title: Effects of olanzapine, quetiapine, and risperidone on neurocognitive function in early psychosis: a randomized, double-blind 52-week comparison. The Comparative Effects of Risperidone Long-Acting Injection and Paliperidone Palmitate on Social Functioning in Schizophrenia: A 6-Month, Open-Label, Randomized Controlled Pilot Trial Compensatory cognitive training for psychosis: who benefits? Who stays in treatment? Compensatory cognitive training for psychosis: effects in a randomized controlled trial. Computerized cognitive remediation training for schizophrenia: An open label, multi-site, multinational methodology study Pretreatment and longitudinal studies of neuropsychological deficits in antipsychotic-naı̈ve patients with schizophrenia The efficacy of supported employment for middle-aged and older people with schizophrenia
abstract: OBJECTIVE The authors sought to compare the effects of olanzapine , quetiapine , and risperidone on neurocognitive function in patients with early psychosis . METHOD In a 52-week double-blind , multicenter study , 400 patients early in the course of psychotic illness ( < 5 years ) were r and omly assigned to treatment with olanzapine ( 2.5 - 20 mg/day ) , quetiapine ( 100 - 800 mg/day ) , or risperidone ( 0.5 - 4 mg/day ) . The mean modal daily dose was 11.7 mg ( SD=5.3 ) for olanzapine , 506 mg ( SD=215 ) for quetiapine , and 2.4 mg ( SD=1.0 ) for risperidone . A total of 224 patients completed neurocognitive assessment s at baseline and at 12 weeks , and 81 patients also completed them at 52 weeks . Neurocognitive composite scores were calculated from the neurocognitive battery used in the Clinical Antipsychotic Trials of Intervention Effectiveness ( CATIE ) and from the Brief Assessment of Cognition in Schizophrenia . RESULTS At week 12 , there was significant improvement in neurocognition for each treatment ( p<0.01 ) , but no significant overall difference between treatments . Composite z score improvements on the CATIE neurocognitive battery were 0.17 for olanzapine , 0.33 for quetiapine , and 0.32 for risperidone .  Composite z score improvements on the Brief Assessment of Cognition in Schizophrenia were 0.19 for olanzapine , 0.34 for quetiapine , and 0.22 for risperidone . Statistically significant relationships between improvements in neurocognition and functional outcome were observed at weeks 12 and 52 . CONCLUSIONS Olanzapine , quetiapine , and risperidone all produced significant improvements in neurocognition in early-psychosis patients . Although cognitive improvements were modest , their clinical importance was suggested by relationships with improvements in functional outcome Purpose : The aim of this study was to compare the effects of risperidone long-acting injection ( RLAI ) and paliperidone palmitate ( PP ) on non-acute-phase social functioning in patients with schizophrenia . Patients and Methods : In this 6-month pilot , open-label , r and omized controlled study , 30 patients with schizophrenia who had been treated with RLAI were r and omly allocated to the RLAI continuation group or switched to the PP group . Patients were evaluated at baseline and 6 months with the Social Functioning Scale ( SFS ) as the primary outcome variable and University of California San Diego Performance-Based Skills Assessment Brief ( UPSA-B ) , Social Emotional Cognition Task ( SECT ) , Positive and Negative Syndrome Scale ( PANSS ) , and Drug-Induced Extrapyramidal Symptoms Scale ( DIEPSS ) scores as secondary outcomes . Results : At baseline , the two groups did not significantly differ in demographic or clinical features . The two groups did not differ in total score changes for the UPSA-B , the SECT , the PANSS , and the DIEPSS . However , the total scores and the two subscales of the SFS , i.e. independence-competence and independence-performance , were more improved in the PP group compared to the RLAI group ( total scores , p = 0.038 ; competence , p = 0.001 , and performance , p = 0.007 , respectively ) . Conclusion : These results suggest that PP may improve the total social functioning , independent life competence , and performance as compared to the RLAI group . However , these results are preliminary and need independent replication in larger sample s before any definitive statement can be made Enhancing cognitive performance to improve functioning in schizophrenia is a fundamental research priority . Previous investigations have demonstrated that various types of cognitive training ( CT ) can improve neuropsychological performance , psychosocial functioning , and psychiatric symptom severity . However , there is limited information about individual differences that may predict CT response and adherence to treatment . The purpose of this study was to identify who is likely to drop out of this type of study as well as this type of intervention and to explore individual factors predicting treatment outcome . Participants included 89 out patients diagnosed with a primary psychotic disorder who enrolled in a r and omized controlled trial of compensatory CT  and were assessed at baseline , 3 months ( posttest ) , and 6 months ( follow-up ) . Study completers had more formal education and lower daily doses of antipsychotic medications than did dropouts with no CT exposure , but the groups did not otherwise differ . There were no significant differences between participants who completed CT and those who began CT but later dropped out . CT-associated improvement was correlated with worse baseline scores on measures of cognitive performance , symptom severity , functional capacity , and self-rated quality of life , cognitive problems , and strategy use . These results suggest that those with lower baseline functioning may have more room to improve following CT . The pattern of correlations in this sample indicated that many types of individuals can improve with CT treatment , including older patients OBJECTIVE Treatments for the cognitive impairments of schizophrenia are urgently needed . We developed and tested a 12-week , group-based , manualized , compensatory cognitive training intervention targeting prospect i ve memory , attention , learning/memory , and executive functioning . The intervention focused on