Computerised cognitive remediation therapy in cognitive improvement and psychosocial functioning in first episode psychosis outpatients in Kuala Lumpur and Selangor, Malaysia

Psychosis is one of the most prominent symptoms of mental illness. It has a tremendous devastating impact not only on the lives of persons with the disorder, but also society as a whole. Early identification and intensive treatment has been the focus of treatment for people with first episode psychosis (FEP). Cognitive remediation is an evidence-based behavioural intervention aiming to improve cognitive functioning and psychosocial functioning with a proven efficacy and durability over time. This study aimed to validate the instrument of the Brief Assessment on Cognition in Schizophrenia – Malay version (BACS-M) and evaluate the effectiveness of the computerised cognitive remediation therapy in improving cognitive and psychosial functioning in patients with first episode psychosis. This research was conducted in two phases. Phase 1 of this study was performed to test the reliability and validity of the BACS-M. Data were collected from 26 outpatients with schizophrenia who had given written informed consent. Tests included in BACS-M were as follow; verbal fluency, verbal memory list learning, token motor test, symbol coding, digit sequencing task, and Tower of London. Meanwhile, Phase 2 of this study were to investigates the effectiveness of computerized cognitive remediation therapy for FEP in Malaysia by comparing patients receiving 10 individual sessions of CCRT (n=34) and being on Wellness Programme (active comparator) (n= 20). Participants in the intervention group were patients from the Psychiatric Clinic of Universiti Putra Malaysia (UPM) and the session of CCRT were conducted at the Hospital Kajang. The control group participants were outpatients from the Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre and received eight sessions of Wellness Program. The mixed between-within subject ANOVA was used to compare mean difference of the BACS-M score between the CCRT and WL groups at baseline, post-test (week 10) and 3 month of follow-up (week 22). Both groups were given identical assessment which were BACS-M, PSP and PANSS at baseline, post-treatment and three month follow up. The mean duration of completion for the BACS-M was 39.27 min (S.D. = 9.03 min). The BACS-M showed high test-retest reliability (ICC = 0.89) and the BACS-M composite score was significantly correlated with all primary measures of the BACS-consecutive assessments. A series of repeated measures of ANOVA yielded no significant difference in the cognitive scores as measured by BACS-M, however the scores of all the cognitive domains were better much improved across over time in baseline, post-treatment and three months follow-up. There was a slight improvement in psychosocial functioning in the WL group than in the CCRT group. Small sample size, intensity of treatment and changes in mental health during the course of the study may have impacted the results.

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