Improving functional outcome, in addition to alleviating psychotic symptoms, is now a major treatment objective in schizophrenia research. Given the large body of evidence suggesting pharmacological treatments generally have minimal effects on indices of functioning, research has turned to psychosocial rehabilitation programs. Among these, neurocognitive and social cognitive interventions are at the forefront of this field and are argued to target core deficits inherent to the schizophrenia illness. However, to date, research trials have primarily focused on chronic schizophrenia populations, neglecting the early psychosis groups who are often as severely impaired in social and occupational functioning. This theoretical paper will outline the rationale for investigating adjunctive cognitive-based interventions in the early phases of psychotic illness, critically examine the current approach strategies used in these interventions, and assess the evidence supporting certain training programs for improving functional outcome in early psychosis. Potential pathways for future research will be discussed. 1. Introduction The field of schizophrenia research and treatment is in a transitional phase, shifting from a focus on outcomes that are measured by symptomatic remission and basic illness management to an all-encompassing outlook on real-world functional recovery [1, 2]. This is an exciting time for researchers and consumers, as the improvement in social, occupational, and personally challenging activities that impact the individual’s day-to-day living are now primary research objectives. In this research era it is also widely acknowledged that the early phase of a psychotic illness, known as the “critical period,” is the most crucial in terms of limiting or even preventing the development of disability, with maximal levels of disability reached within the first 5 years after illness onset . The first onset of psychosis typically occurs between the age of 18 and 24 , although prodromal symptoms are often detectable in the adolescent years . There is a paucity of research that has focused investigation on the “functional” outcome of this early psychosis cohort. A systematic review of 37 early detection/intervention studies in first-episode psychosis (FEP) found that 42% of patients had “good” illness outcomes as opposed to 27% who had “poor” outcomes at an average of 3-year follow-up . However, outcome was predominantly defined by hospital readmission or change in symptom severity, with only 4 of the 37 studies reporting functional recovery.
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