Search

BACKGROUND Cognitive remediation therapy (CRT) and Computerized CRT (CCRT) improve cognition and functioning, but there is no direct evidence of whether there is an advantage of using a computer. This study fills this gap and extends research evidence to the long-term effect of these two treatments in a large sample of Chinese inpatients with a diagnosis of schizophrenia. METHOD We conducted a randomized single-blind, follow-up study with participants randomized to receive CCRT (n = 144), CRT (n = 72) or Active control (n = 54) for 12 weeks with 4-5 sessions per week. The main outcome was cognition (MATRICS Consensus Cognitive Battery total score, MCCB), and secondary outcomes were cognitive domains, symptoms and functioning assessed at baseline (0 month), post-treatment (3 months) and follow-up (6, 12 and 18 months). RESULTS The primary outcome (MCCB total score) improved in both treatment groups which was maintained at 18 months but did not differ between treatment groups. Post hoc analysis demonstrated that the CRT group had an advantage over CCRT for the Trail Making and Symbol Coding Tests (all p

OBJECTIVE: Low self-esteem has been suggested as a putative mechanism in the development and maintenance of psychosis. Uncertainty still exists about how unstable self-esteem relates to psychotic experiences. The present study examines the potential (temporal) associations between momentary self-esteem, fluctuations in self-esteem, and psychotic experiences in daily life. METHODS: Experience sampling data were collected from 46 individuals presenting with an at-risk mental state (ARMS), 51 individuals with first-episode psychosis (FEP), and 53 controls, to investigate associations between (fluctuations in) self-esteem and psychotic experiences within and across FEP, ARMS, and controls, using linear mixed models. RESULTS: In all three groups we found that lower momentary self-esteem was associated with a greater intensity of psychotic experiences (adj. βFEP = -0.15, 95% CI -0.20 to -0.10, p = 0.000; adj. βARMS = -0.20, 95% CI -0.26 to -0.15, p = 0.000; adj. βcontrols = -0.12, 95% CI -0.17 to -0.07, p = 0.000). Variability in momentary self-esteem was associated with a greater intensity of psychotic experiences only in ARMS (adj. βARMS = 0.08, 95% CI 0.04 to 0.11, p = 0.000) and controls (adj. βcontrols = 0.04, 95% CI 0.01 to 0.08, p = 0.023). For instability this association held only in controls (adj. βcontrols = 0.03, 95% CI 0.00 to 0.05, p = 0.020). Furthermore, findings may suggest a reciprocal temporal association between self-esteem and psychotic experiences. CONCLUSIONS: Our findings suggest that self-esteem may be an important mechanism targetable by ecological momentary interventions to reduce the intensity of psychotic experiences and potentially prevent illness progression at an early stage. ispartof: SCHIZOPHRENIA RESEARCH vol:238 pages:188-198 ispartof: location:Netherlands status: published

Cognitive remediation is now widely recognized as an effective treatment for cognitive deficits in schizophrenia. Its effects are meaningful, durable, and related to improvements in everyday functional outcomes. As with many therapies, the evolution of cognitive remediation has resulted in treatment programs that use a variety of specific techniques, yet share common core principles. This paper is the product of a cognitive remediation expert working group consensus meeting to identify core features of the treatment and produce recommendations for its design, conduct, reporting, and implementation. Four techniques were identified as core features of cognitive remediation: facilitation by a therapist, cognitive exercise, procedures to develop problem-solving strategies, and procedures to facilitate transfer to real world functioning. Treatment techniques within each of these core features are presented to facilitate decisions for clinical trials and implementation in clinical settings.

Understanding the link between quality of life and symptoms in schizophrenia is important in enhancing the prospect of patient recovery. Only weak associations have been found between subjective quality of life (SQOL) and negative symptoms. However, this may be because many existing symptom assessment scales inadequately assess the experiential deficits of negative symptoms. This study aimed to re-evaluate these findings using the Clinical Assessment Interview for Negative Symptoms (CAINS), which as been designed to capture both the expressive and experiential subdomains of negative symptoms as separate constructs. In this observational study 275 participants with at least moderate negative symptoms were assessed three times over nine months using the CAINS, the Positive and Negative Syndrome Scale (PANSS), and the Manchester Short Assessment of Quality of Life (MANSA). A significant negative association between SQOL and the CAINS experiential subscale was found in the cross-sectional analysis (adj. B = -0.28, 95% CI = -0.44 to -0.12, P = 0.001), and in the change scores (adj. B = -0.13, 95% CI = -0.26 to -0.01, P = 0.032). No associations between SQOL and expressive symptoms, or negative symptoms measured using the PANSS were detected in the multivariable models. These findings suggest that the association between negative symptoms and SQOL is related primarily to experiential deficits, and highlights the importance of measuring the separate subdomains of negative symptoms as distinct constructs. The findings also highlight the impact of negative symptoms and experiential deficits in particular on social outcomes, further emphasising the need to develop new treatments for these symptoms.

