Cognitive remediation refers to nonpharmacological methods of improving cognitive function in people with severe mental disorders. Cognitive remediation therapy (CRT) can be delivered via computerised programs, of varying length and complexity, or can be undertaken one-on-one by a trained clinician. There has been a considerable interest in cognitive remediation, driven by recognition that cognitive deficits are a major determinant of outcome in people with severe, chronic mental illnesses. CRT has been shown to be effective, especially if combined with vocational rehabilitation. 1. Cognitive Impairment in Severe Mental Illness The term “severe mental illness” (SMI) is generally taken to encompass chronic psychotic disorders. Whilst many people in this category suffer from schizophrenia, disorders such as schizoaffective disorder, delusional disorder and bipolar disorder are also commonly associated with persistent symptoms, cognitive impairment and long-term disability [1]. Data collected from 1875 people with SMI demonstrated that their current cognitive ability was markedly impaired, compared to the general population. On average, people with psychosis scored 1.6 standard deviations below the general population on a test of information processing speed [1]. There are some differences between diagnostic groups. Children who later develop schizophrenia are more likely to be slow to learn to speak [2] and to have impaired language and arithmetic ability during childhood [3], reflecting neurodevelopmental processes underlying adult schizophrenia [4]. In contrast, people with bipolar disorder tend to have average or superior educational achievement as children, suggesting a different illness trajectory [5]. Nevertheless, despite premorbid differences, cognitive impairment is evident in both affective psychoses (bipolar disorder and psychotic depression) and nonaffective psychoses (schizophrenia) [6] even in the early stages of the disorder. Cognitive impairment is generally most profound and pervasive in schizophrenia [7]. Vocational outcomes are poor in people with SMI, with many experiencing long-term unemployment and welfare dependence, despite evidence that they could gain considerable benefit from engagement in paid employment [8]. Numerous studies have demonstrated an association between the severity of cognitive impairment and functional, social, and occupational outcomes in schizophrenia [9, 10]. Similarly, in bipolar disorder, cognitive deficits have been shown to be associated with reduced psychosocial function [11, 12]. Cognitive impairment is
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