (Berl) 2003;169(3-4):376–382. doi: 10.1007/s00213-002-1326-5.
    1. Green MF, Nuechterlein KH, Kern RS, Baade LE, Fenton WS, Gold JM, Keefe RS, Mesholam-Gately R, Seidman LJ, Stover E, Marder SR. Functional co-primary measures for clinical trials in schizophrenia: results from the MATRICS Psychometric and Standardization Study. Am J Psychiatry. 2008;165(2):221–228. doi: 10.1176/appi.ajp.2007.07010089.
    1. McGurk SR, Mueser KT, DeRosa TJ, Wolfe R. Work, recovery, and comorbidity in schizophrenia: a randomized controlled trial of cognitive remediation. Schizophr Bull. 2009;35(2):319–335. doi: 10.1093/schbul/sbn182.
    1. Dickinson D, Wendy T, Morris S, Brwon C, Peer J, Spencer K, Li L, Gold JM, Bellack AS. A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenie. Am J Psychiatry. 2010;167:170–180. doi: 10.1176/appi.ajp.2009.09020264.
    1. Wykes T, Huddy V. Cognitive remediation for schizophrenia: it is even more complicated. Curr Opin Psychiatry. 2009;22(2):161–167. doi: 10.1097/YCO.0b013e328322fbf4.
    1. Wagner BR. The Training of Attending and Abstracting Responses in Chronic Schizophrenics. J Exper Res Personality. 1968;3:77–88.
    1. Bellack AS, Weinhardt LS, Gold JM, Gearon JS. Generalization of training effects in schizophrenia. Schizophr Res. 2001;48(2-3):255–262. doi: 10.1016/S0920-9964(00)00066-9.
    1. Meichenbaum DH, Cameron R. Training schizophrenics to talk to themselves: A means of developing attentional controls. Behav Ther. 1973;4:515–534. doi: 10.1016/S0005-7894(73)80003-6.
    1. Young DA, Freyslinger MG. Scaffolded instruction and the remediation of Wisconsin Card Sorting Test deficits in chronic schizophrenia. Schizophr Res. 1995;16(3):199–207. doi: 10.1016/0920-9964(94)00074-I.
    1. Penades R, Catalan R, Puig O, Masana G, Pujol N, Navarro V, Guarch J, Gasto C. Executive function needs to be targeted to improve social functioning with Cognitive Remediation Therapy (CRT) in schizophrenia. Psychiatry Res. 2010;177(1-2):41–45. doi: 10.1016/j.psychres.2009.01.032.
    1. Reeder C, Smedley N, Butt K, Bogner D, Wykes T. Cognitive predictors of social functioning improvements following cognitive remediation for schizophrenia. Schizophr Bull. 2006;32(Suppl 1):S123–131.
    1. Burgess PW, Alderman N, Forbes C, Costello A, Coates LM, Dawson DR, Anderson ND, Gilbert SJ, Dumontheil I, Channon S. The case for the development and use of "ecologically valid" measures of executive function in experimental and clinical neuropsychology. J Int Neuropsychol Soc. 2006;12(2):194–209.
    1. Evans JJ, Chua SE, McKenna PJ, Wilson BA. Assessment of the dysexecutive syndrome in schizophrenia. Psychol Med. 1997;27(3):635–646. doi: 10.1017/S0033291797004790.
    1. Aubin G, Stip E, Gelinas I, Rainville C, Chapparo C. Daily activities, cognition and community functioning in persons with schizophrenia. Schizophr Res. 2009;107(2-3):313–318. doi: 10.1016/j.schres.2008.08.002.
    1. Holt DV, Rodewald K, Rentrop M, Funke J, Weisbrod M, Kaiser S. The Plan-a-Day Approach to Measuring Planning Ability in Patients with Schizophrenia. J Int Neuropsychol Soc. 2011;17(2):327–335. doi: 10.1017/S1355617710001712.
    1. Seter C, Giovannetti T, Kessler RK, Worth S. Everyday action planning in schizophrenia. Neuropsychological Rehabilitation. 2011;21(2):224–249. doi: 10.1080/09602011.2010.544519.
    1. Medalia A, Revheim N, Casey M. The remediation of problem-solving skills in schizophrenia. Schizophr Bull. 2001;27(2):259–267.
    1. Medalia A, Revheim N, Casey M. Remediation of memory disorders in schizophrenia. Psychol Med. 2000;30(6):1451–1459. doi: 10.1017/S0033291799002913.
    1. Ward G, Morris R. In: The cognitive psychology of planning. Ward G,Morris R, editor. Hove: Psychology Press; 2005. Introduction to the psychology of planning.
    1. Funke J, Krüger T, Fritz A. Plan-a-Day: Konzeption eines modifizierbaren Instruments zur Führungskräfte-Auswahl sowie erste empirische Befunde. [Plan-a-Day. Development of a modifiable instrument for manager assessment and empirical findings.] Bonn: Deutscher Psychologen Verlag; 1995.
    1. Heinrichs RW, Zakzanis KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology. 1998;12(3):426–445.
    1. Mesholam-Gately RI, Giuliano AJ, Goff KP, Faraone SV, Seidman LJ. Neurocognition in first-episode schizophrenia: a meta-analytic review. Neuropsychology. 2009;23(3):315–336.
    1. Ackenheil M, Stotz G, Dietz-Bauer R, Vossen A. M.I.N.I. Mini Internationales Neuropsychiatrisches Interview. German Version 5.0.0, DSM-IV & ICD-10. München: Psychiatrische Universitätsklinik; 1998.
