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Wykes T, Bowie CR, Cella M. Thinking About the Future of Cognitive Remediation Therapy Revisited: What Is Left to Solve Before Patients Have Access? Schizophr Bull 2024:sbae075. [PMID: 38780191 DOI: 10.1093/schbul/sbae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
In our previous paper on the Future of Cognitive Remediation published more than 10 years ago, we envisaged an imminent and wide implementation of cognitive remediation therapies into mental health services. This optimism was misplaced. Despite evidence of the benefits, costs, and savings of this intervention, access is still sparse. The therapy has made its way into some treatment guidance, but these documents weight the same evidence very differently, causing confusion, and do not consider barriers to implementation. This paper revisits our previous agenda and describes how some challenges were overcome but some remain. The scientific community, with its commitment to Open Science, has produced promising sets of empirical data to explore the mechanisms of treatment action. This same community needs to understand the specific and nonspecific effects of cognitive remediation if we are to provide a formulation-based approach that can be widely implemented. In the last 10 years we have learned that cognitive remediation is not "brain training" but is a holistic therapy that involves an active therapist providing motivation support, and who helps to mitigate the impact of cognitive difficulties through metacognition to develop awareness of cognitive approaches to problems. We conclude that, of course, more research is needed but, in addition and perhaps more importantly at this stage, we need more public and health professionals' understanding of the benefits of this therapy to inform and include this approach as part of treatment regimens.
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Affiliation(s)
- Til Wykes
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Matteo Cella
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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2
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Cao J, Zhou C. Effect of computerized cognitive remediation therapy on mental time travel in patients with schizophrenia- a pilot randomized controlled trial. Front Psychiatry 2024; 15:1363290. [PMID: 38757140 PMCID: PMC11096490 DOI: 10.3389/fpsyt.2024.1363290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Objective To investigate the intervention effect of computerized cognitive remediation therapy (CCRT) on mental time travel (MTT) in patients with schizophrenia(SCZ). Methods From August 2020 to July 2021, 60 patients with SCZ were randomly allocated to either the study or the control group. The control group was treated with conventional drugs alone. The study group received CCRT and medical therapy for 40 minutes three times a week for 4 weeks. The participants underwent the MTT test before and after the training. Results A total of 28 patients in the study group and 26 patients in the control group were included in the analysis. Before training, there was no significant difference in the concretization ratio of recalling past and imagining future events between the study group and the control group (P > 0.05). After 4 weeks of training, the specific event ratio of the study group was higher than that of the control group (P < 0.01). In terms of the emotional titer of the events, the concreteness of the positive events in the study group was higher than that of the neutral events and negative events (P < 0.01). The concreteness of negative events was higher than that of neutral events (P < 0.01). Conclusion CCRT can improve the MTT ability of SCZ patients, which is manifested by an increase in the concretiveness of recalling past and imagining future events.
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Affiliation(s)
- Junhua Cao
- School of Medicine, Henan Polytechnic University, Jiaozuo, Henan, China
| | - Cao Zhou
- Department of Psychiatry, The Second People’s Hospital of Guizhou, Guiyang, Guizhou, China
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3
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Deste G, Kakli M, Barlati S, Nibbio G, Dossou P, Degila SL, Ceraso A, Lisoni J, Calzavara-Pinton I, Villa S, Vita A. Application of cognitive remediation in the world: new experiences from two schizophrenia rehabilitation centers in Togo and Benin. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-023-02603-z. [PMID: 38184811 DOI: 10.1007/s00127-023-02603-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE People with schizophrenia in Sub-Saharan Africa often live in very difficult conditions, suffer important social isolation and usually do not receive any kind of treatment. In this context, some non-governmental initiatives have come to light, providing accommodation, food, primary healthcare, medications and, in some cases, education and rehabilitation. The aims of this study were to assess feasibility, effects, and acceptability of a Cognitive Remediation Therapy (CRT) intervention in the particular context of psychiatric rehabilitation in Togo and Benin. METHODS Patients diagnosed with schizophrenia accessing the "Saint Camille" association rehabilitation centers in Togo and Benin during the enrollment period were allocated consecutively with a 1:1 proportion to receive a manualized CRT intervention (46 one-hour sessions over 14 weeks) or continuing Treatment As Usual (TAU). The assessment included validated measures of cognitive performance and real-world functioning and was performed at baseline and at the conclusion of treatment. RESULTS All subjects that were invited into the study agreed to participate and completed the intervention, for a total of 36 participants. CRT produced greater improvements than TAU in processing speed, working memory, verbal memory, cognitive flexibility, and executive functions measures, with moderate to large effect sizes, in particular in processing speed and working memory domains. CONCLUSIONS CRT represents a feasible and effective psychosocial intervention that can be implemented even in contexts with very limited resources, and could represent an important instrument to promote the rehabilitation process of people living with schizophrenia in low-income countries.