BackgroundAnhedonia and amotivation are substantial predictors of poor functional outcomes in people with schizophrenia and often present a formidable barrier to returning to work or building relationships. The Temporal Experience of Pleasure Model proposes constructs which should be considered therapeutic targets for these symptoms in schizophrenia e.g. anticipatory pleasure, memory, executive functions, motivation and behaviours related to the activity. Recent reviews have highlighted the need for a clear evidence base to drive the development of targeted interventions.ObjectiveTo review systematically the empirical evidence for each TEP model component and propose evidence-based therapeutic targets for anhedonia and amotivation in schizophrenia.MethodFollowing PRISMA guidelines, PubMed and PsycInfo were searched using the terms “schizophrenia” and “anhedonia”. Studies were included if they measured anhedonia and participants had a diagnosis of schizophrenia. The methodology, measures and main findings from each study were extracted and critically summarised for each TEP model construct.Results80 independent studies were reviewed and executive functions, emotional memory and the translation of motivation into actions are highlighted as key deficits with a strong evidence base in people with schizophrenia. However, there are many relationships that are unclear because the empirical work is limited by over-general tasks and measures.ConclusionsPromising methods for research which have more ecological validity include experience sampling and behavioural tasks assessing motivation. Specific adaptations to Cognitive Remediation Therapy, Cognitive Behavioural Therapy and the utilisation of mobile technology to enhance representations and emotional memory are recommended for future development.

Background: Cognitive Remediation (CR) is an evidence based treatment targeting cognitive and functional difficulties in people with psychosis. Despite the large number of effectiveness studies, only limited evidence exists for the active ingredients of this therapy. This study begins to fill this gap by exploring the relationship between CR ingredients, including alliance with a therapist, and therapy outcomes. Method: This is a secondary analysis based on data from a published randomised controlled trial comparing CR + treatment-as-usual (TAU) to TAU alone. We considered the association between CR active ingredients including errorless learning, massed practice, strategy use and therapeutic alliance on the cognitive, functioning and symptom outcomes that significantly improved following therapy. Results: Forty-six of the 96 participants were randomised to CR. After therapy the CR group showed significant improvement in non-verbal memory, functioning and approaching significance, improvements in executive functions. All therapy ingredients were inter-related but strategy use alone was associated therapeutic alliance. Cognitive improvements were associated with massed practice, number of useful strategies and therapeutic alliance, but improvements in functioning were associated only with therapeutic alliance. Conclusions: These findings build the evidence base for the usefulness of specific therapy components. As for other psychological therapies it appears that therapeutic alliance may be an important factor in driving change for key CR outcomes, particularly functioning, in people with psychosis.

Background Current emphasis on community integration requires reliable and valid measures of social behaviour; existing assessments largely overlap with symptoms or provide little detail on functioning. This study aims to re-assess the Social Behaviour Schedule (SBS) to fulfil this measurement role. Methods Internal consistency, construct validity and test–retest reliability were investigated in 421 community out-patients with schizophrenia. Concurrent validity was assessed against the Life Skill Profile (LSP), in 143 additional patients. Results A 17-item SBS supported the construct validity of four factors: Antisocial Behaviour, Depressed Behaviour, Social Withdrawal and Thought Disturbance. It showed good test–retest reliability and rated significant social behaviour in a community sample. Weak correlations were observed with positive and negative symptoms. With the exception of Depressed Behaviour, the SBS factors showed strong correlations with the LSP. Conclusion SBS-17 is a valid measure assessing relevant community social functioning factors with relatively few items. The SBS could be useful both in research and in clinical settings.

