T46. THE EFFECT OF COMPREHENSIVE COGNITIVE REMEDIATION IN INDIVIDUALS AT ULTRA-HIGH RISK FOR PSYCHOSIS: A SINGLE-BLIND, RANDOMISED, CLINICAL TRIAL (FOCUS)

Background Individuals at ultra-high risk (UHR) for psychosis display significant cognitive deficits that constitute a barrier to functional recovery. Applying cognitive remediation (CR) before the onset of manifest psychosis may improve cognition and the clinical and functional prognosis of UHR individuals. Methods This randomised, clinical trial randomly assigned 146 UHR individuals aged 18–40 years to treatment as usual (TAU) or TAU plus cognitive remediation. The cognitive remediation consisted of 20-weeks of neurocognitive and social cognitive remediation. Assessments were carried out at 6- and 12-months post baseline. Primary outcome was composite score on the Brief Assessment of Cognition in Schizophrenia (BACS) battery at 6-months. Results Between April 2014 and January 2017, 73 UHR individuals were assigned to TAU and 73 were assigned to TAU + cognitive remediation. Compared to the control group, cognitive remediation did not result in significant improvement on the BACS composite score at 6-month follow-up (b=-0.125, 95%CI: -0.23 to 0.172, p=0.41). Nor did the intervention improve secondary outcomes in clinical symptoms or functioning. Exploratory analyses found emotion recognition latencies to be significantly more reduced in the intervention group than the TAU group at 6-months follow-up. At 12-month follow-up the intervention group exhibited significantly better performance on two exploratory outcomes of executive function and visual memory. The participants in the intervention group attended an average of 12 sessions out of 20. No adverse events were reported relating to the intervention. Discussion While the brief course of treatment did not impact global cognition, symptoms and functioning measures, treatment related benefit was found in exploratory component neuro- and social cognitive measures. Future studies should evaluate whether more personalized interventions such as the separate application of neurocognitive and social cognitive remediation may produce beneficial effect on cognition and functioning compared to treatment as usual, along with establishing the optimal number of training hours to produce cognitive and functional gains.

Improving social function with real-world social-cognitive remediation in schizophrenia: Results from the RemedRugby quasi-experimental trial

Background. Functional capacity (FC) has been identified as a key outcome to improve real-world functioning in schizophrenia. FC is influenced by cognitive impairments, negative symptoms, self-stigma and reduced physical activity (PA). Psychosocial interventions targeting FC are still under-developed. Methods. we conducted a quasi-experimental study evaluating the effects of an exercise-enriched integrated social cognitive remediation (SCR) intervention (RemedRugby [RR]) compared with an active control group practicing Touch Rugby (TR). To our knowledge, this is the first trial to date evaluating the effectiveness of such a program provided in a real-life environment. Results. Eighty-seven people with schizophrenia were included and allocated to either the RR group (n = 57) or the TR group (n = 30) according to the routine clinical practice of the recruiting center. Outcomes were evaluated at baseline and post-treatment in both groups and after 6 months of follow-up in the RR group using standardized scales for symptom severity, social functioning, self-stigma, and a large cognitive battery. After treatment we observed moderate to large improvements in social function (Personal and Social Performance Scale [PSP], p < 0.001, d = 1.255), symptom severity (Positive and Negative Syndrome Scale [PANSS] negative, p < 0.001, d = 0.827; PANSS GP, p < 0.001, d = 0.991; PANSS positive, p = 0.009, d = 0.594), verbal abstraction (p = 0.008, d = 0.554), aggression bias (p = 0.008, d = 0.627), and self-stigma (stereotype endorsement, p = 0.019, d = 0.495; discrimination experiences, p = 0.047; d = 0.389) that were specific to the RR group and were not observed in participants playing only TR. Effects were persistent over time and even larger between post-treatment and follow-up. Conclusions. Exercise-enriched integrated SCR appears promising to improve real-life functioning in schizophrenia. Future research should investigate the potential effects of this intervention on neuroplasticity and physical fitness.

FC16-05 - Efficacy of social cognitive remediation in schizophrenia patients: a meta-analysis including 22 RCTS

IntroductionToday there is an increased interest from clinicians and researchers in social cognition as a treatment objective for schizophrenia patients.ObjectivesDuring the last years, several new Social Cognitive Remediation (SCR) approaches were developed. SCR directly intervene in individual or multiple social cognitive domains declared by the NIMH-MATRICES-Initiative. Some of these approaches integrate social cognitive interventions with therapeutic components intended to ameliorate neurocognitive and social skills or with work rehabilitation.AimsUntil today no quantitative review to evaluate the efficacy of SCR has been presented.Methods22 randomized-controlled trials (RCTs) were identified and included in a meta-analysis. Based on the outcome variables from each study, effect sizes (ES) between SCR and control groups were calculated.ResultsOver an average length of more than 20 weeks a significant global therapy effect of SCR compared to controls was evident (average ES of all conducted variables). Significant effects were found in the proximal outcome addressing social cognition and specifically in the domains of emotional processes, social perception and ToM. Additionally, the neurocognitive area showed significant evidence of amelioration compared with the control groups. More distal effects were found for psychopathology and social functioning. The global therapy effect could be maintained during a mean follow-up period of 10 months. The setting, the type of control groups and the type of intervention in the experimental group were identified as moderators.ConclusionsThe results support strong empirical evidence that SCR has a broad effect on various areas of functioning and symptoms relevant in schizophrenia.