SA25. Guanfacine Augmentation of Cognitive Remediation Therapy in the Schizophrenia Spectrum: Prospects for Improving Cognitive Performance and Functional Skills

摘要

>Background: Cognitive remediation therapy (CRT) has demonstrated efficacy for improving cognition in schizophrenia patients. Trials of agents designed to enhance cognition, on the other hand, have been largely negative in schizophrenia, although we have demonstrated substantial positive effects on cognition in the schizophrenia spectrum with guanfacine, an agent that enhances alpha-2 adrenergic activity. However, there have been no controlled trials of the effects of medications that specifically enhance cognition in the schizophrenia spectrum, in conjunction with CRT, to facilitate and consolidate the effectiveness of the remediation nor have there been examinations of the efficacy of CRT in the broader spectrum in participants with schizotypal personality disorder (SPD), a group with a similar pattern of cognitive and functional deficits, albeit less severe, to what is seen in schizophrenia but which is free of many potential confounds of schizophrenia samples. >Methods: We enrolled participants with SPD in an 8-week, randomized, double-blind, placebo-controlled trial of guanfacine paired with CRT consisting of 2 computerized training sessions and 2 social skills groups per week. All participants were administered the Matrics Clinical Consensus Battery (MCCB), assessing cognitive performance, and the UCSD Performance Based Skills Assessment (UPSA), assessing functional skills, both pre- and posttreatment. >Results: We conducted a series of repeated measures analyses of variance for each of our DVs with time (pre and post) and medication status (guanfacine and placebo) as our IVs. Overall, we found significant main effects for time on MCCB speed of processing, verbal learning, visual learning, and working memory as well as UPSA total score (all Ps > .05), suggesting that participants benefited from the intervention. In addition, there was a significant Time × Medication interaction for MCCB planning and organization and UPSA total score (Ps > .05), with individuals in our guanfacine group demonstrating greater improvement following treatment than those in our placebo group. There were no significant improvements on MCCM working memory or attention (Ps >.05). >Conclusion: Participants with SPD who were treated with CRT plus guanfacine demonstrated statistically significant improvements in reasoning and problem-solving and in their functional skills, suggesting that guanfacine may be an appropriate agent to augment CRT in the schizophrenia spectrum.