compensatory strategies , such as calendar use , self-talk , note taking , and a 6-step problem-solving method , and did not require computers . METHOD In a r and omized controlled trial , 69 out patients with DSM-IV primary psychotic disorders were assigned to receive st and ard pharmacotherapy alone or compensatory cognitive training + st and ard pharmacotherapy for 12 weeks . Assessment s of neuropsychological performance and functional capacity ( primary outcomes ) and psychiatric symptom severity , quality of life , social skills performance , cognitive insight , and self-reported everyday functioning ( secondary outcomes ) were administered at baseline , posttreatment , and 3-month follow-up . Data were collected between September 2003 and August 2009 . RESULTS Hierarchical linear modeling analyses demonstrated significant compensatory cognitive training-associated effects on attention at follow-up ( P = .049 ) , verbal memory at posttreatment and follow-up ( P values ≤ .039 ) , and functional capacity ( University of California , San Diego Performance-based Skills Assessment ) at follow-up ( P = .004 ) . The compensatory cognitive training group also differentially improved in negative symptom severity at posttreatment and follow-up ( P values ≤ .025 ) and subjective quality of life at follow-up ( P = .002 ) . CONCLUSIONS Compensatory cognitive training , a low-tech , brief intervention , has the potential to improve not only cognitive performance but also functional skills , negative symptoms , and self-rated quality of life in people with psychosis . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01521026 A recent single-site study ( Fisher et al. , 2009 . Am J Psychiatry . 166 ( 7 ) 805 - 11 ) showed that repeated training with the Brain Fitness Program ( BFP )  improved performance on a battery of neuropsychological tasks . If replicated these data suggest an important non-pharmacological method for ameliorating cognitive impairment in schizophrenia . Our study evaluated the BFP training effects in an open-label , multi-site , multinational clinical trial . Fifty-five stable adult patients with schizophrenia on regular antipsychotic medication completed ≥ 32 BFP training sessions over 8 - 10 weeks . Training effects on cognitive performance and functional capacity outcome measures were measured using CogState ® schizophrenia battery , UCSD Performance based Skills Assessment ( UPSA-2 ) and Cognitive Assessment Interview ( CAI )  . BFP training showed a large and significant treatment effect on a training exercise task ( auditory processing speed ) , however this effect did not generalize to improved performance on independent CogState ® assessment . There were no significant effects on UPSA-2 or CAI scores . Our study demonstrated the feasibility of implementing BFP training in a multi-site study . However , BFP training did not show significant treatment effects on cognitive performance or functional capacity outcome measures despite showing large and significant effects on a training exercise The early course of neuropsychological dysfunction in schizophrenia and the impact of treatment on these deficits need to be better specified . A sample of 45 patients with schizophrenia underwent five neuropsychological evaluations from prior to treatment with antipsychotic treatment through a 2-year follow-up period . A comparison sample of 33 matched healthy individuals underwent neuropsychological evaluations at similar time points . At baseline , a generalized deficit across cognitive domains was evident for the schizophrenia sample . After 6 weeks of treatment , patients showed modest improvements in visual memory and visual perception , but a decline in verbal memory . Verbal memory performance returned to baseline levels by the 6-month follow-up while deficits in other neuropsychological domains persisted throughout the 2-year period . Relatively static and generalized neuropsychological dysfunction , evident from illness onset , is consistent with neurodevelopmental rather than neurodegenerative models of schizophrenia OBJECTIVE Supported employment is the evidence -based treatment of choice for assisting individuals with severe mental illness to achieve competitive employment , but few supported employment programs specifically target older clients with psychiatric illness . The purpose of this study was to evaluate the efficacy of supported employment for middle-aged or older people with schizophrenia . METHOD Participants included 58 out patients with schizophrenia or schizoaffective disorder aged 45 or older who were recruited from a community mental health clinic . Participants were r and omly assigned to receive Individual Placement and Support ( IPS ; the manualized version of supported employment ) or conventional vocational rehabilitation ( CVR ) for one year , and completed assessment s at baseline , six months , and twelve months . RESULTS IPS was superior to CVR on nearly all work outcome measures , including attainment of competitive employment , weeks worked , and wages earned . Fifty-seven percent of IPS participants worked competitively , compared with 29 % of CVR participants ; 70 % of IPS participants obtained any paid work , compared with 36 % of CVR participants . Within the IPS group , better baseline functional capacity ( as measured by the UCSD Performance Based Skills Assessment ) and more recent employment were modestly associated with better work outcomes . CONCLUSIONS Middle-aged and older adults with schizophrenia are good c and i date s for supported employment services
target: Conclusion The SLOF was the most often used functional measure and had the strongest observed correlation with the UPSA .
  Although knowledge gaps remain , evidence from this review indicates that there is a quantitative relationship between functional capacity and real-world outcomes in individuals with schizophrenia
background: Objective To perform a systematic review of the published literature to evaluate how functional capacity , as measured by the University of California at San Diego ( UCSD ) Performance-based Skills Assessment ( UPSA ) , relates to other functional measures and real-world outcomes among individuals with schizophrenia .