Schizophrenia Plus and Minus: Cognitive course nudges patients into workforce

Two approaches to treating schizophrenia, a severe mental disorder that affects an estimated 1 in 100 adults worldwide, receive contrasting evaluations in new studies.

On the disappointing side, patients with schizophrenia who took any of five highly touted antipsychotic drugs for 1 year experienced only modest gains in holding down jobs, sustaining friendships, and otherwise functioning well in daily life. These drugs, the second generation of such medications, achieved no better results in improving patients’ quality of life than an older antipsychotic medication did.

On the encouraging side, people with schizophrenia who had completed a computerized training program in cognitive skills as part of a vocational program worked more and made more money over the next 2 to 3 years than did patients in the same program who received no cognitive training.

These results underscore the need for studies of various drugs in combination with psychological and social interventions for schizophrenia, remarks psychiatrist John Lauriello of the University of New Mexico in Albuquerque. “Improving quality of life does not come prepackaged in a medication bottle,” he says.

Both new reports appear in the March American Journal of Psychiatry.

In the first study, a team led by psychiatrist Marvin S. Swartz of Duke University School of Medicine in Durham, N.C., tracked 455 patients with schizophrenia who took randomly assigned antipsychotic medications for 1 year. They also received a mix of rehabilitation and vocational services. As part of a larger study (SN: 9/24/05, p. 195: Available to subscribers at Meds Alert: Old schizophrenia drug stands up to new ones), the patients had been recruited at facilities throughout the United States.

No matter which drug a participant took, after a year he or she still displayed severe impairments. Participants who scored lowest on a quality-of-life measure at the start of the study reported the most gains.

The second study, directed by psychologist Susan R. McGurk of Dartmouth Medical School in Hanover, N.H., focused on 44 people with schizophrenia or related psychotic disorders who were enrolled in either of two employment programs at mental-health clinics in New York City. Of those patients, 38 were taking an antipsychotic medication.

For 2 to 3 years, all the participants met with an employment specialist who assisted them in finding and keeping jobs. Twenty-three of the study participants were randomly assigned to receive computer-based cognitive training in 24 roughly hour-long sessions. That training lasted for about 3 months and included practice on mental tasks that demanded attention, concentration, memory, reasoning, and fast responses.

Depression and social isolation declined after the cognitive training. The employment rate for those who completed cognitive training fluctuated but peaked at 40 percent, compared with a peak of 13 percent for patients in the regular employment programs. Still, cognitive-training graduates worked an average of only 6 months during the 2-to-3-year follow-up.

It’s not clear whether the apparent benefits of cognitive training stemmed from increased hopefulness, self-esteem, or other positive effects of receiving trainers’ attention, comments Boston University psychologist Courtenay Harding. She recommends that researchers also examine training programs tailored to specific cognitive impairments, which vary among people with schizophrenia.