Background Cognitive remediation (CRT) affects functioning but the extent and type of cognitive improvements necessary are unknown. Aim To develop and test models of how cognitive improvement transfers to work behaviour using the data from a current service. Method Participants (N49) with a support worker and a paid or voluntary job were offered CRT in a Phase 2 single group design with three assessments: baseline, post therapy and follow-up. Working memory, cognitive flexibility, planning and work outcomes were assessed. Results Three models were tested (mediation — cognitive improvements drive functioning improvement; moderation — post treatment cognitive level affects the impact of CRT on functioning; moderated mediation — cognition drives functioning improvements only after a certain level is achieved). There was evidence of mediation (planning improvement associated with improved work quality). There was no evidence that cognitive flexibility (total Wisconsin Card Sorting Test errors) and working memory (Wechsler Adult Intelligence Scale III digit span) mediated work functioning despite significant effects. There was some evidence of moderated mediation for planning improvement if participants had poorer memory and/or made fewer WCST errors. The total CRT effect on work quality was d = 0.55, but the indirect (planning-mediated CRT effect) was d = 0.082 Conclusion Planning improvements led to better work quality but only accounted for a small proportion of the total effect on work outcome. Other specific and non-specific effects of CRT and the work programme are likely to account for some of the remaining effect. This is the first time complex models have been tested and future Phase 3 studies need to further test mediation and moderated mediation models.

Purpose There is a lack of evidence on the cost-effectiveness of cognitive remediation therapy (CRT). Methods Randomised controlled trial comparing usual care plus CRT with usual care alone. Participants had a diagnosis of schizophrenia and cognitive and social functioning difficulties. Health/social care and societal costs were estimated at 14 weeks (time 2) and 40 weeks (time 3) after randomisation. The outcome, proportion of participants improving their working memory since baseline, was combined with costs to explore cost-effectiveness. Results 85 participants were recruited. There were no differences in total health/social care or societal costs between the two groups at either time 2 or time 3. An additional 21% of participants in the CRT group improved their working memory at both follow-ups. When placing these cost and outcomes in hypothetical scenarios concerning how much policy-makers would pay for another 1% of participants improving their working memory, there was more than an 80% chance that CRT would be cost-effective compared to usual care; at time 3, the likelihood of cost-effectiveness peaked at 30% even for investments up to £5000. Conclusions CRT can improve memory among people with schizophrenia and cognitive deficits at no additional cost. Although cost-effective in the short term, CRT may have limited potential to save costs in the medium term because it could increase take up of services. This could confer important longer term benefits for the patient group examined here, in terms of improved social functioning and less reliance on services. This can only be ascertained through longer follow-up.

Background Cognitive remediation (CR) therapy in its various disguises can be helpful for people with schizophrenia but it is not clear if patient characteristics are likely to interfere with its effectiveness. Methodology This paper describes the assessment of one putative moderating variable, age, on the outcome of CRT in a rigorous randomised control trial with memory, cognitive flexibility and planning as primary outcomes and social behaviour, symptoms and self-esteem as secondary outcomes. Calendar age was divided into younger (

Objective Real-life function is markedly impaired in schizophrenia and is an important outcome for interventions, but direct assessment is time consuming and resource intensive. Virtual reality (VR) enables assessment using simulation, akin to real life (RL), but allowing greater experimental control, reliability, and a more timely assessment. This study explores whether VR simulation predicts RL performance in supermarket shopping and how both relate to underlying cognitive abilities. Method Forty three people with DSM-IV schizophrenia were included in the study. Participants were required to shop for items using a self-directed search in both RL and VR. In each task, accuracy (number of correct items) and efficiency (time taken and number of aisles entered) were measured. IQ, executive function, working memory, spatial memory and social cognition were also assessed. Results Specific correlations were found between RL accuracy and VR accuracy, and between RL and VR efficiency measures. Multiple regression analyses indicated that VR efficiency measures contributed significant unique variance to RL efficiency outcomes, in addition to that explained by background cognitive measures, with a final model predicting 58% of variance in RL efficiency. Conclusions VR functional shopping measures may enhance predictions of real life performance, over and above existing cognitive test procedures, and provide a more time-efficient method for evaluating real life outcomes.

