“Food for Thought”: Improving Cognition in People With Schizophrenia

Abstract

We have known that cognitive difficulties are related to functional outcomes in schizophrenia for many years. However, we have only paid attention to potential treatments relatively recently. This paper describes the development of cognitive remediation treatments to improve cognitive skills and their effects on functioning. It also reviews the types of cognitive remediation with some evidence on their effects. This evidence allowed the models of treatment to be clarified and led to a landmark paper by cognitive remediation experts around the world on the ingredients of cognitive remediation to have the best chance of benefit. This expert judgement on good clinical practice was justified by a large meta-analysis that supported the extra benefit of the four ingredients: an active therapist, massed practice of cognitive skills, the teaching of cognitive strategies and additional rehabilitation to transfer skills to real life. Although there is evidence of efficacy there is little implementation of cognitive remediation, so the review ends by suggesting a pathway to establish cognitive remediation into mental health services. The paper is a summary of a lecture given to the spring conference 2023 of the Korean Society of Schizophrenia Research. This review was also published in Psychiatric Investigation by agreement between the editors.