Implementing cognitive rehabilitation interventions for schizophrenia patients in mental health services: focus on Integrated Psychological Therapy (IPT)

S. Barlati ¹, P. Valsecchi ², A. Galluzzo ¹, C. Turrina ^{1 2}, A. Vita ^{1 2}

¹ Department of Mental Health, ASST-Spedali Civili of Brescia, Italy; ² Department of Clinical and Experimental Sciences, University of Brescia, Italy

Objectives

Integrated Psychological Therapy (IPT) is a group-based cognitive-behavior therapy program for schizophrenia that integrates cognitive and social cognitive remediation with psychosocial rehabilitation. IPT is based on the underlying assumption that basic deficits in cognitive functioning have a pervasive effect on higher levels of behavioral organization, including social skills and social and independent functioning. Meta-analytic studies underlined that IPT is an evidence-based rehabilitation approach for schizophrenia patients. The aim of this review was to discuss the feasibility and effectiveness in implementing IPT in everyday clinical practice in an Italian mental health service, among patients with schizophrenia and to identify the promoting strategies and the barriers against IPT implementation. 

Methods

For these purpose, five studies published from 2011 to 2016 were included in the review, investigating the IPT cost-effectiveness ratio, compared with treatment as usual (TAU) in people with schizophrenia in a real-world psychiatric rehabilitative setting at the University Department of Mental Health of the Spedali Civili Hospital in Brescia (Italy). 

Results

IPT was accepted by the majority proportion of schizophrenia patients and findings have shown promising improvement in clinical, cognitive and psychosocial functioning, persisting over time, after IPT intervention, with a favorable cost-effectiveness ratio. 

Conclusions

In summary, our experience demonstrated that IPT could be effectively implemented as an integral component of psychosocial interventions and that it was accepted by a significant proportion of people with schizophrenia admitted to a medium-length-of-stay psychiatric rehabilitation setting. Participants who completed the cognitive training were observed to have significantly improved cognition and psychosocial functioning, whereas the groups who did not participate or discontinued the training did not demonstrate similar gains. Although these promising and encouraging results on IPT efficacy in real-world psychiatric rehabilitative setting, there is need for further translational research evaluating the effectiveness and applicability of cognitive remediation in everyday clinical practice.