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Affiliation(s)
- Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mawuko Kakli
- Association Saint Camille de Lellis, Lomé, Togo
- Diocese of Aného, Aného, Togo
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
| | | | | | - Anna Ceraso
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Irene Calzavara-Pinton
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - Simona Villa
- Congregation "Suore Misericordine" mission in Fatebenefratelli Hospital of Afagnan, Afanyagan, Togo
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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4
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Efficacy of Cognitive Training Program Given to Patients with Schizophrenia Using Computer Tablets: a Preliminary Study. Int J Cogn Ther 2023. [DOI: 10.1007/s41811-023-00156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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5
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Mororó LG, Guimarães AL, Costa AC, Genaro L, Cavalcanti MT, Scoriels L, Panizzutti R. Association between motivation and engagement with changes in cognition and symptoms after digital cognitive training in schizophrenia. Schizophr Res 2023; 251:1-9. [PMID: 36527953 DOI: 10.1016/j.schres.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 09/14/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Digital cognitive training can remediate cognitive deficits present in schizophrenia. However, limited motivation and engagement may impact adherence to training. Therefore, identifying factors that may enhance (facilitators) or decrease (barriers) engagement in digital cognitive training and possibly modulate its effects are of great clinical relevance. METHODS We measured cognition, symptom severity, motivation (semi-structured interview), and engagement (adapted Utrecht Work Engagement Scale - UWES) of 27 patients with schizophrenia after a 40-h digital cognitive training. The interview transcript quotes were coded and categorized into facilitators and barriers. Thereafter, we tested the association of motivation and engagement with changes in cognition and symptoms after training. RESULTS The facilitator 'good performance' and the barrier 'difficult exercise' were associated with larger gains in attention (p = 0.03) and reasoning and problem solving (p = 0.02), respectively. 'Poor performance' was associated with smaller gains in global cognition (p < 0.01), attention (p = 0.03), and working memory (p = 0.02). The facilitator 'welcoming setting' was associated with larger reductions in the negative (p = 0.01) and total (p = 0.01) symptoms measured by the Positive and Negative Syndrome Scale. The UWES engagement scale was associated with different facilitators and barriers that emerged from the interview, an indication of consistency among both qualitative and quantitative assessments. DISCUSSION Using a mixed quantitative and qualitative research design, we showed associations between motivation and engagement and the response to digital cognitive training in schizophrenia. Facilitators and barriers were associated with engagement, gains in cognition, and reduced symptoms after the intervention, providing insights on how to increase engagement in the digital cognitive training delivered to subjects with schizophrenia.
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Affiliation(s)
- Luana G Mororó
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Anna Luiza Guimarães
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Ana Carolina Costa
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Larissa Genaro
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Maria T Cavalcanti
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil
| | - Linda Scoriels
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris, Inserm 1266, Paris, France
| | - Rogerio Panizzutti
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil.
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6
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Buonocore M, Spangaro M, Bechi M, Trezzani S, Terragni R, Martini F, Agostoni G, Cocchi F, Cuoco F, Guglielmino C, Bosia M, Cavallaro R. Cognitive remediation in schizophrenia: What happens after 10 years? Schizophr Res Cogn 2022; 29:100251. [PMID: 35402166 PMCID: PMC8983434 DOI: 10.1016/j.scog.2022.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 10/26/2022] Open
Abstract
Cognitive Remediation Therapy (CRT) represents the gold standard treatment for cognitive impairment in schizophrenia, but the permanence of its effects over time have been poorly investigated. Our study aims to evaluate long lasting cognitive and functional effects of CRT together with standard rehabilitation interventions (SRT) in a group of patients diagnosed with schizophrenia, 10 years after the end of the treatment. Forty patients, previously included in a 5-year follow-up study evaluating the effects of CRT combined with SRT, were revalued 10 years after the complete of the intervention. Results revealed that cognitive and functional improvements of combined CRT/SRT interventions are still preserved 10 years after the end of the treatments, with the only exception of psychomotor speed and coordination cognitive subdomain. Moreover, investigating persistence of the influence of SRT, patients that underwent a shorter SRT following CRT (six months vs one year) showed worsened processing speed abilities. This is the first study confirming that cognitive and functional improvements of joint CRT/SRT interventions are still conserved 10 years after the end of the treatments. Preliminary datas suggest that a longer SRT following CRT may lead to significant benefits, in terms of cognitive gains, in patients affected by schizophrenia.
