Asian Journal of Psychiatry 25 (2017) 109117

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Asian Journal of Psychiatry

journal homepage: www.elsevier.com/locate/ajp

Review article

Cognitive rehabilitation for patients with schizophrenia in Korea

Won Hye Leea , Woo kyeong Lee, PhDb,*
a
National Center for Mental Health, Korea
b
Department of Counseling Psychology, Seoul Cyber University, 193-15, Mia Dong, Gang Buk Gu, Seoul, 142-700 Korea

A R T I C L E I N F O A B S T R A C T

Article history:
Received 1 October 2015 Psychosocial rehabilitation programs received mental health professional support in addition to
Received in revised form 31 July 2016 traditional medication therapy. Many psychosocial programs were developed since the 1990s, including
Accepted 7 October 2016 cognitive remediation therapy. In this review, we focus on cognitive remediation therapy in Korea since
the 1990s. We review several cognitive rehabilitation programs developed in Korea and their outcome
Keywords: studies and suggest future research directions and prospects. We reviewed cognitive rehabilitation
Cognitive remediation therapy programs including social cognitive training as well as more recent forms of computerized cognitive
Computerized cognitive rehabilitation rehabilitation. Although there are differences in cognitive domains by training targets, almost all
Social cognitive programs
neurocognitive remediation trainings in Korea have benecial effects on early visual processing, various
Functional outcomes
attention types, and executive function. Future studies need to investigate the mechanisms and various
mediators underlying the relationships between cognitive functions and functional outcomes. With
more comprehensive cognitive and social cognitive programs, we can enhance both cognition and
functional outcomes of the patients with schizophrenia.
2016 Elsevier B.V. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
2. Studies on neurocognitive remediation training in Korea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
3. Studies on social cognitive remediation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
4. Studies on computerized cognitive remediation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
5. Discussion and future direction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

1. Introduction cognitive impairments persist during the illness acute and

remission periods (Heaton et al., 2001; Morrison et al., 2006;
Cognitive decits are a core characteristic of schizophrenia and Simon et al., 2007) There is little evidence of a relationship
are related to functional outcomes. Researchers started conducting between positive symptoms (hallucinations, delusions) and
cognitive remediation studies in the 1980s in Western countries. cognitive function (Keefe and Harvey, 2008; Mohamed et al.,
However, development and outcome studies began to be 1999). However, there is consistent evidence supporting a
conducted in the mid-1990s in Korea. Patients with schizophrenia relationship between cognitive function and negative symptoms
show poor performance on most cognitive domains on neuro- (Addington et al., 1991). Cognitive functions are important
cognitive measures such as psychomotor speed, attention, vigi- considering their impact on practical aspects of daily life
lance, verbal learning, working memory, and executive functions functioning, social problem solving, interpersonal relationships,
(Green et al., 2004; Keefe et al., 2006; Palmer et al., 1997). Such and quality of life (Bozikas and Andreou, 2011; Evans et al., 2004;
Green et al., 2004; Szoke et al., 2008). Recently, social cognitive
functions have also been considered important to functional
outcomes. In particular, consistent evidence showed that social
* Corresponding author. cognition can mediate the relationship between neurocognitive
E-mail addresses: berbetlee@hanmail.net (W.H. Lee), wisemind96@iscu.ac.kr
function and functional outcomes (Green et al., 2014). Meta-
(W.k. Lee).