Background: This paper investigates the durability of the effects of cognitive remediation therapy (CRT). In a randomised control trial, CRT was compared with a control therapy (intensive occupational therapy activities), matched for length of therapist contact. The main three cognitive outcomes, (i) number of categories achieved on the Wisconsin Card Sort Test, (ii) age-scaled score on the Digit Span subtest of the WAIS-R, and (iii) mean number of moves on the Tower of London test, were chosen because they are known to be problematic in schizophrenia. In addition, a wide variety of other outcomes (symptoms, social functioning, self-esteem and cognition) were assessed. At the end of treatment, CRT conferred a benefit to people with schizophrenia in cognition and self-esteem [Schizophr. Bull. 25 (1999) 291]. This study investigates these outcomes 6 months after the therapies were withdrawn. Method: Participants were assessed at baseline, posttreatment and 6-month follow-up (n=17 for the CRT group; n=16 for the control therapy group). In addition to the functioning measures, data on use of services and cost of therapy were collected. Results: The effects of CRT on cognition were still apparent at follow-up, particularly in the memory domain. When these cognitive improvements reached a criterion threshold, there were also improvements in social behaviour and symptoms. The gains made in self-esteem disappeared following the withdrawal of therapy. The economic analysis showed overall reductions in the care packages of both patient groups but there was a significant increase in day-care costs for patients who have received CRT. This additional use of day care may confer further advantages to the CRT group, such as improved social functioning and quality of life. Conclusions: The overall results of this first trial of a novel CRT approach have produced encouraging results which merit further investigation.

If cognitive remediation is to be developed further, there have to be not only large-scale randomized trials but also detailed analysis of the strategies used to produce improved performance. In this study the strategies adopted by two people who took part in a remediation program are investigated, with their results on neuropsychological tasks and with concomitant brain image data gathered via SPECT while the participant was performing a Verbal Fluency task. After remediation there were improvements in many of the neuropsychological tests, and changes in the scan data. The changes in strategies and brain activation were different for both individuals. One person increased his verbal output but without close monitoring, so also increased his errors. The other participant decreased his output but monitored it more closely, and so decreased the errors. These strategies were reflected in the changes in activation between scans, i.e. increases in temporal areas for the increased output and bilateral decreases in the anterior cingulate and left pre-motor areas for the decreased output case. Together these results imply that the participants continue to use individual strategies which for many of the neuropsychological tasks produced gains. Further investigation of whether it is possible to change idiosyncratic strategy use is needed if we are to develop the efficacy of this remediation technique.

BackgroundCognitive remediation (CR) aims primarily to improve cognition and functional outcomes. However, a limited number of studies reported a positive effect on symptoms. This limited effect may be because the symptom clusters considered are too broad and heterogeneous. This study explores, for the first time, the effect of CR on five empirically defined symptom dimensions of schizophrenia.MethodParticipants were patients with schizophrenia taking part in a randomised controlled trial comparing CR plus treatment as usual (CR, N = 43) to treatment as usual (TAU, N = 42). All participants were assessed at baseline and 14-weeks (i.e. at the conclusion of treatment for the CR group) with the Positive and Negative Symptoms Scale (PANSS). Five symptom dimensions were derived from the PANSS scores: Positive (POS), Negative (NEG), Disorganised (DIS), Excited (EXC) and Emotional Distressed (EMD).ResultsAfter CR, the therapy group had a significant reduction in DIS and NEG symptom dimensions compared to the TAU group. The traditional PANSS factors showed no effect of CR on symptoms.ConclusionCR can have not only a positive effect on disorganisation but also on negative symptoms. Using detailed symptom dimensions can characterise more accurately the effect of CR on symptom of schizophrenia.

Background Persistent auditory hallucinations are common, disabling and difficult to treat. Cognitive behavioural therapy is recommended in their treatment though there is limited empirical evidence of the role of cognitive factors in the formation and persistence of voices. Low self-esteem is thought to play a causal and maintaining role in a range of clinical disorders, particularly depression, which is prevalent and disabling in schizophrenia. It was hypothesized that low self-esteem is prominent in, and contributes to, depression in voice hearers. Methods Beliefs about persistent auditory hallucinations were investigated in 82 patients using the Beliefs About Voices Questionnaire — revised in a cross-sectional design. Self-esteem and depression were assessed using standardized measures. Results Depression and low self-esteem were prominent as were beliefs about the omnipotence and malevolence of auditory hallucinations. Beliefs about the uncontrollability and dominance of auditory hallucinations and low self-esteem were significantly correlated with depression. Low self-esteem did not mediate the effect of beliefs about auditory hallucinations- both acted independently to contribute to depression in this sample of patients with schizophrenia and persistent auditory hallucinations. Conclusions Low self-esteem is of fundamental importance to the understanding of affective disturbance in voice hearers. Therapeutic interventions need to address both the appraisal of self and hallucinations in schizophrenia. Measures which ameliorate low self-esteem can be expected to improve depressed mood in this patient group. Further elucidation of the mechanisms involved can strengthen existing models of positive psychotic symptoms and provide targets for more effective treatments.

