Rehabilitation pp 267-284 | Cite as

Cognitive Remediation of Psychotic Patients

  • Robert S. Kern
  • Michael F. Green
Part of the Human Brain Function book series (HBFA)


In the United States, recent estimates indicate that approximately $12 billion are spent annually to treat schizophrenia, and lost productivity as a result of the disease costs approximately $28 billion. It is well documented that schizophrenia also involves a host of cognitive, social, and occupational deficits that place limits on the ability to function independently. Approximately two-thirds of individuals diagnosed with schizophrenia are unable to maintain full independence and require some degree of supervised care. Because functional deficits are relatively refractory to traditional forms of treatment, it is imperative to develop innovative treatments that focus on improving social and occupational functioning.


Schizophrenia Patient Psychotic Patient Abnormal Psychology Stimulus Card Perseverative Error 
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  1. Anderson, S. W., Damasio, H., Jones, D. R., & Tranel, D. (1991). Wisconsin Card Sorting Test performance as a measure of frontal lobe damage. Journal of Clinical and Experimental Neuropsychology, 13, 909–922.PubMedCrossRefGoogle Scholar
  2. Asarnow, R. F., & MacCrimmon, D. J. (1978). Residual performance deficit in clinically remitted schizophrenics: A marker of schizophrenia? Journal of Abnormal Psychology, 87, 597–608.PubMedCrossRefGoogle Scholar
  3. Asarnow, R. F., & MacCrimmon, D. J. (1981). Span of apprehension deficits during the postpsychotic stages of schizophrenia: A replication and extension. Archives of General Psychiatry, 38, 1006–1011.PubMedCrossRefGoogle Scholar
  4. Asarnow, R. F., Stetty, R. A., MacCrimmon, D. J., & Cleghorn, J. M. (1977). An attentional administration of foster children at risk for schizophrenia. Journal of Abnormal Psychology, 86, 267–275.PubMedCrossRefGoogle Scholar
  5. Asarnow, R. F., Granholm, E., & Sherman, T. (1991). Span of apprehension in schizophrenia. In S. R. Steinhauer, J. H. Gruzelier, & J. Zubin (Eds.), Handbook of schizophrenia: Vol. 5. Neuropsychology, psychophysiology and information processing, (pp. 335–370 ). Amsterdam: Elsevier Science.Google Scholar
  6. Bauman, E. (1971a). Schizophrenic short-term memory: A deficit in subjective organization. Canadian Journal of Behavioural Science, 3, 55–65.CrossRefGoogle Scholar
  7. Bauman, E. (1971b). Schizophrenic short-term memory: The role of organization at input. Journal of Consulting and Clinical Psychology, 36, 14–19.PubMedCrossRefGoogle Scholar
  8. Bauman, E., & Murray, D. J. (1968). Recognition versus recall in schizophrenia. Canadian Journal of Psychology, 22, 18–25.PubMedCrossRefGoogle Scholar
  9. Bellack, A. S., Mueser, K. T., Morrison, R. L., Tierney, A., & Podell, K. (1990). Remediation of cognitive deficits in schizophrenia. American Journal of Psychiatry, 147, 1650–1655.PubMedGoogle Scholar
  10. Bowen, L., Wallace, C.J., Glynn, S. M., Nuechterlein, K. H., Lutzger, J. R., & Kuehnel, T. G. (1989). Relationships among schizophrenic patients on attentional deficits, social problem-solving skills, and performance in psychoeducational rehabilitation tasks. Paper presented at the 23rd annual convention of the Association for the Advancement of Behavior Therapy, Washington, DC.Google Scholar
  11. Bracha, H. S. (1989). Is there a right hemi-hyper-dopaminergic psychosis? Schizophrenia Research, 2, 317–324.PubMedCrossRefGoogle Scholar