http://dx.doi.org/10.1016/j.ajp.2016.10.010
1876-2018/ 2016 Elsevier B.V. All rights reserved.
110 W.H. Lee, W. Lee / Asian Journal of PsychiatryAJP 25 (2017) 109117
analysis showed that neurocognition is related to social skill
acquisition such as problem solving, attention, and vigilance.
Furthermore, the association between social cognitive domains
such as theory of mind, emotional processing, and social
perception and functional outcomes including community func-
tioning is stronger than that of neurocognitive function and
functional outcomes (Fett et al., 2011). Many studies showed that
social cognition has signicant relationships to neurocognitive
function on one hand and to job function and social community
functioning on the other hand. Thus, a direct relationship between
neurocognitive function and functional outcomes is reduced when
social cognition is entered into a model (Schmidt et al., 2011).
In Korea, several studies were also conducted to investigate the
relationship between cognition and psychosocial functions of
Schizophrenia. These studies (Choi et al., 2002; Sea, 2009; Son
et al., 2000) showed that neurocognitive functions, such as
auditory-verbal memory and executive function were signicant
variables to predict social and occupational functions. These
neurocognitive functions also signicantly predicted the subjec-
tive quality of life (Choi et al., 2002). A recent study (Ko and Lee,
2016) showed that the Perceptual Reasoning Index of the WAIS-IV
was signicant in correlation to the independent living skills in
patients with chronic schizophrenia. They also found that the
Verbal Comprehension Index and the Working Memory Index of
the WAIS-IV were signicant in correlation to the insight measured
by the Scale to assess Unawareness of Mental Disorder (SUMD).
Therefore, cognitive decit interventions and clinical symptom
reduction for daily life adaptation and community functioning of
patients with schizophrenia are important. Early researchers
suggested that decit interventions for patients with schizophre-
nia emphasize problem strategy acquisition (Meichenbaum and
Cameron, 1973) or thought provoking (Platt and Spivack, 1972);
this did not lead to further studies. Since then, limitations of
medical therapy only were suggested and the necessity of
cognitive remediation was emphasized, as neurocognitive decits
can cause adaptation problems (Spohn and Strauss, 1989). Brener
et al. developed Integrated Psychological Therapy (IPT) to reduce
cognitive decits and improve social function (Brenner et al., 1987;
Roder et al., 1987). Bellack (1992) suggested that cognitive decits
should be remediated for effective psychosocial rehabilitation and
its prospects were relatively promising. Since then, various
cognitive remediation programs have been developed based on
evidence showing the relationship between cognitive decits and
functional outcomes.
Recently, differences in particular cognitive remediation
approaches for patients with schizophrenia are apparent. Almost
all focus on behavioral training for improving neurocognition and
social cognition (Wyke et al., 2011). As dened by the Cognitive
Remediation Experts Workshop (Florence, Italy, April 2010),
cognitive remediation approaches are a behavioral training based
intervention that aims to improve cognitive processes such as
attention, memory, executive function, social cognition or meta-
cognition, with the goal of durability and generalization.(Wykes
et al., 2011, p472) Neurocognitive remediation remediates decits
of basic information processing, such as attention, memory, and
learning executive function, while training for improving social
cognition focuses on complex social information processing such
as emotional recognition and expression, social perception, and
theory of mind (Miller and Porter, 1988; Green, 1999).
Meta-analyses of cognitive remediation for patients with
schizophrenia have proven its effects (Grynszpan et al., 2010;
McGurk et al., 2009; Wyke et al., 2011). When combined with
psychosocial rehabilitation programs, it is more effective and
generalized to psychosocial function, especially for stable symp-
tom periods of patients with schizophrenia. Effects of cognitive
remediation programs on clinical symptoms are weak, but have
reduced negative symptoms and enhanced motivation (Elis et al.,
2013; Sanchez et al., 2014; Wyke et al., 2011).
In the late 1990s in Korea, the completely revised Mental Health
Act shifted the focus for people with chronic mental illness from
traditional inpatient programs to community return and adapta-
tion. Psychosocial rehabilitation programs received mental health
professional support in addition to traditional medication therapy.
Many psychosocial programs were developed since the 1990s,
including cognitive remediation therapy. In this review, we focus
on cognitive remediation therapy in Korea since the 1990s. We
reviewed fourteen articles regarding cognitive rehabilitation
programs developed in Korea for patients with schizophrenia
and their outcome studies. These articles were identied through a
computer-based search of RISS (Korea Education and Research
Information Service) and Pubmed from 1990 to 2015 using
combinations of the following key words: cogn*, social cognition,
emotion* management, rehabilitation, remediation, enhancement,
training, schizophrenia and Korea. We also suggest future research
directions and prospects (Table 1).
2. Studies on neurocognitive remediation training in Korea
Early neurocognitive remediation programs in Korea began in
the mid-1990s; most early programs were based on IPTs Cognitive
Differentiation Training (CDT; Brenner et al., 1994). CDT improved
cognitive function through card sorting exercises, verbal concept
exercises, and object guessing exercises. Lee et al. (1998) developed
the Cognitive Rehabilitation Program based on Brenner's IPT and
investigated CDTs effects on cognitive functioning of patients with
schizophrenia. They trained three CDT stages for 12 sessions, three
times weekly, 60 min each session. The comparison group received
psychosocial education for same time and period by psychiatric
nurses. There were signicant interaction effects between time
and group on reaction time (F = 5.18, p < 0.05), decision reaction
time (F = 6.00, p < 0.05) on the Vienna Test, and information
processing speed. However, there were no signicant effects on the
General Memory Index, Delayed Memory Index, or attention and
concentration measures of the Wechsler Memory Scale-Revised
(1987).
Lee et al. (1999) modied CDT to a Korean-Cognitive
Differentiation Program (K-CDP) and executed an outcome study.
The K-CDP combined categorization exercises and crossword
puzzles on verbal concept exercises, the three CDT stages, and
visual attention exercises, not included in the original CDT. The
participants were randomly assigned to K-CDP or control groups.
The K-CDP group (N = 14) received it twice weekly for 11 weeks (22
sessions), 60 min each session. The control group (N = 14) received
psychosocial education for the same period and number of
sessions. There was a signicant interaction effect between time
and groups on the arithmetic subtest (F = 6.35, p < 0.05) of the
Korean-Wechsler Adult Intelligence Scale-Revised (K-WAIS-R), but
there were no signicant interaction effects between time and
group on other subscales of the K-WAIS-R. There was also a
signicant effect on the problem solving skill subscale (F = 4.88,
p < 0.05) of the self-reported Social Problem Solving Inventory. On
the other hand, there was no signicant interaction effect between
time and group on the problem orientation scale. Comparison of
the Positive and Negative Syndrome Scale (PANSS) scores showed
that the groups did not differ signicantly on positive or negative
symptoms, or general psychopathology. K-CDP can improve
sustained attention, but social problem solving skill and psycho-
pathology did not improve (Table 2).
Cho et al. (2004) investigated CDT effects using general
neurocognitive measures and a psychosocial function scale. They
also investigated the association between cognitive function
improvement via cognitive training and psychosocial functioning.
Table 1
Neurocognitive Rehabilitation Program for the patients with Schizophrenia in Korea.

Study Sample Cognitive Rehabilitation Control Condition Age Gender Duration Intensity of Training Outcomes Measures Major Findings
Training (Mean) (% of Illness (total sessions)
Male) (years)
Lee 26 inpatients with Cognitive Differentiation Psychoeducation 28.2 65.4 7.0 Three 60-min sessions per Wechsler Memory Scale-Revised CDT participants
et al. schizophrenia Training(CDT) of Integrated wk for 4 wk (WMS-R), Decision Reaction Test of improved on reaction
(1998) Psychological Therapy(IPT) [12] Vienna Test time and decision reaction
time relative to controls
Lee 28 inpatients with Korean-Cognitive Psychoeducation 34.2 46.4 10.0 Two 60-min sessions per Arithmetic(AR), Vocabulary(VC), K-CDT participants
et al. schizophrenia DifferentiationProgram(K-CDP) wk for 11 wk Similarities(SI) and Picture completion improved on AR subtest of

W.H. Lee, W. Lee / Asian Journal of PsychiatryAJP 25 (2017) 109117

(1999) [22] (PC) subtests K-WAIS and problem
of Korean version of Wechsler solving skill subscale of
Intelligence Scale Revised(K-WAIS), SPSI relative to controls
Positive and Negative Symptoms Scale
(PANSS), Social Problem-Solving
Inventory(SPSI)
Cho 24 outpatients with Cognitive Differentiation Psychoeducation 33.3 50 8.7 Two 90-min sessions per Korean version of Wechsler Intelligence CDT participants
et al. schizophrenia in Training(CDT) of Integrated wk for 12 wk Scale Revised(K-WAIS), Stroop Color- improved on measures of
(2004) community mental Psychological Therapy(IPT) [24] Word Test(STWT), Wisconsin Card attention, problem solving
health center Sorting Test(WCST), Behavioral and interpersonal
Symptoms Identication Scale-32 relationships relative to
(BAIS-32), Relationship Change Scale controls but not on other
(RCS), Problem Solving Inventory(PSI) psychosocial skills and
symptoms
Lee 30inpatientswith Cognitive Behavioral General 39.5 50 13.7 One 60-min session per WARD7 Short form-Korean Wechsler CBRT participants
et al. schizophrenia Rehabilitation Training (CBRT) psychosocialrehabilitation wk for 20 wk Adult Intelligence Scale (WARD7- improved on SPAN
(2001) group, Treatment as usual [20] KWIS), Degraded Stimulus Continuous relative to controls
(TAU) Performance Test (DS-CPT), The Span of
Apprehension (SPAN), Word uency
test (Animal category uency & 3-word
Phonemic uency)

111
 112
Table 2
Social Cognitive Rehabilitation Program for the patients with Schizophrenia in Korea.