Background Schizophrenia with an onset in adolescence is known to be associated with a poorer outcome and cognitive difficulties. These impairments have an impact on quality of life and represent treatment targets. Cognitive remediation therapy (CRT) attempts to improve cognitive deficits by teaching information processing strategies through guided mental exercises. The objective of this study is to evaluate the efficacy of CRT in alleviating cognitive deficits compared to treatment as usual and explore the mediating and moderating effects of cognitive improvement. Method Single-blind randomized controlled trial with two groups, one receiving CRT (N21) and the other standard care (N19) assessed at baseline, 3 months (post therapy) and follow-up (3 months post therapy). Participants were recruited from specialist inpatient and community mental health services and were young patients with recent onset schizophrenia (average age of 18) and evidence of cognitive and social behavioural difficulties. The intervention was individual cognitive remediation therapy delivered over a period of 3 months with at least three sessions per week. The main outcome measures were cognition (memory, cognitive flexibility and planning) and secondary outcomes (symptoms, social contacts and self-esteem). Results Compared to standard care, CRT produced significant additional improvements in cognitive flexibility as measured by the Wisconsin Card Sort Test (WCST). Therapy moderated the effects of improved planning ability on symptoms such that improvements only had a beneficial effect when they were achieved in the context of CRT. Improvements in cognition in all domains had a direct effect on social functioning and improvements in WCST had a direct effect on overall symptom improvement. Conclusions Cognitive remediation therapy can contribute to the improvement in WCST even in adolescents. The changes in cognitive outcomes also contributed to improvements in functioning either directly or solely in the context of CRT. Evidence of the mediator and moderator effects of cognitive changes should lead to more effective therapy development.

of association was tested by inspection of the OR over the thirds of the inflammatory marker distribution. Regression models were adjusted for age, sex, body mass index, ethnicity, social class, past psychological and behavioural problem, and maternal post-natal depression. Results: At age 18 years, 101 participants reported psychotic experiences (4.0%), 35 met the criteria for psychotic disorder (1.4%), and 423 met the criteria for depression (17.2%) (all based on clinical interviews). Participants in the top third of IL-6 values compared with the bottom third at age 9 years were more likely to develop psychotic experiences at age 18 years (adjusted OR 1.81 (95% CI 1.01 to 3.28). The risks of psychotic disorder and of depression at age 18 years were also increased with higher IL-6 at baseline; adjusted OR 2.40 (95% CI 0.87 to 6.62) and 1.55 (95% CI 1.13 to 2.14), respectively. In addition, the associations between serum IL-6 at age 9 years and the risks of psychotic experiences and depression at age 18 years were consistent with a dose-response relationship. The results remained virtually unchanged using the questionnaire measure of depression. Discussion: Higher levels of the systemic inflammatory marker IL-6 in childhood is associated with the risk of subsequent psychosis and depression. Processes in the inflammatory pathway may be therapeutic targets for these disorders. Inflammation might explain the high comorbidity between cardiovascular disease, diabetes, schizophrenia and depression.

The current study investigates whether an executive processing measure, response inhibition, is stable over time and across new samples of patients with schizophrenia. Two groups of patients (with and without diagnoses of schizophrenia) were followed up 6 years after baseline data collection. Another separate group of patients with less institutionalized care also completed the same measures to determine whether the response inhibition difficulties had the same prevalence in this new sample.The response inhibition measure was stable over time only in the group of patients with a diagnosis of schizophrenia. The relationship between symptoms and response inhibition difficulties changed over time but was explicable in terms of the interaction between environmental demands and information processing difficulties. The level of response inhibition difficulties (about one-third) was identical in the new sample of patients, which suggests that response inhibition is not dependent on clinical history.

Patients with schizophrenia have been described as being poor at processing Gestalt aspects of stimuli, but efficient in processing their local aspects. The present study examined Gestalt processing in normal subjects classified according to the positive dimensions of schizotypy. It further explored whether the Gestalt deficit is due to a more fundamental deficit in rapid global processing which occurs at an early stage and precedes local processing. In addition, it was postulated that the right hemisphere should be more involved in dysfunctional global processing. Thirty-three normal individuals assessed as having high or low scores on schizotypy scales were asked to recall the name of a set of hierarchically formed letters in a divided visual field paradigm. The results support a deficit in involuntary rapid global processing and an underlying right-hemisphere dysfunction in high scorers on the unusual experiences' (UnEx) and STA scales of schizotypy. This indicates that in such subjects local stimuli excessively intrude into the processing of global information in the right hemisphere.

