Effects of cognitive remediation therapy and computerized cognitive remediation therapy on cognitive deficits in patients with schizophrenia: a randomized controlled study

Objective To explore the effects of cognitive remediation therapy (CRT) and computerized cognitive remediation therapy ( CCRT ) on cognitive deficits in patients with schizophrenia. Methods A total of 180 chronic inpatients with schizophrenia in stable clinical condition was randomized divided into three groups: CCRT, CRT and Work and Amusement Therapy (WAT). In addition to medication as usual, and under directions of therapists, patients in CCRT group received computerized cognitive remediation therapy (CCRT) which developed by this research team, CRT group received a Chinese version of manual cognitive remediation therapy derived from Neurocognitive Remediation Manual which revised by Til, Wykes, WAT group received operative musical therapy and dancing training. All of the three types of therapy lasted 3 months with 4 sessions per week, 45 minutes per session. A series of assessment were administrated pre-and post-treatment and 3-month follow up, including clinical symptoms using the PANSS scales and cognitive functions using a Chinese cognitive function test battery of schizophrenia and Wisconsin card sorting test ( WCST ). Results A total of 108 ones was recruited in CCRT group, 36 in CRT group, and 36 in WAT group. There were no significant difference among three groups in age ( 46.4 ±8.9,47.5 ±8. 1,45.8 ± 8.3) ,years of education(10. 0 ±2.5,10.4 ±2.7,10. 1 ±2.6),duration of disease (years) (22. 1 ±10. 2, 23.8 ± 10. 2, 20.9 ± 10.5) ,total score of PANSS (60. 4 ±12.5,61.3 ± 11.7, 62.8 ± 14. 1 ) or any index of cognitive measurement at baseline. After a three-month treatment, comparing with WAT group, significant improvements revealed in categories of WCST test (F=4. 16,P=0. 017),trail A (F=4.25,P = 0. 016), spatial span(F=5.40,P=0. 005),symbol coding ( F = 3.09, P = 0. 048 ) both in CCRT and CRT groups. A significant advantage ( P ＜ 0. 05 ) appeared in spatial span in CCRT group comparing to CRT. However, CRT had an advantage in symbol coding than CCRT(P ＜0.05). At a three-month follow up point, comparing with posttreatment, there was a nonsignificant(F = 1.69, P = 0. 15 )improvement of categories of WCST both in CCRT and CRT. However, a significant improvement of spatial span appeared in CCRT as comparing to CRT and WAT ( F = 2. 79,P = 0. 03 ). There was no significant change of clinical symptoms neither at posttreatment nor at follow up among three groups. Conclusion Both CCRT and CRT can significantly improve cognitive functions of patients with schizophrenia, especially in memory, execute function and psychomotor speed. In generally,the effects on cognitive improvement of CCRT and CRT are similar. However, CCRT have an advantage on spatial memory than CRT. And the effects on psychomotor speed improvement of CRT are superior to CCRT. The effects on execute function, memory, psychomotor speed of CCRT and CRT can maintain three months at least. Key words: Schizophrenia;  Cognitive therapy;  Computers;  Cognition