Authors (including presenting author) :
Lam HC(1), Lai SK(1), Mok CM(1), Tsang MY(1)
Affiliation :
(1)Occupational Therapy Department, Castle Peak Hospital
Keyword 1: :
Mental Disorder
Keyword 2: :
Forensic Psychiatry
Keyword 3: :
Occupational therapy
Keyword 4: :
Cognitive remediation
Introduction :
The literature suggests that impaired cognitive function, especially executive function, is a significant predictor of psychiatric patient’s violent risk. The impulsivity and cognitive rigidity associated with cognitive impairment is possibly reducing patient’s self-regulation of anger and effective coping strategies. Cognitive remediation (CR) is a part of occupational therapy intervention that has been persistently provided to Forensic Psychiatry in-patients with cognitive impairment. There are evidences on CR improving neurocognition and functioning in schizophrenic patients. Yet the effectiveness of CR on patient risk management remains unclear.
Objectives :
This project studies the effects of CR on cognitive function, functioning, and clinical risks in Forensic Psychiatry in-patients.
Methodology :
A single group pre-post interventional study was conducted on Forensic Psychiatry in-patients receiving CR during occupational therapy intervention between year 2023 to 2025. CR was delivered via computerised cognitive training tasks in Multi-Activity Centre (MAC) and Occupational Therapy department (OTD). Interventions were tailored by experienced occupational therapists based on each patient’s baseline MATRICS Consensus Cognitive Battery (MCCB) cognitive profile. Therapists provided continuous guidance throughout all sessions, focusing on strategy coaching and the generalization of cognitive skills into activities of daily living. The primary outcomes were i) MCCB, ii) Social and Occupational Functioning Assessment Scale (SOFAS), and iii) Short-Term Assessment of Risk and Treatability (START). Paired T-tests were conducted to analyse the difference between the outcome scores at baseline and post‑CR. Pearson’s r was calculated to examine the correlations between the outcomes. It is determined that p value < 0.05 was regarded as statistically significant.
Result & Outcome :
Twenty-two Forensic in-patients with mean age 41.6 years (SD=12.5) were evaluated. The majority of the participants (95.5%) were male, and 90.9% of the participants were diagnosed with Schizophrenia Spectrum Disorders. Statistical analysis demonstrated significant differences between baseline and post-CR measures on cognitive function, social and occupational functioning, and risk factor ratings. There was a significant increase in MCCB neurocognitive composite T-score at baseline and post-CR (t=4.910, p< 0.001). Statistically significant increments were also noted in the T-scores of the cognitive domains of speed of processing (t=3.237, p=0.004), reasoning and problem solving (t=3.949, p< 0.001), and verbal learning (t=2.964, p=0.007). A significant improvement on SOFAS score was also reported (t=5.967, p< 0.001). There was a significantly higher START summed protective factor rating (t=3.543, p=0.002). Significant associations between outcomes were also noted. The post-CR MCCB neurocognitive composite and SOFAS score were significantly positively correlated (r=0.633, p=0.003). There was a consistent significant positive correlation between MCCB reasoning and problem solving and START protective factor rating, both at baseline (r=0.665, p=0.002) and post-CR (r=0.663, p=0.002). These findings supported the benefit of CR in occupational therapy intervention on Forensic in-patients. It is concluded that improved cognitive function was associated with higher functioning and more prominent protective factors against violent risk.
