Integrated cognitive remediation therapy prevents relapses in schizophrenia outpatients 8-year follow-up: final RCT results

Müller, Daniel; Steichen, Conny; Reymond, Annina R.; Roder, Volker (6 April 2018). Integrated cognitive remediation therapy prevents relapses in schizophrenia outpatients 8-year follow-up: final RCT results (Unpublished). In: 6th Biennial Schizophrenia International Research Society Conference (SIRS), Integrated prevention and treatment: shifting the way we think. Florence, Italy. April 4-8 2018.

Introduction
Relapses do not only add psychological burden to the individuals, their friends and families, but also are costly to the government and the health care system. Thus relapse prevention is a major concern and goes along with the primary goal of any treatment: remission of positive and also negative symptoms within functional recovery. The Remission in Schizophrenia Working Group (RSWG) defines remission as mild or less severe symptoms for a period of at least 6 months. Besides medication, relapse prevention became an important treatment goal for psychosocial intervention. Since years, study data support evidence for successful relapse prevention of psycho-educative and family therapy approaches, but little is known about any impact Cognitive Remediation Therapy (CRT) has.
Method
The purpose of this study was to investigate whether additional CRT could prevent relapses compared to treatment as usual (TAU). The CRT approach of choice was the Integrated Neurocognitive Therapy (INT) developed in our lab. INT is a group approach consisting of 4 modules including intervention on all neuro- and social cognitive domains defined by the MATRICS initiative as well as educational and stress reduction tasks. A total of 56 stabilized schizophrenia outpatients according to DSM-IV participated in the study and were randomly allocated to INT or TAU. Patients showed mild or no symptoms according to RSWG criteria in PANSS at study intake. A relapse was defined as an increase of symptoms in any of the RSGW areas for remission to a level of moderate or higher symptom severity. Assessments including e.g. PANSS, GAF and cognitive tests was administered before and after therapy (30 bi-weekly sessions) and at a 1-year follow-up.
Results
Highly significant results support evidence for relapse prevention of INT compared to TAU during therapy. This effect could be maintained during the 1-year follow-up period: 76% of the patients in the INT group and 46% in the TAU group did not relapse. This primary outcome was in line with significant improvements in negative symptoms, psychosocial functioning (GAF) and in the cognitive domains of speed, executive functioning and emotion processing at the follow-up favoring INT compared to TAU.
Conclusions
These data on INT intervention support evidence for an impact of CRT in relapse prevention. The further outcome results seems to be in accordance with empirical integrated models suggesting a mediation role of social cognition and negative symptoms between neurocognition and functional outcome. The successful INT intervention in negative symptoms and social cognition may help to improve the functional outcome and to prevent relapse.

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