Cognitive Training and Remediation in First-Episode Psychosis: A Literature Review

BACKGROUND: Neurocognitive and social cognitive impairments are core characteristics of psychotic disorders, which are present in the first episode of psychosis (FEP) and strongly predict poor social functioning. Addressing cognitive impairments through cognitive training and remediation (CTR) may be a crucial component of recovery-oriented treatment. AIMS: The objectives of this review were to (1) evaluate the CTR theoretical basis and intervention components and (2) examine the effects of CTR on cognition and social functioning in FEP. METHOD: A combined search of Ovid Medline, Embase, and Psych Info databases was conducted using keywords. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quality and risk of bias were assessed using established instruments. RESULTS: Ten randomized controlled trials were included in this review and had an overall fair to poor quality. CTR interventions in FEP utilize a range of theoretical backgrounds, with most including a focus on higher order cognitive processes. Varied doses and intervention components are used. All but one study found improvements in at least one cognitive domain. Global cognition, verbal learning, and memory and executive function were most commonly improved. Three studies found an effect on a range of functional outcomes. CONCLUSIONS: A broad range of CTR interventions have promising effects for addressing cognitive impairments in FEP. Evidence of functional impact is less consistent. Further research is needed in FEP on CTR targeting sensory and perceptual processes, and to identify CTR intervention targets and treatment components that will lead to robust improvements in cognition and functioning.