Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Cognitive remediation for schizophrenia: it is even more complicated Til Wykes and Vyv Huddy Introduction The development of cognitive rehabilitation for schizo- phrenia, although only a recent addition to the thera- peutic armamentarium, has recently seen an increase in the number of studies suggesting success both in the improvement of cognition and in the effects on function- ing. Although there has not been wide acclaim for these efforts [1], studies have produced data that can be used to develop an understanding of the relationships between cognition and outcome. The concentration of efforts to improve cognition is vital as our patients complain of the interference these produce on their quality of life; however, another reason was the assumed link between cognitive data and long-term func- tional outcome which has been supported by a number of early studies [2,3]. The link between community out- comes and cognitive rehabilitation [4,5] also provides a strong foundation for therapeutic optimism that compre- hensive rehabilitation programmes can achieve further community integration and sense of recovery. There is a lot more that we need to know about cognitive remediation and we thought that this brief review of the recent publications would shed some light on where we should be putting our efforts in the future. Although we conclude that it has all become much more compli- cated, we also show how we might capitalize on this complexity to provide a guide for future developments in the area. Do cognitive deficits change or do they need to be forced to change? For many years there has been a recognition that cogni- tive deficits are present both before the onset of the disorder [6,7] as well as throughout the course of the disorder in many people who develop schizophrenia. In the last year, a large meta-analysis of 2476 people Department of Psychology, Institute of Psychiatry, King’s College London, London, UK Correspondence to Til Wykes, Department of Psychology, PO box 77, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK E-mail: t.wykes@iop.kcl.ac.uk Current Opinion in Psychiatry 2009, 22:161–167 Purpose of review Attempts to remediate the cognitive difficulties of people with a diagnosis of schizophrenia have shown efficacy; however, existing treatment studies display huge variation, frustrating efforts to determine how best to apply this treatment tool. This review summarizes findings of induced cognitive change in schizophrenia, with reference to the remediation method, the presence of accompanying treatment(s), how cognitive change generalizes and its value. Recent findings Although there is strong evidence that cognitive change can be induced in schizophrenia, there is little evidence for the superiority of any treatment approach. Furthermore, remediation is most effective when in combination with other treatments, such as vocational training. Cognitive rehabilitation can be cost-effective and is valued by patients. A number of studies show generalization of positive outcomes beyond cognitive variables, with more focused treatment associated with less generalization. Summary Induced cognitive change does not necessarily need to be large to facilitate functional outcomes. Instead, opportunities to apply newly acquired cognitive skills and strategies in the real world are vital. The next generation of studies need to compare different treatments using specific and more general measures of cognitive outcome. These may then throw light on their mechanisms of action. The results of these more sophisticated studies will allow therapists to tailor treatments to individuals to maximize gain for patients. Keywords cognitive rehabilitation, cognitive remediation, computerized remediation, functional outcome, work outcome Curr Opin Psychiatry 22:161–167 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 0951-7367 0951-7367 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI:10.1097/YCO.0b013e328322fbf4