Study Sample Cognitive Rehabilitation Control Age Gender Duration Intensity Outcomes Measures Major Findings
Training Condition (Mean) (% of Illness of Training
Male) (years) (total
sessions)
Cho 53 inpatients and Emotional management Training Attention 29.0 51 6.1 Two60- Trait Meta-Mood Scale-short form(TMMS-S), Paired EMT participants improved on visual
et al. outpatients with (EMT) (Brenner et al., 1992; placebo group min Associate Learning of WMS-R, Similarities subtest of perception of SPS, SPSI, positive
(1999) schizophrenia Brenner et al., 1997) received sessions K-WAIS, Social Perception Scale(SPS), Social Problem symptoms and general
psychoeducation per wk for Solving Inventory(SPSI), PANSS psychopathology of PANSS relative to
12 wk controls

W.H. Lee, W. Lee / Asian Journal of PsychiatryAJP 25 (2017) 109117

[24]
Won 52 outpatients with Emotional Management Nursing General mental NR 61.5 Not One 60- Berkeley Expressivity Questionnaire(BEQ), Emotional EMNP participants improved on
et al. schizophrenia in Program (EMNP) Revised Yongin health service Presented min Behavior Scale (EBS), Relationship Change Scale(RCS), emotional expression, emotional
(2012) community mental Emotional management Training group session per Social Behavior Scale(SBS) behavior, interpersonal relationship
health center (Y-EMT) (Lee et al., 2004) wk for 8 and social behavior relative to
wk controls
[8]
Kwon 31 outpatients in Social Cognition Enhancement Treatment as 36.3 34 13.9 One Picture Arrangement (PA) subtest Korean Wechsler SCET participants improved on
and community mental Training (SCET) usual(TAU) 60  90- intelligence Scale for Child-revised(KEDI-WISC), independent living skill relative to
Koh health center and min Social Living Skill Scale(SLSS), Independent Living controls
(2002) inpatients with session per Skill Survey (PEI), Social Perception Scale(SPS)
schizophrenia wk for
10wk
[10]
Choi 34 outpatients with Social Cognition Enhancement Standard 32.0 56 11.0 Two 90- Picture Arrangement (PA) subtest of KEDI WISC, SECT participants improved on PA
and schizophrenia Training (SCET) psychosocial min Social Behavior Sequencing Task(SBST), Emotion subtest relative to controls
in community mental
Kwon (2006) rehabilitation sessions Recognition Test(ERT)
health center per wk for
24wk
[36]
Kim 37 outpatients with Theory of mind Training (TMT) Standard 38.3 75.6 16.5 Two 60- False Belief task, Faus pax task, Hinting task, Picture TMT participants improved on faux
et al. schizophrenia in revised Social Cognition psychosocial min Arrangement (PA) subtest of KEDI WISC, Social pas task, hinting task, social living
(2013) community mental Enhancement Training (SCET) rehabilitation sessions Behavior Sequencing Task(SBST), Social Living Skill skill relative to controls
health center per wk for Scale(SLSS), Independent Living Skill Survey (PEI)
8 wk
[16]
 W.H. Lee, W. Lee / Asian Journal of PsychiatryAJP 25 (2017) 109117
The participants were assigned randomly to CDT (N = 12) or control
groups (N = 12), and received psychoeducation training twice
weekly for three months for 90 min (24 sessions). The pre-post
differences showed that the cognitive rehabilitation group only
showed improvement on all Wisconsin Card Sort Test subscales
(except total number of categories), STROOP test, interpersonal
relationship, and problem solving areas. However, there were no
effects on other psychosocial functioning and psychiatric symp-
toms.
Green et al. (2000) suggested a new model of the relationship
between specic neurocognitions and functional outcomes; social
cognition can be mediated by these two variables. Lee et al. (2001)
developed a cognitive remediation program, named Cognitive
Behavioral Rehabilitation Training (CBRT), based on Greens model,
to target of specic neurocognitive functions enhancement,
differently affecting psychosocial functioning, and executed an
outcome study. CBRT consists of training low cognitive functioning
levels (orientation, attention, concentration, memory) to high
levels of cognitive functioning (organization, reasoning). They
compared shortcomings of previous cognitive remediation pro-
grams and enhanced generalization and ecological validity. First,
they included compensatory strategies to minimize refractory
cognitive decits as well as cognitive remediation via repetitive
training. Second, CBRT included daily life activities (e.g., shopping,
packing a suitcase, planning a route, traditional play, etc.) to enhance
generalization of cognitive training effects using the experimental
design. They also emphasized the familiarity of daily stimuli
reected in Korean cultures (e.g. clothes, food, toys, furniture, home
appliances, etc.). Third, the program focused on the denition,
characteristics, and effects of cognition on daily life. They
conducted an outcome study with chronic patients who had been
ill for at least ve years. The inpatients were assigned to CBRT
(N = 12), general psychosocial rehabilitation (N = 9), and control
groups (N = 9). The CBRT and general psychosocial rehabilitation
groups received 20 sessions of 60 min once weekly for ve months.
The control group received antipsychotic medication and general
interviewing routinely for the same period. The CBRT group
showed signicant interaction effects between time and group on
12 matrices of the Span of Apprehension(SPAN) Program for IBM-
Compatible Microcomputers Version 5.3 (Asarnow and Nuechter-
lein, 1999a), whereas there were no signicant effects on CPT:
Degraded stimulus Continuous Performance Test(DS-CPT) Pro-
gram for IBM-Compatible Microcomputers Version 8.12 (Asarnow
and Nuechterlein, 1999b), Word uency test: Animal category &
phonemic uency test.
In short, the rst neurocognitive rehabilitation program for
schizophrenia started in Korea was based on Brenners CDT. Later
on, CBRT was developed by applying stimuli based on Korean
culture and lifestyle. It was improved through appliance of
generalization and ecological validity. These neurocognitive
rehabilitation training groups compared to other psychosocial
rehabilitation groups or TAU groups showed signicant improve-
ment in early visual processing speed and attention. Some studies
identied the improvement of problem solving skills and
interpersonal relationships through neurocognitive rehabilitation.
However, studies concerning neurocognitive rehabilitations effect
on functional outcomes are still lacking and more research is
needed (Table 3).
3. Studies on social cognitive remediation
Increasing evidence shows that social cognitive decits and
cognitive decits mediate the relationship between neurocogni-
tion and functional outcomes in patients with schizophrenia
(Kurtz and Richardson, 2012). Therefore, many psychosocial
rehabilitation programs emphasize social cognitions importance
113
and include it combined with cognitive training with medical
treatment and cognitive rehabilitation (Cameron et al., 2012;
Stephen, 2006). In Korea, since the 1990s, the social cognitive
domain has been combined with cognitive remediation programs
and included social cognitive outcome measures.
Cho et al. (1999) modied Emotional Management Training
(EMT) developed by Brenner et al. (1992) and Brenner et al. (1997)
and conducted an outcome study. Study participants were 53
chronic patients with schizophrenia. The treatment group (N = 30)
received EMT twice weekly for 12weeks, 60 min each session. The
original EMT by Hodel and Brenner (1997) used still pictures as
visual material; Cho et al. used video clips edited via TV drama and
cinema to enhance understanding of social situations in the Korean
EMT. The video clip included basic emotion cards such as
happiness, sadness, surprise, disgust, and contempt; each emotion
was displayed by facial expressions and script. The video clip was
segmented to 12 min each, because attention spans of patients
with schizophrenia were short. The eight EMT stages were as
follows: description and analysis of depicted emotion in each video
clip, description of patients emotion similar to presented
situations or settings, description of patients coping strategies
and behavioral consequences about emotional experience, alter-
native coping strategy elaboration, analysis of coping strategy
adequacy, coping strategy individualization and selection, selected
strategy role plays, and individual coping strategies. Training
outcomes showed signicant interaction effects between time and
groups on social perception-visual perception of the Social
Perception Scale(SPS) (An et al., 1998) (F = 4.56, p < 0.05), verbal
uency (F = 5.45, p < 0.05), PANSS positive symptoms (F = 4.08,
p < 0.05), PANSS general psychopathology (F = 4.45, p < 0.05), and
social problem solving (F = 4.10, p < 0.05). There were no interac-
tion effects on Trait Meta-Mood Scale-short form (TMMS-S)
(Salovey et al., 1995), verbal memory, verbal reasoning, social
perception-contextual perception of the Social Perception Scale
(SPS) (An et al., 1998), and negative PANSS symptoms.
Lee et al. (2004) developed Yongin Emotional Management
Training (Y-EMT), based on previous emotional processing decit
research (Bellack et al., 1992; Kerr and Neale, 1992), and
subcomponents of emotional intelligence by emotional intelli-
gence model (Mayer et al., 1990). Specically, Y-EMT consists of
four topics, including emotional recognition, emotional expres-
sion, emotional transformation, and emotional regulation, ve
sessions per topic (20 sessions). Won et al. (2012) conducted an
outcome study on the Y-EMT short form of eight sessions, 90 min
per session. Pre-post outcome measures showed that the Y-EMT
group (N = 22) showed signicant improvement on emotional
expression (t = 3.27, p < 0.05), emotional behavior (F = 61.65,
p < 0.001), interpersonal relationship (t = 4.01, 0 < 0.001), and
social behavior (t = 8.69, p < 0.001) compared to a general mental
health service group.
Kwon (2000) developed Social Cognition Enhancement Train-
ing (SCET) combined with two social perception and social skill
trainings. This program used cartoon stimuli including various
social situations. The rst training set focused on social perception
to understand the expressed cartoon protagonists emotion, judge
each social situation, and speculate on story development. Later in
the program, social skills training for adequate speech and
behaviors in each situation was introduced, role plays were
performed, feedback was provided, and nally more adaptive and
adequate behaviors in certain situations were rehearsed. Kwon and
Koh (2002) conducted a pilot study; the SCET group (N = 12)
showed signicant improvement of social skill ability (F = 13.36,
p < 0.001) compared to the medication only group
Choi and Kwon (2006) conducted a SCET randomized con-
trolled study with 34 patients with schizophrenia in a community
mental health service center. The SCET group participated in
 114
Table 3
Computer Based Cognitive Rehabilitation Program for the patients with Schizophrenia in Korea.

