Effectiveness of dynamic cognitive intervention in rehabilitation of clients with schizophrenia

To examine the efficacy of dynamic cognitive treatment in rehabilitation of schizophrenic clients.

Fifty-eight schizophrenic clients that were matched equally into two groups: a study group (n = 29) (treated by Instrumental Enrichment) and a control group (treated with traditional occupational therapy methods).

The subjects were treated in a day rehabilitation centre in the community.

The programme lasted one year, the same schedule was provided for both groups. Subjects were randomly assigned and assessed before and after intervention with the same battery and at a follow-up six months later, work and residence status were evaluated.

Instruments included: (1) memory and thought processes, measured by a battery of structured tests from the Learning Potential Assessment Device (LPAD), Raven Progressive Matrices and General Aptitude Test Battery (GATB); (2) functional outcomes, instrumental activities of daily living (IADL), measured by a questionnaire; work and residence status; (3) self-concept measured with Fitts questionnaire.

Results showed significant differences between the groups on almost all the cognitive tests (MANOVA revealed significant differences between the two groups for both memory and thought process (F(2.52) = 13.75, p < 0.001; and F(1.46) = 7.28, p < 0.001, respectively) as well as in work (chi2 = 14.30, p < 0.001), and residence (chi2 = 3.86, p < 0.05) status. There were no significant differences in IADL questionnaire or the self-concept scale.

The successful outcome points to the importance of including long-term cognitive intervention in rehabilitation of schizophrenic clients. This work suggests that the classic view of schizophrenia as a progressive irreversible decline that cannot be altered may be wrong.