    1. Kohler J, Beck U. Planungstest. Konstanz: Beck & Kohler; 2004.
    1. Shallice T. Specific impairments of planning. Philos Trans R Soc Lond B Biol Sci. 1982;298(1089):199–209. doi: 10.1098/rstb.1982.0082.
    1. Wilson BA, Aldermann N, Burgess PW, Emslie HC, Evans JJ. The Behavioural Assessment of the Dysexecutive Syndrome. Flempton: Thames Valley Test Company; 1996.
    1. Ufer K. BADS - Behavioural Assessment of the Dysexecutive Syndrome. Göttingen: Hogrefe; 2000.
    1. Wiedl KH, Uhlhorn S. Osnabrücker Arbeitsfähigkeitenprofil (O-AFP) Göttingen: Hogrefe; 2006.
    1. Bolton B, Roessler R. Manual for the work personality profile. Fayetteville: University of Arkansas; 1986.
    1. Wiedl KH, Uhlhorn S, Jons K. Das Osnabrücker Arbeitsfähigkeitenprofil (O-AFP) für psychiatrisch erkrankte Personen: Konzept, Entwicklung und Erprobung bei schizophrenen Patienten. Rehabilitation (Stuttg) 2004;43(6):368–374.
    1. Von Aster M, Neubauer A, Horn R. Wechsler-Intelligenztest für Erwachsene (WIE) Frankfurt: Harcourt Test Services; 2006.
    1. Schellig D. Corsi-Block-Tapping-Test. Mödling: Schuhfried; 1993.
    1. Reitan RM. Trail Making Test: Manual for administration and scoring. Tucson: Reitan Neuropsychology Laboratory; 1992.
    1. Markela-Lerenc J, Kaiser S, Fiedler P, Weisbrod M, Mundt C. Stroop performance in depressive patients: a preliminary report. J Affect Disord. 2006;94(1-3):261–267. doi: 10.1016/j.jad.2006.04.011.
    1. Lehrl S. Mehrfachwahl-Wortschatz-Intelligenztest MWT-B. Balingen: Spitta Verlag; 2005.
    1. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261–276.
    1. Rheinberg F, Vollmeyer R, Burns BD. FAM: Ein Fragebogen zur Erfassung aktueller Motivation in Lern- und Leistungssituationen. Diagnostica. 2001;47:57–66. doi: 10.1026//0012-1924.47.2.57.
    1. Galderisi S, Piegari G, Mucci A, Acerra A, Luciano L, Rabasca AF, Santucci F, Valente A, Volpe M, Mastantuono P, Maj M. Social skills and neurocognitive individualized training in schizophrenia: comparison with structured leisure activities. Eur Arch Psychiatry Clin Neurosci. 2010;260(4):305–315. doi: 10.1007/s00406-009-0078-1.
    1. Kohler JA, Poser U, Schönle W. Die Verwendung von Plan-a-Day für die neuropsychologische Diagnostik und Therapie. Bonn: Deutscher Psychologen Verlag; 1995.
    1. Nemoto T, Yamazawa R, Kobayashi H, Fujita N, Chino B, Fujii C, Kashima H, Rassovsky Y, Green MF, Mizuno M. Cognitive training for divergent thinking in schizophrenia: a pilot study. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33(8):1533–1536. doi: 10.1016/j.pnpbp.2009.08.015.
    1. Vita A, De Peri L, Barlati S, Cacciani P, Cisima M, Deste G, Cesana BM, Sacchetti E. Psychopathologic, neuropsychological and functional outcome measures during cognitive rehabilitation in schizophrenia: A prospective controlled study in a real-world setting. Eur Psychiatry. 2010. in press .
    1. Watzke S, Galvao A, Gawlik B, Huehne M, Brieger P. Change in work performance in vocational rehabilitation for people with severe mental illness: distinct responder groups. Int J Soc Psychiatry. 2006;52(4):309–323. doi: 10.1177/0020764006065141.
    1. Bell M, Fiszdon J, Greig T, Wexler B, Bryson G. Neurocognitive enhancement therapy with work therapy in schizophrenia: 6-month follow-up of neuropsychological performance. J Rehabil Res Dev. 2007;44(5):761–770. doi: 10.1682/JRRD.2007.02.0032.
    1. Goldberg TE, Goldman RS, Burdick KE, Malhotra AK, Lencz T, Patel RC, Woerner MG, Schooler NR, Kane JM, Robinson DG. Cognitive improvement after treatment with second-generation antipsychotic medications in first-episode schizophrenia: is it a practice effect? Arch Gen Psychiatry. 2007;64(10):1115–1122. doi: 10.1001/archpsyc.64.10.1115.
    1. Twamley EW, Jeste DV, Bellack AS. A review of cognitive training in schizophrenia. Schizophr Bull. 2003;29(2):359–382.
    1. Wykes T, Reeder C, Corner J, Williams C, Everitt B. The effects of neurocognitive remediation on executive processing in patients with schizophrenia. Schizophr Bull. 1999;25(2):291–307.
    1. Ojeda N, Pena J, Sanchez P, Elizagarate E, Ezcurra J. Processing speed mediates the relationship between verbal memory, verbal fluency, and functional outcome in chronic schizophrenia. Schizophr Res. 2008;101(1-3):225–233. doi: 10.1016/j.schres.2007.12.483.

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