Study Sample Cognitive Control Condition Age Gender Duration Intensity of Outcomes Measures Major Findings
Rehabilitation (Mean) (% Male) of Illness Training
Training (years) (total
sessions)
An 21 inpatients with RehaCom Standard 24.6 52.4 Not Two 20-min Vigilance version 4.0 of Vienna Test, PANSS RehaCom participants improved on Vigilance
et al. schizophrenia in psychosocialrehabilitation Presented sessions per relative to controls
(1997) day care hospital wk for 5 wk
[10]
Jang 40 inpatients and Attention Typing exercise combined 39.2 Not 15.6 Three 40- Rey-Ostrerrieth Complex Figure Test(ROCF), CogRehab participants improved on ROCF, color-

W.H. Lee, W. Lee / Asian Journal of PsychiatryAJP 25 (2017) 109117

and outpatients with domain with medical therapy presented min Korea-California Verbal Learning Test(K-CVLT), word task of SCWT, negative symptoms and general
Kim schizophrenia Training of PSS group & only medical sessionsper Trail Making Test(TMT), Stroop Color-Word psychopathology of PANSS relative to controls
(2011) CogRehab therapy group wk for 6 wk Test(SCWT), WCST, K-WAIS, PANSS
[19]
Park 30 outpatients Executive General 40.4 50 16.5 Three 45- Rey-Ostrerrieth Complex Figure Test(ROCF), CogRehab participants improved on total error and
and with function recreationprogram min Korea-California Verbal Learning Test(K-CVLT), perseverative error of WCST, Forward and Backward
Kim schizophrenia in domain sessionsper Trail Making Test(TMT), Stroop Color-Word of DST relative to controls
(2015) community Training of PSS wk for 6 wk Test(SCWT), WCST, Digit Span Test(DST), PANSS
mental health CogRehab [18]
system
Lee 38inpatients with Computer Medical Therapy 43.7 52.6 17.2 One30-min Degraded Stimulus Continuous Performance CogTrainer participants improved most cognitive
et al. schizophrenia based sessionper Test (DS-CPT), The Span of Apprehension measures relative to controls, but not on false alarm
(2009) Attention wk for 12 (SPAN), Trail Making Test(TMT), Stroop Color- of DS-CPT
Training wk Word Test(SCWT), Digit Span Test(DST),
Program of [12]
CogTrainer
Lee 60inpatients with Computer Usual psychosocial 43.5 55 17.6 Two60-min Degraded Stimulus Continuous Performance CogTrainer participants improved hit rate and
(2013) schizophrenia in based rehabilitation sessions per Test (DS-CPT), K-WAIS, PANSS, Work Behavior sensitivity of DS-CPT, Forward and Backward of Digit
psychiatric Attention wk for 12 Inventory(WBI) Span, work quality and work habit of WBI relative to
rehabilitation Training wk controls, but not on psychiatric symptoms of PANSS
units Program of [24]
CogTrainer
 W.H. Lee, W. Lee / Asian Journal of PsychiatryAJP 25 (2017) 109117
training twice a week for six months (36 sessions). The SCET group
showed signicant interaction effects between time and group on
picture arrangement scores (PA) compared to a standard psycho-
social rehabilitation group, but showed no effects on a social
behavior sequencing test (SBST) or an emotional recognition test
(ERT). The SCET group showed that PA score increases after two
months; this improvement persisted at four and six months. The
SBST score enhancement at two months did not persist at four and
six months. There were no differences between groups on ERT
measures.
Previously, the social cognition domain focus was emotional
processing and social perception, but the social cognition
concept was expanded to attentional bias and theory of mind
(Couture et al., 2006). Kim et al. (2013) modied SCET (Kwon,
2000) and re-constructed a 16-session program based on 14
cartoons of Theory of mind(ToMs) about understanding others
mental states. This program compared cartoon protagonists
exercises about intentions, appropriateness, and deliberation.
An outcome study with patients with schizophrenia in a
community mental health center was conducted and compared
to a ToMs group combined with a general psychosocial program
and a psychosocial program only group. Signicant interaction
effects between time and groups on faux pas and hint tasks on
the ToMs assessment scales and social skills scores, but there
were no effects on the false belief task, social behavioral
sequencing, and interpersonal function.
In summary, social cognitive programs in Korea were developed
based on emotional processing, social perception, and theory of
mind. These programs proved to improve not only social cognitive
functions but also psychosocial functions such as interpersonal
relationships, social behavior and skills, and independent living
skills. However, most studies only conducted pre-post assessment.
In the future, programs including comprehensive social cognitive
domains such as Social Cognition and Interaction Training (SCIT)
(Comb et al., 2007), Social Cognitive Skills Training (SCST) (Horan
et al., 2011) and Koreas social and cultural context should be
developed. Furthermore, longitudinal effects of this program
should be conrmed.
4. Studies on computerized cognitive remediation
The neurocognitive decit patterns of patients with schizo-
phrenia is heterogeneous and differs in severity (Ermoli et al.,
2005; Weickert et al., 2000). Specic patient-centered cognitive
enhancement strategies are suggested (Lee, 2013; Reeder et al.,
2006). As an alternative, computer based cognitive training in
cognitive remediation is receiving increasing clinical and research
interest. In Korea, outcome studies of computerized cognitive
remediation programs adapted in other countries and Korea have
been conducted.
Schuhfried (1994) developed a computerized remediation
training program, RehaCom for patients with cognitive disorders
from brain damage. Each program was devised to provide specic
patient feedback based on performance results; the difculty level
was automatically modulated based on patients performances. An
et al. (1997) conducted an outcome study of vigilance training with
RehaCom with patients with chronic schizophrenia. Participants
were randomly assigned; the treatment group (N = 10) received
RehaCom combined with standard psychosocial rehabilitation
twice weekly for 20 min (10 sessions) and the control group
(N = 11) received psychosocial rehabilitation only. There was a
signicant interaction effect between time and group on a visual
vigilance scale.
Bracy (1994) developed a computerized cognitive remediation
program (PSS CogReHab), targeting attention, memory, problem
solving, executive functions, and visuospatial ability with patients
115
with schizophrenia. Several Korean researchers conducted out-
come studies (Jang and Kim, 2011; Park and Kim, 2015). In
particular, Jang and Kim (2011) modied the PSS CogRehab
attention domain and reported outcomes. They provided 19
sessions of computerized cognitive remediation training combined
with medical therapy three times weekly for six weeks for 40 min,
provided a comparison group (N = 10) with a typing exercise
