IJSP-2010(3-4) - Indian Association For Social Psychiatry

have also demonstrated that people with mental illness who
have cognitive deficits are more likely to be unemployed or
have a lower occupational status even when they have no
active symptoms. Thus, cognitive dysfunction is increasingly
being recognized as a major contributor to the adaptive
impairment seen in most patients with schizophrenia.
McGurk et al (2000) found a significant correlation between
cognitive tasks, verbal learning, memory and adaptive skills,
negative symptoms, at follow-up also but positive symptoms
were not correlated with impaired adaptive skills. These results
were consistent with the finding of Harvey et al (1999) who
found that instrumental and social skills deficits were more
strongly correlated with cognitive impairments than with the
severity of under-controlled behaviour. Each of the cognitive
measures was correlated with global social-adaptive deficits,
with minimal variation in the magnitude of correlations. Harvey
et al (1998) also revealed that cognitive functioning and
adaptive functioning both declined over the follow-up period,
whereas there was no change in schizophrenic symptoms.
Changes in cognitive functioning accounted for 25% of the
variance in adaptive decline, whereas the baseline severity
of cognitive impairment and schizophrenia symptoms were
not correlated with adaptive decline. These data indicate that
cognitive decline may predict deterioration in overall functional
status and imply that treatment of cognitive impairment might
have a beneficial effect on global functional status. Great deal
of research is carried on to remediate such cognitive deficits.
Pharmacological intervention in itself is not yet successful in
ameliorating impaired cognition in schizophrenia (Harvey &
Keefe, 2001; Keefe et al, 2006). Cognitive rehabilitation in
turn has been found effective in remediating such cognitive
deficits (Silverstein et al, 2005; Lewis et al, 2003). The
mechanism of cognitive improvement resulting from cognitive
rehabilitation is not well understood. However, one
randomized controlled study has shown dorsolateral prefrontal
cortical activity changes following cognitive remediation
therapy in patients with schizophrenia of at least two years
duration (Wykes et al, 2002). After reviewing the current
literature regarding the effectiveness of cognitive rehabilitation
Kanchan et al
and its association with independent living skill, the need was
realized to cognitively rehabilitate the patients with
schizophrenia and to bring out all round improvement in them
and thus the present study was targeted to remediate attention
and memory of patients with schizophrenia and to evaluate
the effect of remediation on social functioning and daily living
skills.
MATERIALS AND METHODS
Sample Characteristics: Based on the purposive sampling
technique, five chronic patients diagnosed as schizophrenia
according to ICD-10 DCR criteria, who were falling in the age
range of 30-40 years and who were cooperative and educated
up to secondary level, were selected from different wards of
Ranchi Institute of Neuropsychiatry and Allied Sciences
(RINPAS), Ranchi. Informed consent of the patients was taken
prior to the intervention. Patients with any co-morbid psychiatric
illness, who were left handed, who had active psychopathology
or those having a history of alcohol or substance dependence,
head injury, seizures, hearing and visual impairment or severe
physical illness in near past were excluded from the study.
Appropriate ethical approval was obtained from the
participants in the study.
Design: A single group pretest and posttest research design
was used for the present study. All five participants were
grouped in one and they were tested on all the essential tests
before the intervention. Subsequently they were given
rehabilitation training for more than two months followed by a
post-test assessment of all the same tests which were
administered in the pre-test design.
Tools for Pre-Test & Post-Test Assessment of the Patients
Tools Used for Screening the Patients: A proforma designed
for the study was used to collect socio-demographic and
clinical data. Brief Psychiatric Rating Scale (BPRS, Overall &
Gorham, 1962) was administered to rule out any active positive
symptoms i.e., delusions and hallucinations in the patients,
participants with score of three and below were chosen for
© 2010 Indian Association for Social Psychiatry 125