REHACOP arrests negative schizophrenia symptoms
medwireNews: A course of neuropsychologic rehabilitation - the REHACOP program - improves negative symptoms in patients with schizophrenia, which in turn relieves functional disability, shows a randomized, controlled trial.
Negative symptoms have a large impact on schizophrenia patients, but respond poorly to current medications. Study author Natalia Ojeda (University of Deusto, Avda, Spain) and colleagues say that cognitive impairment caused by schizophrenia "imposes discouraging life experiences on patients," causing them to develop negative expectations and "defeatist beliefs."
They believe the success of the study intervention may be down to its inclusion of positive feedback, and training to transfer the learned skills to the patients' daily lives.
"Patients may feel themselves to be more capable of overcoming daily problems caused by cognitive impairments," they write in Schizophrenia Bulletin. "As a result, patients may be more encouraged to take part in activities that they tended to avoid previously, improving negative symptomatology."
The 38 patients who participated in the REHACOP program attended 90-minute group sessions at least three times a week. The 48 patients in the control group attended an equivalent number of group sessions during which they did activities such as drawing, crafts, and reading the news.
All patients received standard treatment in addition, so over 3 months of treatment both groups had significant improvements in clinical symptoms. However, patients participating in REHACOP had significantly larger improvements in negative symptoms than those in the control group, with scores for negative symptoms on the Positive and Negative Syndrome Scale falling from 27.23 to 21.91 versus 24.85 to 22.84.
As anticipated, neuropsychologic rehabilitation significantly improved cognitive functioning, but did not improve positive symptoms, excitement, or insight. However, "unexpectedly," it significantly improved disorganization and emotional distress symptoms, relative to the changes in controls.
"Group support, positive feedback, the involvement of family members in the patients' treatment, and the improvements in other areas may account for these positive results in emotional distress," Ojeda et al suggest.
These clinical changes contributed to changes in functional outcomes, but whereas negative symptom improvements were associated with improvements in Global Assessment of Functioning (GAF) scores in both groups, improved cognition was associated with improvements in GAF scores in the REHACOP group only.
Functional outcomes significantly improved in both groups but again improvements were significantly larger in the REHACOP than the control group, in both GAF and the World Health Organization Disability Assessment Schedule (DAS WHO) - specifically in the social competence, vocational outcome, and family contact DAS WHO domains.
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By Eleanor McDermid, Senior medwireNews Reporter