combined with medical therapy for the same period, and provided
a control group (N = 10) medication only. Signicant interaction
effects between time and group were shown on visuospatial ability
(F = 5.284, p < 0.01), delayed visual memory (F = 4.313, p < 0.05),
selective attention (F = 3.341, p < 0.05), negative PANSS symptoms
(F = 3.280, p < 0.05), and general PANSS psychopathology
(F = 4.869, p < 0.05).
More recently, Park and Kim (2015) applied Korean PSS
CogRehab versions, specically executive functioning, and per-
formed an outcome study. The CogRehab group (N = 15) was
provided with recreation programs such as singing class, sports, or
cooking class combined with CogRehab, three times weekly, six
weeks, for 45 min (18 sessions); a control group (N = 15) received
recreation only. Signicant interaction effects between time and
group occurred on WCST total error (F = 4.05, p < 0.05), WCST
perseverative errors (F = 4.79, p < 0.05), Digit Span Forward
(F = 8.25, p < 0.01) and Digit Span Backward (F = 8.45, p < 0.01).
However, there was no interaction effect on symptoms and quality
of life.
Lee et al. (2008) developed a computerized cognitive
remediation program, (CogTrainer) focused on attention modules
based on previous research. CogTrainer consisted of 10 units
(three steps each) targeting vigilance enhancement, sustained
attention, working memory, selective attention, mental tracking,
and processing speed. Each step comprises real life-related
familiar stimuli provoking interests. This CogTrainer program
recorded each participants performance and provided feedback.
Lee et al. (2009) conducted a CogTrainer outcome study with
patients with chronic schizophrenia. The participants were
randomly assigned to one of two groups. The treatment group
(N = 19) was provided with the CogTrainer program combined
with medication once weekly for 30 min (12 sessions); the control
group (N = 19) received medication only. Signicant interaction
effects between time and group occurred on most cognitive
measures such as attention span, visual vigilance, sustained
attention, mental set shifting, selective attention, and working
memory. Another CogTrainer outcome study with chronic
schizophrenia (Lee, 2013) was performed. One group (N = 30)
was given CogTrainer combined with general psychosocial
rehabilitation, once or twice weekly, three months for 60 min.
The control group (N = 30) received usual psychosocial rehabili-
tation. Compared to the usual psychosocial rehabilitation group,
Cog-Trainer showed signicant improvements in attention,
working memory, and work quality and work habits subscales
of a work behavior inventory. However, there was no effect of
computerized cognitive training on symptoms. Additional analy-
sis showed a signicant correlation between changes in
sensitivity of the CPT and job quality.
From the late 2000s there has been an increase in studies and
development of computer based cognitive rehabilitation programs.
Studies based on PSS CogRehab were performed along with studies
through CogTrainer, a Korean program. These programs were
found to improve not only neurocognitive functions but also
occupational functions. Up to now computer based cognitive
rehabilitation programs have mainly been focused on neuro-
cognitive functions. In the future, it will be necessary to develop
computer based social cognitive rehabilitation programs using the
virtual reality technology and augmented reality too.
116 W.H. Lee, W. Lee / Asian Journal of PsychiatryAJP 25 (2017) 109117
5. Discussion and future direction
This is the rst review to analyze controlled cognitive
rehabilitation training outcome studies for Korean patients with
schizophrenia. We reviewed programs including social cognitive
training as well as more recent forms of computerized cognitive
rehabilitation.
Although there are differences in cognitive domains by training
targets, almost all neurocognitive remediation trainings in Korea
have benecial effects on early visual processing and various
attention types; several studies proved benecial effects on
executive function. Quality analysis via written feedback ques-
tionnaires among patients showed further cognitive rehabilitation
program benets. Participants noted brain activation such as I feel
that my IQ gets better due to cognitive training, my brain get
softer than before the training, and self-efcacy expressed in my
brain becomes more sophisticated and get condent in cognitive
ability (Lee, 2013, p.90). Lee (2013) reported benecial effects on
work behavior but the relationship between cognitive function
changes and functional outcomes was not sufciently addressed.
Generalizations to functional outcomes are still decient. Further-
more, using methodologically robust experimental designs,
comparison studies with various comparison groups, and various
patients (inpatients, community mental health center, outpatients,
etc.) will be necessary.
More recent forms of computerized neurocognitive remedia-
tion training have been applied to chronic patients and showed
benecial effects on a broad range of cognitive function domains
compared to traditional ofine-based neurocognitive remediation
trainings. Some researchers reported improvement of negative
symptoms and psychopathology reduction (Jang and Kim, 2011),
and job function improvement (Lee, 2013). Computerized cogni-
tive remediation programs tailored to specic patients can be
benecial to functional outcomes. Recently, Green et al. (2014)
reported that early visual perception can be a neurocognitive
domain affecting social cognition in models testing the relation-
ship of cognition and functional outcomes. Early visual perception
tasks can be more easily embodied in computerized cognitive
remediation programs in speed, quantity, and temporal accuracy.
However, previous computerized cognitive remediation programs
used stimuli or activities drawing on neuropsychological assess-
ment paradigms. This aspect provokes generalization issues. In
developing cognitive training programs, task should transfer
acquired cognitive ability to daily life.
Previous studies emphasized social cognitive functions more
than neurocognitive functions in improving functional outcomes.
However, social cognitive enhancement programs developed in
Korea mostly addressed limited areas of social cognition such as
emotional processing, social perception, and social cognition.
Recently, researchers suggested including attributional style and
theory of mind in social cognitive domains (Matthew et al., 2011);
outcome studies of social cognitive enhancement programs were
conducted (Comb et al., 2007; Horan et al., 2011). Therefore, in
Korea, we need to cover various social cognition domains and
conduct outcome studies. Various forms of computerized neuro-
cognitive remediation programs were developed and studied, but
