Predictors of gains in social functioning after cognitive remediation in schizophrenia: Results from the multicenter ISST (Integrated Social Cognition and Social Skills Therapy) trial.

内容摘要

Cognitive remediation therapy (CRT) is an evidence-based behavioral intervention that enhances functional outcomes in schizophrenia patients by improving cognition. However, not all patients benefit equally from CRT, and predictors of real-world functional improvement are poorly understood. This study aimed to identify patient-related baseline predictors of functional improvement by evaluating two distinct CRT approaches targeting different types of cognition: social cognition (Integrated Social Cognition and Social Skills Training, ISST) and neurocognition (Neurocognitive Remediation Therapy, NCRT). This secondary analysis used data from a large, multicenter randomized controlled trial. Participants with schizophrenia (N = 174) were randomly assigned to ISST or NCRT for six months. Multiple linear regression analyses were performed to determine whether baseline demographic, cognitive, clinical, or functional characteristics predicted changes in real-world functioning, as measured by the Social and Occupational Functioning Assessment Scale. The Digit Symbol Substitution Test was the strongest and most consistent predictor of functional improvement. Lower baseline functioning also predicted greater gains, although only in multivariable models. Domain-specific predictors were identified for each intervention: better affect recognition predicted better outcomes in ISST, whereas verbal memory did so in NCRT. The CRT approaches studied here appear to be most effective for individuals with a more preserved baseline level of cognitive performance, especially in terms of processing speed. These findings support the use of brief cognitive assessments to guide CRT implementation and suggest that tailoring interventions to individual cognitive profiles may enhance treatment efficacy.