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Cognitive Interventions for
Schizophrenia: Compensatory
and Restorative Approaches
Sean Kidd, Ph.D.
CAMH Schizophrenia Division
University of Toronto Department of Psychiatry
December 1st, 2014
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Funders and Collaborators

Dawn Velligan and Natalie Maples – University
of Texas at San Antonio
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Jaswant Kaur – George Brown College
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Rohan Ganguli, Tony George, Yarissa Herman,
Kwame McKenzie, Gursharan Virdee
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*There are no competing interests in the work presented
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presentation overview: a tale
of two approaches
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What is promising
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What is problematic
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What is next
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some general background
 Tools
are available for addressing
positive symptoms (delusions,
hallucinations).
 But,
we have little to offer for cognitive
impacts and negative symptoms
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cognitive impacts
 Attention
 Memory
 Problem
 Social
Solving
Cognition
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what to do about it?
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1. enhance
 Practice
cognitive tasks
A
variable literature (types of tasks,
adjunct intervention)
 Linking
to “real world” contexts and
challenges important
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people working in CR
research
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Susan McGurk – Boston U
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Til Wykes – London Institute of Psychiatry
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Matthew Kurtz - Yale
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Bruce Wexler – Yale
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Chris Bowie – Queen’s U
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Alice Medalia - Columbia
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cognitive remediation – the
evidence





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Psychosis symptoms (highly variable,
.28 avg)
Neurocognition (.41)
Psychosocial functioning (.35)
Gains are sustained
Benefit over comparable tasks
Little link between outcome and
intervention duration
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an example – George Brown
College
 Built
into academic curriculum
 Group
and individual computer
exercises
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matching with McGurk
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the pilot – summer 2010
 People
like it!
 Turned
up and stayed
 Improved
Kidd, S.A., Kaur Bajwa, J., Haji-Khamneh, B., McKenzie, K., & Ganguli, R.
(2012). Cognitive Remediation for Individuals with Psychosis in a
Supported Education Setting: A Pilot Study. Journal of Rehabilitation
Research and Practice, 2012, 1-5.
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the rct
 Same
intervention model
 Randomized
 19
in term 1
to CR+SE, 18 to SE
 Cognitive
battery, PANSS, Self Esteem,
academic functioning
 Baseline,
up
term 1 end, term 2 end follow
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rct findings
 Again
people liked it, only 1 person
dropped out
 Cognition
improved for both groups,
but no improvement for CR
 PANSS
 Self
– no change for either group
Esteem (.44) sustained at f/u
 Academic:
More term 1 completers
(.74), at f/u better contributions, attitude
etc. (.64-.75)
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challenges and what comes
next
 Bang
for the buck
and seeing evidence
through the hype
 Dismantling
 Better
screening
 Better
bridging and
focus
 Considering
setting
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Compensatory Approaches
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Compensatory Approaches
 Some
overlap, but emphasize:
Compensatory strategy rather than
improving function
 Home and non-treatment/education
contexts

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cognitive adaptation
training (CAT) - described
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Focus primarily on medication taking and
basic functional domains
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Builds from assessment
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Intensive – typically 9 months
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2. adapt - cognitive
adaptation training
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cat – the evidence
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Compared to control conditions, clients
receiving CAT
 Psychosis Symptoms (mostly ns)
 Lower relapse rates (65% versus 19%
over 19 months)
 Higher levels of adaptive functioning
(1.00)
 Most consistently, better medication
adherence (approx 1.00)
 Not for everyone
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the revision
9
months
 Intensive
CAT 4 months, with 5 months
case manager follow up
 Eval
– baseline, 4 months, 9 months
 Symptoms
(BPRS, NSA), functioning
MCAS, SOFAS, GAS
N
= 23
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the outcomes
 It
worked, people liked it
 Symptoms:
BPRS .41 - .24; NSA .33 - .33
 Functioning:
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the challenges
 Bedbugs
 Time
and travel
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next steps
 Family
CAT
 Inpatient
CAT
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where do we go from here?
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considering...
 Sequencing/staging
in care pathways
approaches
 Better
screening and providing
individualized care
 Linkages:
CBT, CBSST, MBCT/SR,
Supported Voc and Ed, family
intervention, concurrent disorders tx
 The
tool is as only good as the person
using it – common factors and fidelity
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a decent summary paper
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McGurk, S.R., Mueser, K.T., Covell, N.H., Cicerone,
K.D., Drake, R.E., Silverstein, S.M., Medalia, A.,
Myers, R., Bellack, A.S., Bell, M.D., Essock, S. M.,
2013. Mental health system funding of cognitive
enhancement interventions for schizophrenia:
Summary and update of the New York Office of
Mental Health Expert Panel and Stakeholder
Meeting. Psychiat Rehab J. 36 133-145.