computerized social cognition programs remain decient. Recent-
ly, IT technology has progressed; therefore, computerized social
enhancement programs combined with neurocognitive training
can be applied to daily problem solving such as interpersonal and
emotional management problems.
Defeatist beliefs and negative symptoms can also be important
variables that affect motivation and functional outcomes (Green
et al., 2014). The feasibility of behavioral activation techniques
originally for patients with depression can be applied to reduce
negative symptoms of patients with schizophrenia and to enhance
motivation (Mairs et al., 2011; Choi et al., 2012). In applying
cognitive skill to real life, cognitive remediation programs
combined with behavioral techniques for enhancing motivation
can be effective.
Among the reviewed studies, only one study (Choi and Kwon,
2006) was a Randomized Controlled Trial and the others were
conducted through case-controlled studies. The effectiveness of
programs was only shown through pre-post assessment; studies
regarding psycho-social function change were relatively small. In
the future, studies using RCTs should be conducted and longitudi-
nal and generalized effects should be investigated.
Cognitive rehabilitation training programs have made substan-
tial benets on cognition itself. The current cognitive remediation
programs are criticized by researchers, as the effects of training on
specic cognitive abilities have not necessarily generalized to
psychosocial functioning. Future studies need to investigate the
mechanisms and various mediators underlying the relationships
between cognitive functions and functional outcomes. With more
comprehensive cognitive and social cognitive programs, we can
enhance both cognition and functional outcomes of the patients
with schizophrenia.
References
Addington, J., Addington, D., Maticka-Tyndale, E., 1991. Cognitive functioning and
positive and negative symptoms in schizophrenia. Schizophr. Res. 5, 123134.
An, S.K., Oh, B.H., Hyun, M.H., Yoo, K.J., 1997. The effect of attention training using
computer-aided cognitive rehabilitation program (REHACOM) in Chronic
Schizophrenics. J. Korean Neuropsychiatr. Assoc. 36 (1), 7279.
Bellack, A.S., 1992. Cognitive rehabilitation for schizophrenia: is it possible? Is it
necessary?. Schizophr. Bull. 18, 4350.
Bozikas, V.P., Andreou, C., 2011. Longitudinal studies of cognition in rst episode
psychosis: a systematic review of the literature. Aust. N. Z. J. Psychiatry 45, 93
108.
Bracy, O.L., 1994. PSS CogReHAb Attention Manual. Psychological Software Services,
Inc., Indianapolis.
Brenner, H., Hodel, B., Roder, V., 1987. Cognitive therapy of schizophrenic patients:
poblem analysis and empirical result. Nervenarzt 58, 7283.
Brenner, H., Roder, V., Hodel, B., et al., 1994. Integrated Psychological Therapy for
Schizophrenic Patients. Hogrefe & Huber, Tronto.
Cameron, C.D., Bron-Iannuzzi, J.L., Payne, B.K., 2012. Sequentail priming measures of
implicit social cognition: a meta-analysis of associations with behavior and
explicit attitudes. Pers. Soc. Psychol. Rev. 16, 330350.
Cho, H.S., Lee, M.H., Choi, M.J., Sohn, S.H., Choe, E.H., Lee, E.C., Choi, T.K., Kim, T.Y.,
Ahn, H.R., Paik, M.J., Yoo, K.J., 1999. Effects of emotional management training in
schizophrenic patients. J. Korean Neuropsychiatr. Assoc. 38 (6), 12231233.
Cho, S.J., Lee, S.M., Jeong, E.H., Kwon, H.C., 2004. The effects of neurocognitive and
social function of cognitive rehabilitation training for schizophrenic patients.
Korean J. Clin. Psychol. 23 (3), 559575.
Choi, K.H., Kwon, J.H., 2006. Social cognition enhancement training for
schizophrenia: a preliminary randomized controlled trial. Commun. Ment.
Health J. 42 (2), 177187.
Choi, S.C., Kim, K.J., Paik, Y.S., Oh, S.W., Kim, J.H., 2002. The relationship of
neurocognitive function, symptoms, social cognition and social function in
patients with schizophrenia. J. Korean Neuropsychiatr. Assoc. 41 (3), 430441.
Choi, K.H., Saperstein, A.M., Medalia, A., 2012. The relationship of trait to state
motivation: the role of self-competency beliefs. Schizophr. Res. 139, 7377.
Comb, D.R., Admas, S.D., Penn, S.L., et al., 2007. Social Cognition and Interaction
Training (SCIT) for inpatients with schizophrenia spectrum disorders:
preliminary ndings. Schizophr. Res. 91, 112116.
Couture, S.M., Penn, D.L., Roberts, D.L., 2006. The functional signicance of social
cognition in schizophrenia: a review. Schizophr. Bull. 32 (Suppl. 1), S44S63.
Elis, O., Caponigro, J., Kring, A.M., 2013. Psychosocial treatment for negative
symptoms in schizophrenia: current practices and futures directions. Clin.
Psychol. Rev. 33, 914928.
Ermoli, E., Anselmetti, S., Bechi, M., Cocchi, F., Smerald, I.E., Cavallaro, R., 2005.
Assessment of psychosis in schizophrenia: neuropsychological prole of
chronic schizophrenia. Clin. Neuropsychiatry 4, 243249.
Evans, J.D., Bond, G.R., Meyer, P.S., et al., 2004. Cognitive and clinical predictors of
success in vocational rehabilitation in schizophrenia. Schizophr. Res. 70, 331
342.
Fett, A.-K.J., Viechtbauer, W., Dominguez, M.-G., Penn, D.L., Os, J., &van Krabbendam,
L., 2011. The relationship between neurocognition and social cognition with
functional outcomes in schizophrenia: a meta-analysis. Neurosci. Biobehav. Rev.
35, 573588.
Green, M.F., Kern, R.S., Braff, D.L., Mintz, J., 2000. Neurocognitive decits and
functional outcome in schizophrenia: are we measuring the right stuff.
Schizophr. Bull. 26, 119136.
 W.H. Lee, W. Lee / Asian Journal of PsychiatryAJP 25 (2017) 109117
Green, M.F., Neuchterlein, K.H., Gold, M., Barch, D.M., Choen, J., Essock, S., Fenton, W.
S., Frese, F., Goldberg, T.E., Heaton, R.K., Keefe, R.S.E., Kern, R.S., Kraemer, H.,
Stover, E., Weinberger, D.R., Zalcman, S., Marder, S.R., 2004. Approching a
concensus cognitive battery for clinical trials in schizophrenia: the NIMH-
MATRICS conference to select cognitive domains and test criteria. Biol.
Psychiatry 56, 301307.
Green, M.F., Harris, J.G., Neuchterlein, K.H., 2014. The MATRICS consensus cognitive
battery: what we know 6 years later. Am. J. Psychiatry 171, 11511154.
Green, M.F., 1999. Should schizophrenia be treated as a neurocognitive disorder?
Schizophr. Bull. 25, 309319.
Grynszpan, O., Perbal, S., Pelissolo, A., et al., 2010. Efcacy and specicity of
computer-assisted cognitive remediation in schizophrenia: a meta-analytical
study. Psychol. Med. 41, 163173.
Heaton, R.K., Gladsjo, J.A., Palmer, B.W., Kuck, J., Marcotte, T.D., Jeste, D.V., 2001.
Stability and course of neuropsychological decits in schizophrenia. Arch. Gen.
Psychiatry 58 (1), 2432.
Hodel, B., Brenner, H.D., 1997. A new development in integrated psychological
therapy for schizophrenic patients(IPT): First result of emotiona lmanagement