  12. Brenner, H. D., Kraemer, S., Hermanutz, M., & Hodel, B. (1990). Cognitive treatment in schizophrenia. In E. R. Straube & J. Hahleg (Eds.), Schizophrenia: Concepts, vulnerability, and interventions, (pp. 161–192 ). New York: Springer-Verlag.Google Scholar
  13. Brenner, H. D., Hodel, B., Roder, V., & Corrigan, P. (1992). Treatment of cognitive dysfunctions and behavioral deficits in schizophrenia: Integrated psychological therapy. Schizophrenia Bulletin, 18, 21–26.PubMedCrossRefGoogle Scholar
  14. Calev, A., Venables, P. H., & Monk, A. F. (1983). Evidence for distinct verbal memory pathologies in severely and mildly disturbed schizophrenics. Schizophrenia Bulletin, 9, 243–264.CrossRefGoogle Scholar
  15. Calev, A., Korin, Y., Kugelmass, S., & Lerer, B. (1987). Performance of chronic schizophrenics on matched word and design recall tasks. Biological Psychiatry, 22, 699–709.PubMedCrossRefGoogle Scholar
  16. Carlsson, A. (1988). The current state of the dopamine hypothesis of schizophrenia. Neuropsychopharmacology, 1, 179–186.PubMedCrossRefGoogle Scholar
  17. Corrigan, P. W., Wallace, C. J., Schade, M. L., & Green, M. F. (1994). Cognitive dysfunctions and psychosocial skill learning in schizophrenia Behavior Therapy, 25, 5–15.CrossRefGoogle Scholar
  18. Delis, D. C., Kramer, J. H., Kaplan, E., & Ober, B. A. (1987). California Verbal Learning Test. San Antonio, TX: Psychological Corp: Harcourt Brace Jovanovich.Google Scholar
  19. Estes, W. K., & Taylor, H. A. (1966). Visual detection in relation to display size and redundancy of critical elements. Perception and Psychophysics, 1, 9–16.CrossRefGoogle Scholar
  20. Flor-Henry, P. (1976). Lateralized temporal-limbic dysfunction and psychopathology. Annual New York Academy Sciences, 280, 777–795.CrossRefGoogle Scholar
  21. Gaag, M. van der. (1992). The results of cognitive training in schizophrenic patients. Oegstgeest, The Netherlands: Eburon Delft.Google Scholar
  22. Gold, J. M., Randolph C., Carpenter, C. J., Goldberg, T. E., & Weinberger, D. R. (1992). Forms of memory failure in schizophrenia. Journal of Abnormal Psychology, 101, 487–494.PubMedCrossRefGoogle Scholar
  23. Goldberg, T. E., Weinberger, D. R., Berman, K. F., Pliskin, N. H., & Podd, M. H. (1987). Further evidence for dementia of the prefrontal type in schizophrenia? A controlled study of teaching the Wisconsin Card Sorting Test. Archives of General Psychiatry, 44, 1008–1014.PubMedCrossRefGoogle Scholar
  24. Goldstein, G. (1986). The neuropsychology of schizophrenia. In I. Grant and K. M. Adams (Eds.), Neuropsychologi cal assessment of neuropsychiatric disorders, (pp. 147–171 ). New York: Oxford University Press.Google Scholar
  25. Green, M. F. (1993). Cognitive remediation in schizophrenia: Is it time yet? American Journal of Psychiatry, 150, 178–187.PubMedGoogle Scholar
  26. Green, M. F., Satz., P., Ganzell, S., & Vaclav, J. F. (1992). Wisconsin Card Sorting Test performance in schizophrenia: Remediation of a stubborn deficit. American Journal of Psychiatry, 149, 62–67.PubMedGoogle Scholar
  27. Gur, R. E. (1978). Left hemisphere dysfunction and left hemisphere overactivation in schizophrenia. Journal of Abnormal Psychology, 87, 226–238.PubMedCrossRefGoogle Scholar
  28. Heaton, R. K. (1981). Wisconsin Card Sorting Test Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  29. Hellman, S. G., Green, M. F., Kern, R. S., & Christenson, C. D. (1992). The effects of instruction versus reinforcement on the Wisconsin Card Sorting Test [abstract]. Journal of Clinical and Experimental Neuropsychology, 14, 63.Google Scholar