Background: Cognitive remediation has demonstrated effectiveness in increasing cognitive performance, and when combined with psychosocial interventions to have moderate effects on social functioning. Recent research has suggested that cognitive remediation my favorably impact vocational outcomes. Given the effort and expense of providing cognitive interventions it is important to determine who needs this added treatment in order to benefit from other rehabilitation services. In an earlier report, we found that those with lower community functioning were more likely to obtain competitive employment in a supported employment (SE) program if they received cognitive remediation as compared to a control group who received SE services alone. Those with better community functioning were just as likely to obtain competitive employment whether or not they received cognitive remediation. In this study, we report on a similar analysis with a much larger sample of subjects. Methods: Subjects (N=174) with schizophrenia or schizoaffective disorder were recruited from an urban community mental health center and assigned to receive a year of supported employment or a year of supported employment augmented with cognitive remediation services. Subjects were followed for an additional year. Cumulative rates for obtaining competitive employment were calculated. Baseline assessments included background and illness characteristics, the Quality of Life Scale (QLS), and neurocognitive assessments. χ2 Results: Using the median score of the QLS total at baseline, subjects were categorized as Low Community Functioning (LCF, n=90) or Higher Community Functioning (HCF, n=84). Logistic regression and chi-square analyses comparing rates of employment by Community Function (Low, Higher) and Condition (Cog Rem, No Cog Rem) found significant main effects (p

bipolar I patients: p=0.013). Discussion: Both remitted patients with schizophrenia and bipolar disorder I in the present study were impaired in the perception of affective prosody as compared with healthy individuals. In contrast, the direct comparison of the two patient groups yielded no significant differences in this regard. Our finding suggests that difficulties in the perception of affective prosody are not restricted to acute episodes of the disorders, but represent a more enduring deficit that might contribute to the interpersonal and occupational problems observed in both patient groups even during interepisode recovery.

and not in the context of a clinical trial. For instance is it as effective or cost-effective to provide therapy in a group rather than individually? Are the effects dependent on the expertise of the therapist? Should CBTp be confined to those who are treatment resistant who are often more chronic and stable patients or is it helpful to thosewhoare also in the acute stage? This symposium will try to answer these questions and inparticular investigate howCBTmethodology has been extended for use with other groups and with targets other than positive symptoms. The speakers are experts both in research and practice in the field. They will report on new findings from meta-analyses, randomised controlled trials of new therapies as well as new smaller feasibility and pilot studies. The papers will provide evidence to guide researchers and clinicians in the next stages of trial design and service improvement. In particular it will aid the process of service development from the guidance of several countries. The speakers represent the cutting edge of cognitive behaviour therapy and are all practitioners from across Europe.

This study investigated whether executive impairments are predictive of the poor functional outcome found in the Psychomotor Poverty syndrome of schizophrenia. Functional impairments in a supermarket-shopping task were investigated in a cross-sectional study of three groups of participants: those with and those without psychomotor poverty symptoms and normal controls. Groups were matched for age, sex, premorbid IQ and memory function. Novel measures of real-life skills were developed which emphasised relevant executive processes within the shopping task. Four executive tasks were also administered which provided six measures of working memory, initiation and strategy use. The psychomotor poverty group demonstrated verbal working memory, spatial strategy and verbal initiation impairments and greater impairment in functional accuracy and strategic efficiency on the shopping task compared to the non-psychomotor poverty group and normal controls. The nonpsychomotor poverty group were more efficient than controls in some real-life skills. Verbal working memory independently predicted functional accuracy and efficiency in relation to other executive processes. Neither verbal working memory nor general memory independently predicted accuracy or the majority of efficiency measures. Experimentally determined executive impairments are ecologically valid in their impact on functional outcome in schizophrenia. Verbal working memory may constitute an important mediator of the relationship between poor verbal memory and poor functional outcome in the psychomotor poverty syndrome. These findings provide a theoretical framework through which cognitive remediation programmes may be developed to enhance generalisable executive and real-life skills and improve the poor functional outcome in the psychomotor poverty syndrome of schizophrenia.