BACKGROUND: It has been suggested that the effect of cognitive remediation (CR) on functioning is mediated by the improvement in neurocognitive domains; especially executive function. However, the correlations are generally moderate and this has prompted the search for other mediators including negative symptoms (NS).
AIMS: To investigate whether the effect of CR on functioning could be mediated by executive function and/or NS.
METHOD: In a previous study, 62 outpatients with schizophrenia were randomized to 32 group sessions of REPYFLEC CR or leisure activities. Functioning (Life Skills Profile; LSP), NS (PANSS) and executive function (Behavioral Assessment of the Dysexecutive Syndrome; BADS) were measured at baseline and post-therapy. To assess how the effect of REPYFLEC CR is expressed in functioning at post-treatment, an autoregressive mediation model was employed.
RESULTS: There was a significant effect of the REPYFLEC CR compared with the control group in improving BADS total score and PANSS NS. There was also a significant association between NS and functioning while executive function was not significantly related to functioning. Finally, there was a significant intervention effect on functioning mediated by NS but not by executive function.
CONCLUSION: It is apparent that improving executive function does not lead directly to improved functional outcome and that NS might be closely linked to functioning in the context of our study.