  30. Jaeger, J., & Douglas, E. (1991). Adjunctive neuropsychological remediation in psychiatric rehabilitation: Program description and preliminary data. Schizophrenia Research, 4, 304–305.CrossRefGoogle Scholar
  31. Jaeger, J., Berns, S., Tigner, A., & Douglas, E. (1992). Remediation of neuropsychological deficits in psychiatric populations: Rationale and methodological considerations. Psychopharmacology Bulletin, 28, 367–390.PubMedGoogle Scholar
  32. Kahneman, D. (1973). Attention and effort. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  33. Kayton, L., & Koh, S. D. (1975). Hypohedonia in schizophrenia. Journal of Nervous and Mental Disorders, 161, 412–420.CrossRefGoogle Scholar
  34. Kern, R. S., Wallace, C.J., Hellman, S. G., Womack, L. M., & Green, M. F. (1996). A training procedure for remediating WCST deficits in psychotic patients: An adaptation of errorless learning principles. Journal of Psychiatric Research, 30, 283–294.PubMedCrossRefGoogle Scholar
  35. Kern, R. S., Wallace, C. J., Green, M. F., & Hellman, S. G. (1993). The application of errorless learning on WCST performance in psychotic patients. Paper presented at the eighth annual meeting of the Society for Research in Psychopathology. Chicago.Google Scholar
  36. Kern, R. S., Green, M. F., & Goldstein, M. J. (1995). Modifiability of performance on the span of apprehension, a putative vulnerability indicator of schizophrenia. Journal of Abnormal Psychology, 104, 385–389.PubMedCrossRefGoogle Scholar
  37. King, H. E. (1991). Psychomotor dysfunction in schizophrenia. In S. R. Steinhauer, J. H. Gruzelier, & J. Zubin (Eds.), Handbook of schizophrenia: Vol. 5. Neuropsychology, psychophysiology and information processing, (pp. 273–301 ). Amsterdam: Elsevier ScienceGoogle Scholar
  38. Koh, S. D., & Kayton, L. (1974). Memorization of “unrelated” word strings by young nonpsychotic schizophrenics. Journal of Abnormal Psychology, 33, 14–22.CrossRefGoogle Scholar
  39. Koh, S. D., Kayton, L., & Berry, R. (1973). Mnemonic organization in young nonpsychotic schizophrenics. Journal of Abnormal Psychology, 81, 299–310.PubMedCrossRefGoogle Scholar
  40. Koh, S. D., Kayton, L, & Peterson, R. A. (1976). Affective encoding and consequent remembering in schizophrenic young adults. Journal of Abnormal Psychology, 85, 156–166.PubMedCrossRefGoogle Scholar
  41. Koh, S. D., Grinker, R. R., Sr., Marusarz, T. Z., & Forman, P. L. (1981). Affective memory and schizophrenic anhedonia. Schizophrenia Bulletin, Z 292–307.Google Scholar
  42. Kovelman, J. A., & Scheibel, A. B. (1984). A neurohistological correlate of schizophrenia. Biological Psychiatry, 19, 1601–1621.PubMedGoogle Scholar
  43. Kraemer, S., Zinner, H. J., & Moller, H. J. (1989). Cognitive training and social skills training in relation to basic disturbances in chronic schizophrenic patients. Paper presented at the proceedings of the World Congress of Psychiatry, Amsterdam.Google Scholar
  44. Larsen, S. F., & Fromholt, P. (1976). Mnemonic organization and free recall in schizophrenia. Journal of Abnormal Psychology, 85, 61–65.PubMedCrossRefGoogle Scholar
  45. Maher, B. A. (1991). Language and schizophrenia. In S. R. Steinhauer, J. H. Gruzelier, & J. Zubin (Eds.), Handbook of schizophrenia: Vol. 5. Neuropsyclwlogy, psychophysiology and information processing, (pp. 437–464 ). Amsterdam: Elsevier Science.Google Scholar
  46. Mednick, S. A., Parnas, J., & Schulsinger, F. (1987). The Copenhagen high-risk project, 1962–1986. Schizophrenia Bulletin, 13, 485–495.PubMedCrossRefGoogle Scholar
  47. Milner, B. (1963). Effects of different brain lesions on card sorting. Archives of Neurology, 9, 90–100.CrossRefGoogle Scholar
