Cognitive Remediation for Schizophrenia

The importance of treatment of cognitive impairments of people with schizophrenia has long been established. Among many pharmaceutical and non-pharmaceutical approaches, cognitive remediation offers one of the best promises for the rehabilitation of cognitive impairments of schizophrenia. The purpose of this paper is to introduce one such approach, the Neuropsychological Educational Approach to Remediation (NEAR). NEAR has been utilized as a leading treatment model for cognitive impairments of schizophrenia. Cognitive remediation including NEAR is administered within a framework of psychiatric rehabilitation program. Cognitive remediation is most effectively administered when the rehabilitation goals in the social and domain are clarified. Social functions associated with the cognitive impairments of schizophrenia are discussed in the specific categories of independent living skills, vocational skills and social problem-solving. Highlights of various models of cognitive remediation are presented to illustrate the unique features of NEAR. In the theoretical framework of NEAR, intrinsic motivation, personalization and contextualization are the central concepts, and the patients are regarded as learners aiming for independent living. In order to provide a clinical overview, specific treatment issues, staff training and patient characteristics are discussed. A summary of the NEAR outcome studies with a diverse psychiatric population is presented to demonstrate its effectiveness. Functional measures associated with cognitive impairments are presented to suggest directions for future studies.