The Feasibility and Effectiveness of Home-based Cognitive Remediation in Clinically Stable Schizophrenia Patients Attending a North Indian Tertiary Care Institution

Abstract

Background: Cognitive deficits are one of the core symptoms of Schizophrenia that compromises real-world functioning, adversely impacts rehabilitation, and negatively influence the quality of life. Studies evaluating interventions for cognitive remediation in Schizophrenia are scarce in India.  This study aimed to evaluate the effectiveness of the add-on home-based cognitive remediation strategy in schizophrenia in comparison to the schizophrenic patients receiving treatment as usual.  Methods: The research was carried out in a North Indian tertiary care teaching hospital. Clinically stable patients diagnosed with schizophrenia were randomly assigned to study and control groups. The control group had received treatment as usual, whereas the study group had received 8 weeks of home-based manual-based cognitive remediation in addition to the treatment as usual. Assessment of psychopathology, cognitive functioning, disability, and quality of life was done at baseline, completion at 8 weeks and 16 weeks follow up. Results: A total of 186 patients with schizophrenia were screened based on selection criteria. 74 patients were included in the study. During the intervention, 17 patients were dropped out, making the sample size of the study group to be 28 and the control group to be 29. At the baseline, the socio-demographic, as well as clinical variables, were comparable. After cognitive remediation intervention, the study group had better cognitive functioning, less disability, and better quality of life in comparison to the control group. The benefits were sustained in the study group at the end of two-month follow-up period. The effect size of home-based cognitive remediation was found to be moderate (Cohen’s d 0.4 to 0.69) at the end of the intervention. Conclusion: Home-based cognitive remediation is a feasible and effective strategy of intervention in patients with schizophrenia which has at least a short-lasting effect and it is also useful in limiting the disability and improving the quality of life.