  48. Moray, N. (1969). Attention: Selective processes in vision and hearing. London: Hutchinson.Google Scholar
  49. Mueser, K. T., Bellack, A. S., Douglas, M. S., & Wade, J. H. (1991). Prediction of social skill acquisition in schizophrenic and major affective disorder patients from memory and symptomatology. Psychiatry Research, 37, 281–296.PubMedCrossRefGoogle Scholar
  50. Nachmani, G., & Cohen, B. D. (1969). Recall and recognition free learning in schizophrenics. Journal of Abnormal Psychology, 74, 511–516.Google Scholar
  51. Nuechterlein, K. H., & Asarnow, R. F. (1989) Perception and cognition. In H. I. Kaplan & B. J. Sadock (Eds.), Comprehensive textbook of psychiatry, (5th ed., Vol. 1, pp. 241–256 ). Baltimore: Williams & Wilkins.Google Scholar
  52. Nuechterlein, K. H., & Dawson, M. E. (1984). Information processing and attentional functioning in the developmental course of schizophrenia. Schizophrenia Bulletin, 10, 160–203.PubMedCrossRefGoogle Scholar
  53. Nuechterlein, K. H., Dawson, M. E., Gitlin, M., Ventura, J., Goldstein, M. J., Snyder, K. S., Yee, C. M., & Mintz, J. (1992). Developmental processes in schizophrenic disorders: Longitudinal studies of vulnerability and stress. Schizophrenia Bulletin, 18, 387–425.PubMedCrossRefGoogle Scholar
  54. Olbrich, R., & Mussgay, L. (1990). Reduction of schizophrenic deficits by cognitive training: An evaluative study. European Archives of Psychiatry and Neurological Science, 239, 366–369.CrossRefGoogle Scholar
  55. Sacuzzo, D. P., & Braff, D. L. (1981). Early information processing deficit in schizophrenia. Archives of General Psychiatry, 38, 175–179.CrossRefGoogle Scholar
  56. Sanders, A. F. (1983). Towards a model of stress and human performance. Acta Psychologica, 53, 61–97.PubMedCrossRefGoogle Scholar
  57. Saykin, A. J., Gur, R. C., Gur, R. E., Mozley, P. D., Mozley, L. H., Resnick, S. M., Kester, D. B., & Stafiniak, P. (1991). Neuropsychological function in schizophrenia: Selective impairment in memory and learning. Archives of General Psychiatry, 48, 618–624.PubMedCrossRefGoogle Scholar
  58. Spaulding, W. D., & Sullivan, M. (1991). From the laboratory to the clinic: Psychological methods and principles in psychiatric rehabilitation. In R. P. Liberman (Ed.), Handbook of psychiatric rehabilitation. Elmsford, NY: Pergamon.Google Scholar
  59. Summerfelt, A. T., Alphs, L. D., Wagman, A. M. I., Funderburk, F. R., Hierholzer, R. M., & Strauss, M. E. (1991). Reduction of perseverative errors in patients with schizophrenia using monetary feedback. Journal of Abnormal Psychology, 100, 613–616.PubMedCrossRefGoogle Scholar
  60. Terrace, H. S. (1963). Discrimination learning with and without errors. Journal of the Experimental Analysis of Behavior, 6, 1–27.Google Scholar
  61. Wagner, B. R. (1968). The training of attending and abstracting responses in chronic schizophrenics. Journal of Experimental Research in Personality, 3, 77–88.Google Scholar
  62. Woodworth, R. S. (1948). Experimental psychology. New York: Cambridge University Press.Google Scholar
  63. Yozawitz, A. (1986). Applied neuropsychology in a psychiatric center. In I. Grant & K. M. Adams (Eds.), Neuropsychological assessment of neuropsychiatric disorders. New York: Oxford University Press.Google Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Robert S. Kern
    • 1
  • Michael F. Green
    • 2
  1. 1.West Los Angeles VA Medical Center (B 116AR)Los AngelesUSA
  2. 2.UCLA-Neuropsychiatric Institute and HospitalLos AngelesUSA

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