Executive functions rehabilitation for schizophrenia: A critical systematic review

• Published in: Journal of psychiatric research 2013-01, Vol.47 (1), p.91-104
• Main Authors: Kluwe-Schiavon, B, Sanvicente-Vieira, B, Kristensen, C.H, Grassi-Oliveira, R
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Biological and medical sciences; Cognitive skills training; Executive function; Executive Function - physiology; Executive functions; Humans; Interventions; Medical sciences; Neuropsychology; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Psychotherapy; Randomized controlled trials; Randomized Controlled Trials as Topic - trends; Rehabilitation; Schizophrenia; Schizophrenia - rehabilitation; Schizophrenic Psychology; Working memory
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/j.jpsychires.2012.10.001

Abstract Background Consistent evidences suggest that poor functional outcomes in schizophrenia are associated with deficits in executive functions (EF). As result cognitive training, remediation and/or rehabilitation (CR) programs have been developed and many theories, methods and approaches have emerged in support of them. This article presents a systematic review of randomized controlled trials (RCT), including EF rehabilitation interventions, with a focus on methodological issues and evidences of EF improvements. Method Eletronic databases (Medline, Web of Science, PsycINFO and Embase) were searched for articles on schizophrenia, EF and cognitive rehabilitation terms. The methodological quality of each article was measured by 5-point JADAD scale. Results A total of 184 articles were initially identified, but after exclusion criteria, 30 RCT remained in this review. A proportion of 23% of studies scored higher than 4 points in JADAD scale, 40% scored 3 points, 33% scored 2 points and one study scored only 1 point. The average length of interventions was approximately 80 h distributed around 3.42 h/week. Conclusion The reviewed articles corroborate the literature pointing that CR could be a promising therapeutic option for cognitive deficits in schizophrenia. In general, CR could improve cognitive domains and social adjustment either using computerized or paper-and-pencil programs. Additionally, CR combined with cognitive behavioral therapy and/or group sessions is particularly effective. In this paper, we also speculated and discussed optimal doses of treatment and the differences regarding modalities and approaches.