CET ‘feasible’ in schizophrenia patients with substance misuse

By Lynda Williams, Senior medwireNews Reporter

Patients with schizophrenia and comorbid substance abuse diagnoses are able to benefit from cognitive enhancement therapy (CET), preliminary research suggests.

For the study, 28 patients with schizophrenia or schizoaffective disorder alongside alcohol and/or cannabis addiction were randomly assigned to receive an 18-month CET programme (n=19) or usual care (n=9), report Shaun Eack (University of Pittsburgh, Pennsylvania, USA) and co-workers.

Just 53% of the CET patients completed the treatment programme, with three patients withdrawing consent, four ending treatment due to symptom instability, and one patient dropping out for poor attendance or heroin dependence each.

Nevertheless, patients who actively participated in CET rated their treatment as “very helpful”, the team reports in Schizophrenia Research.

Moreover, intent-to-treat efficacy analysis indicated that CET patients made “large and significant” gains in neurocognition and social-cognitive functioning compared with those given usual care. Social adjustment outcomes also favoured CET over usual care.

And although there was no significant difference in alcohol or drug abstinence between the treatment groups after 18 months, the CET group significantly reduced the number of days in the month they used alcohol compared with the preceding month by 67%. This compared with a reduction of just 25% for the usual care group.

“The results of this initial trial of CET for substance misusing patients with schizophrenia suggest that cognitive remediation can be feasibly applied to some people with the disorder who have at least moderately severe alcohol and/or cannabis use problems”, Eack et al write.

Suggesting that greater psychiatrist involvement to combat instability and pre-treatment motivational interviewing may improve patient engagement with CET in the future, they conclude: “Adequately-powered studies that employ active control interventions and assess cognitive mechanisms of substance use change are needed to extend the cognitive remediation evidence base to this significant and underserved population.”

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