training. In: Brenner, H.D., Boker, W., Genner, R. (Eds.), Toward a Comprehensive
Therapy for Schizophrenia. Hogrefe & Huber Publishers, Toronto, pp. 118134.
Horan, W.P., Kring, A.M., Gur, R.E., Reise, S.P., Blanchard, J.J., 2011. Development and
psychometric validation of the clinical assessment interview for negative
symptoms. Schizophr. Res. 132, 140145.
Jang, H.J., Kim, M.S., 2011. The effect of computerized attention training on the
improvement of cognitive functions in patients with schizophrenia. Korean J.
Clin. Psychol. 30 (3), 803823.
Keefe, R.S.E., Harvey, P.D., 2008. Implementation considerations for multi-site
clinical trials with cognitive neuroscience task. Schizophr. Bull. 34, 656663.
Keefe, R.S., Bilder, R.M., Harvey, P.D., et al., 2006. Baseline neurocognitive decits in
the CATIE schizophrenia trial. Neuropsychopharmacology 31, 20332046.
Kim, S.H., Lee, W.H., Kwon, J.H., 2013. A study on the efcacy of a social cognition
enhancing rehabilitation program (SERP) focused on theory of mind for
individuals with schizophrenia in the community. Korean J. Clin. Psychol. 32 (3),
699725.
Ko, H.Y., Lee, W.H., 2016. The Effect of Cognitive Function on Psycho-Social Function
in Chronic Mental Illness Patients; Pilot Study. Spring Academic Conference of
Korean Clinical Psychology Association, poster presentation.
Kurtz, M.M., Richardson, C.L., 2012. Social cognitive training for schizophrenia: a
meta-analytic investigation of controlled research. Schizophr. Bull. 38, 1092
1104.
Kwon, J.H., Koh, Y., 2002. A preliminary study on the effectiveness of social cognition
enhancing rehabilitation program. Korean J. Clin. Psychol. 21 (2), 281292.
Lee, H.S., Hyun, M.H., Cho, H.S., Lee, Y.H., Kim, T.Y., Chang, S.A., Roh, K.S., Jung, K.R.,
Lee, M.H., Yoo, K.J., 1998. Effect of cognitive differentiation training of integrated
psychological therapy to the basic cognitive functions in schizophrenic patients.
J. Korean Neuropsychiatr. Assoc. 37 (5), 801810.
Lee, M.H., Lee, H.S., Cho, H.S., An, S.K., Hyun, M.H., Kim, T.Y., Kim, K.W., Choi, C.S., Lee,
Y.H., Song, S.M., Yoo, K.J., 1999. Development of a cognitive rehabilitation
problem for patients with schizophrenia-Korean cognitive differentiation
program. J. Korean Neuropsychiatr. Assoc. 38 (2), 375388.
Lee, W.H., Hwang, T.Y., Lee, W.K., 2001. Effects of cognitive behavioral rehabilitation
therapy on the cognitive functions in schizophrenia. J. Korean Assoc. Soc.
Psychiatry 6 (2), 139147.
Lee, W.K., Hwang, T.Y., Park, Y.J., 2009. Efcacy of computerized cognitive
rehabilitation training for inpatients with schizophrenia: a pilot study. J. Korean
Neuropsychiatr. Assoc. 48, 160167.
Lee, W.K., 2013. Effectiveness of computerized cognitive rehabilitation training on
symptomatological: neuropsychological and work function in patients with
schizophrenia. Asia-Pacic Psychiatry 5, 90100.
Mairs, H., Lovell, K., Campbell, M., Keeley, P., 2011. Development and pilot
investigation of behavioral activation for negative symptoms. Behav. Modif. 35,
486506.
117
Mayer, J.D., Dipaolo, M., Salovey, P., 1990. Perceiving affective content in ambiguous
visual stimuli a component of emotional intelligence. J. Pers. Assess. 54, 772
781.
McGurk, S.R., Mueser, K.T., DeRosa, T.J., Wolfe, R., 2009. Work, recovery, and
comorbidity in schizophrenia: a randomized controlled trial of cognitive
remediation. Schizophr. Bull. 35, 319335.
Meichenbaum, D., Cameron, R., 1973. Training schizophrenics talk to themselves: a
means of developing attentional controls. Behav. Ther. 4, 515534.
Miller, D., Porter, C.A., 1988. Errors and biases in the attribution process. In:
Abramson, L.Y. (Ed.), Social Cognition and Clinical Psychology: A Synthesis.
Guilford Press, New York, pp. 330.
Mohamed, S., Paulsen, J.S., OLeary, D., Arndt, S., Andreasen, N., 1999. Generalized
cognitive decits in schizophrenia: a study of rst-episode patients. Arch. Gen.
Psychiatry 56, 749754.
Morrison, G., OCarroll, R., McCreadie, R., 2006. Long-term course of cognitive
impairment in schizophrenia. Br. J. Psychiatry 189, 556557.
Palmer, B.W., Heaton, R.K., Paulsen, J.S., Kuck, J., Braff, D., Harris, M.J., Zisook, S., Jeste,
D.V., 1997. Is it possible to be schizophrenic yet neuropsychologically normal?
Neuropsychology 11, 437446.
Park, J.H., Kim, M.S., 2015. The effect of computerized executive function
rehabilitation on the improvement of cognitive functions in patients with
schizophrenia. Korean J. Clin. Psychol. 34 (1), 3760.
Platt, J.J., Spivack, G., 1972. Problem-solving thinking of psychiatric patients. J.
Consult. Clin. Psychol. 30, 148151.
Roder, V., Studer, K., Brenner, H., 1987. Experiences with an integrated psychological
therapy program for training communication and cognitive abilities in the
rehabilitation of ill chronic schizophrenic patients. Schweiz Arch. Neurol.
Psychiatry 138, 3144.
Sanchez, P., Pena, J., Bengoetxea, E., Ojeda, N., Elizagarate, E., Ezcurra, J., Gutierrez,
M., 2014. Improvements in negative symptoms and functional outcome after a
new generationcognitive remediation program: a randomized controlled trial.
Schizophr. Bull. 40, 707715.
Schmidt, S.J., Mueller, D.R., Roder, V., 2011. Social cognition as a mediator variable
between neurocognition and functional outcome in schizophrenia: empirical
review and new result by structural equation modeling. Schizophr. Bull. 37
(Suppl. 2), S41S54.
Schuhfried, G., 1994. Catalogue of REHACOM. DR . G. Schuhfried Ges MBH, Vienna,
pp. 37.
Sea, J.Y., 2009. The Effects of Chronic Schizophrenia Patients Symptoms and
Cognitive Functions. (Unpublished Masters Thesis). Catholic University of
Daegu, Korea.
Simon, A.E., Cattapan-Ludewig, K., Zmilacher, S., et al., 2007. Cognitive functioning
in the schizophrenia prodrome. Schizophr. Bull. 33, 761771.
Son, H.R., Lim, Y.R., Hwang, T.Y., 2000. Relationship between occupational
functioning and Wisconsin Card Sorting Test, symptoms in chronic
schizophrenia. Korean J. Clin. Psychol. 19 (2), 281292.
Spohn, H.E., Strauss, M.E., 1989. Relation of neuroleptic and anticholingergic
medication to cognitive functions in schizophrenia. J. Abnorm. Psychol. 4, 367
380.
Szoke, A., Trandar, A., Dupont, M.-E., Meary, A., Schurhoff, F., Leboyer, M., 2008.
Longitudinal studies of cognition in schizophrenia: meta-analysis. Br. J.
Psychiatry 192, 248257.
Weickert, T.W., Goldberg, T.E., Gold, J.M., Bigelow, L.B., Egan, M.F., Weinberger, D.R.,
2000. Cognitive impairment in patients with schizophrenia displaying
preserved and compromised intellect. Arch. Gen. Psychiatry 57, 907913.
Won, M.R., Lee, K.J., Lee, J.H., Choi, Y.J., 2012. Effects of an emotion management
nursing program for patients with schizophrenia. Arch. Psychiatr. Nurs. 26 (1),
5462.
Wyke, T., Huddy, V., Cellard, C., McGurk, S., Czobor, P., 2011. A meta-aalysis of
contivie remediation for schizophrenia: methodology and effect sizes. Am. J.
Psychiatry 168, 472485.