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CRT Combined Approach — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisCRT Combined ApproachMRCPsych Paper B

A 30-year-old man with schizophrenia is clinically stable but has persistent cognitive difficulties and impaired occupational and social functioning. His multidisciplinary team plans cognitive remediation therapy (CRT). Which programme design is most likely to improve the transfer of cognitive gains into everyday functioning?

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Correct answer: E — CRT integrated with psychosocial rehabilitation and explicit real-world skills practice

The correct answer is E. Cognitive remediation can improve cognitive performance in schizophrenia, but improvement in everyday functioning is greater when CRT is integrated with psychosocial rehabilitation that provides structured opportunities to apply cognitive strategies to real-world goals. Examples include supported employment and functional skills interventions with explicit bridging between therapy tasks and daily life. Stand-alone cognitive exercises may improve test performance without reliably generalising to functional outcomes. Antipsychotic dose escalation is not a mechanism for transferring cognitive learning and may worsen cognition through adverse effects. Family intervention has established roles in relapse prevention and family functioning but is not, by itself, a cognitive-skills bridging intervention. Similarly, unstructured occupational activity lacks the explicit strategy application that distinguishes an integrated rehabilitation approach.

Reference: Vita A, Barlati S, Ceraso A, et al. Effectiveness, Core Elements, and Moderators of Response of Cognitive Remediation for Schizophrenia: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Psychiatry. 2021. https://pubmed.ncbi.nlm.nih.gov/21406461/