Antipsychotic treatment adherence, cognitive remediation boost brain function in schizophrenia

In the initial period of schizophrenia, consistent adherence to long-acting antipsychotic medication may enhance the effects of cognitive remediation (CR) and produce significant improvements in core cognitive deficits and work/school performance, according to the results of a trial.

“The impact of medication adherence on cognition has not been as systematically examined in the period after the first episode [of psychosis], particularly in the context of CR,” the investigators said.

The present data confirm that the beneficial effects of consistent adherence to long-acting antipsychotic medication extend to cognition and work/school outcome in first-episode patients, they added.

A total of 60 patients (mean age, 21.7 years; 77 percent male) with a recent first episode of schizophrenia participated in the trial. They were randomly assigned to one of the following treatment groups: CR with long-acting injectable (LAI) risperidone (n=12), CR with oral risperidone (n=17), Healthy Behaviors Training (HBT) with LAI risperidone (n=17), and HBT with oral risperidone (n=14) for 12 months.

CR involved programmes focused on basic cognitive processes (eg, processing speed, attention, memory, problem solving) as well as more complex, life-like situations. HBT, on the other hand, aimed at improving lifestyle habits and wellbeing through education and engagement. All patients were provided supported employment/education to encourage return to work or school.

After 12 months of treatment, both antipsychotic medication adherence and CR contributed to cognitive improvement, which was measured using the MATRICS Consensus Cognitive Battery (MCCB) overall composite T score for cognition. [Psych Med 2020;doi:10.1017/S0033291720003335]

“The impact of medication adherence on cognition was clearest in the first 6 months after randomization when a continuous index of medication adherence was used,” the investigators noted.

CR yielded greater effects than HBT in the groups that received LAI but not oral risperidone. This points to the synergistic impact of LAI antipsychotic medication and cognitive training, the investigators added. CR also proved superior in an analysis that adjusted for medication adherence and protocol completion.

Likewise, both LAI antipsychotic medication and CR yielded significantly greater improvement in work/school functioning. The positive changes in cognition and work/school function were strongly correlated.

“It would be useful for future research to evaluate the impact of [the combination of medication adherence and CR] on functional recovery,” according to the investigators.