Cognitive enhancement in the early phases of psychosis

Abstract

Major psychoses, including schizophrenia (SKZ), bipolar disorder (BD), and major depression (MD) with psychotic features, include the continuity of positive symptoms ranging from mild to severe. Literature suggests that cognitive deficits and brain changes, associated with long duration of illness, are markers of vulnerability of psychoses, with important consequences on day-to-day functioning and quality of life. Working memory, attention, executive functions, and theory of mind are the most altered cognitive domains in psychosis. Based on such evidence, neurocognition may be considered a main focus of treatment, in particular at the onset of psychosis. We have defined a cognitive intervention program for young psychotic patients (aged 18-40) in which a computerized cognitive training (CR), associated with social skills training or mindfulness groups, integrates medical/ physical treatment. Here we present the case of a 25-year-old single male patient with a diagnosis of SKZ and cognitive deficits. The patient was asked to complete pre- and post-group assessment to allow formal evaluation of the treatment program, as well as neurocognitive testing. After the engagement in this intervention (CR associated with mindfulness), a reduction of psychological stress and improved social functioning were obtained. With regard to neurocognition, we observed an enhancement of executive functions (in particular working memory, planning capacity, and decisionmaking abilities) and increased performances on ecological tests, showing the actual impact of the integrated CR on patients' life.