College of Psychiatric and Neurologic Pharmacists

While there is no doubt that medication treatments have demonstrated efficacy for improving clinical symptoms and decreasing rates of relapse for individuals with schizophrenia, many aspects of the illness have not responded or have only partially responded to pharmacotherapy. Multiple psychosocial treatments have been pursued to address these needs. This presentation will focus on two primary types of treatment:  Cognitive Behavior Therapy (CBT) and Cognitive Rehabilitation. CBT is designed to decrease the frequency, severity, and the impact on functional outcome of positive symptoms that persist despite adequate medication treatment.

CBT is based partly on the evidence that emotional processes, information-processing deficits and reasoning and appraisal biases contribute to the formation and maintenance of delusions and hallucinations and that these processes can be changed through cognitive intervention. The therapist in CBT works to understand the client’s perspective regarding specific symptoms and over time to develop ways to test and evaluate these beliefs. Research has demonstrated that individuals participating in CBT have better insight into their illness, and fewer positive symptoms than those in control treatments. Cognitive rehabilitation strategies target deficits in memory, attention and planning that underlie problems in independent living, work, and social role functioning. Cognitive remediation (CR) is an approach using practice with pen and paper or computerized tests of these cognitive skills to improve deficits. Research has shown the participants in CR improve in specific cognitive skills and have better work outcomes than those in control treatments. 

Cognitive Adaptation Training (CAT) uses environmental supports such as signs, checklists, alarms, pill containers, and the organization of belongings to bypass cognitive deficits and to cue and sequence adaptive behavior in the home or work environment. CAT has been found to improve specific target behaviors such as hygiene and medication adherence, global functional outcome, and amotivation, and to reduce rates of relapse in comparison to control treatments. While medication treatments are an important foundation, the use of psychosocial approaches is necessary to produce the best outcomes for individuals with schizophrenia.

1. Describe the various non-pharmacological treatment modalities and data supporting their use.
2. Explain the benefits of cognitive behavioral therapy in schizophrenia.
3. Describe the systematic use of environmental supports to bypass cognitive deficits and improve functional outcomes in schizophrenia.
4. Outline the resources available to implement evidence-based psychosocial rehabilitation techniques in community practice.

Activity Dates: 04/20/2009 - 04/20/2012
ACPE Contact Hours: 1.0
ACPE Number: 0284-0000-09-008-H01-P
Nursing Credit Reminder: Note that ACPE and ACCME credit is accepted for certification renewal.

This course is provided online at cpnp.org and consists of the speaker audio and slides. A PDF file of the slides is also provided and access is available to participants indefinitely although ACPE credit is available only through the course expiration date.

Participants in this course must complete an examination and achieve a score of 60% or greater. Successful completion of the course also requires the completion of a course evaluation. ACPE statements of credit can be retrieved by participants online at cpnp.org immediately upon successful completion of the course.

If you are a pharmacist, nurse practitioner or other healthcare professional involved in the medication therapy management of psychiatric and/or neurological patients, we invite you to participate in this online course.

This programming was supported in part by grants from Bristol-Myers Squibb, Forest Laboratories, Inc., Lilly, Schering-Plough, Cyberonics, Shire, and Janssen, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. administered by Ortho-McNeil Janssen Scientific Affairs, LLC.