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Affiliation(s)
- Mariachiara Buonocore
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Spangaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Margherita Bechi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Francesca Martini
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Federica Cocchi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Cuoco
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmelo Guglielmino
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Bosia
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
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7
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Harvey PD, Bosia M, Cavallaro R, Howes OD, Kahn RS, Leucht S, Müller DR, Penadés R, Vita A. Cognitive dysfunction in schizophrenia: An expert group paper on the current state of the art. Schizophr Res Cogn 2022; 29:100249. [PMID: 35345598 PMCID: PMC8956816 DOI: 10.1016/j.scog.2022.100249] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/12/2022]
Abstract
Cognitive impairment in schizophrenia represents one of the main obstacles to clinical and functional recovery. This expert group paper brings together experts in schizophrenia treatment to discuss scientific progress in the domain of cognitive impairment to address cognitive impairments and their consequences in the most effective way. We report on the onset and course of cognitive deficits, linking them to the alterations in brain function and structure in schizophrenia and discussing their role in predicting the transition to psychosis in people at risk. We then address the assessment tools with reference to functioning and social cognition, examining the role of subjective measures and addressing new methods for measuring functional outcomes including technology based approaches. Finally, we briefly review treatment options for cognitive deficits, focusing on cognitive remediation programs, highlighting their effects on brain activity and conclude with the potential benefit of individualized integrated interventions combing cognitive remediation with other approaches.
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Affiliation(s)
- Philip D Harvey
- Division of Psychology, Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marta Bosia
- Vita-Salute San Raffaele University School of Medicine, Milan, Italy; Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Roberto Cavallaro
- Vita-Salute San Raffaele University School of Medicine, Milan, Italy; Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Oliver D Howes
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.,MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefan Leucht
- Section Evidence-Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Daniel R Müller
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rafael Penadés
- Department of Psychiatry and Psychology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel Street, 08036 Barcelona, Spain
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
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8
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Cognitive gains as a mechanism of functional capacity improvement in schizophrenia: Results from a multi-site randomized controlled trial. J Psychiatr Res 2022; 151:554-560. [PMID: 35636031 DOI: 10.1016/j.jpsychires.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/28/2022] [Accepted: 05/19/2022] [Indexed: 11/21/2022]
Abstract
Randomized-controlled trials of Cognitive Enhancement Therapy (CET) reveal its impact on cognitive and functional improvements in schizophrenia and serve as an opportunity for causal claims of potential mediational relationships. In order to examine cognitive gains during CET as a mechanism for improving functional capacity, this secondary analysis included 86 outpatients in the early course of schizophrenia from an 18-month randomized-controlled trial of CET. Functional capacity was measured using the Brief UCSD Performance-Based Skills Assessment (UPSA-B) and cognitive performance by the MATRICS Consensus Cognitive Battery (MCCB) and additional measures of social cognition. Mixed-effects models were used to examine the effects of treatment on the UPSA-B changes and mediation through cognitive improvements. Changes in overall cognition proved to be a significant mediator of CET-related gains in functional capacity at mid-treatment and treatment completion. Exploratory models examining separable cognitive domains further found that improvements in attention, theory of mind, and emotion processing significantly mediated CET effects on functional capacity. This study suggests that CET has potential for improving functional capacity in individuals with schizophrenia, and that cognitive improvements partially mediate this relationship. This evidence can be beneficial for guiding more targeted approaches for rehabilitation in this population.
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9
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Gega L, Jankovic D, Saramago P, Marshall D, Dawson S, Brabyn S, Nikolaidis GF, Melton H, Churchill R, Bojke L. Digital interventions in mental health: evidence syntheses and economic modelling. Health Technol Assess 2022; 26:1-182. [PMID: 35048909 DOI: 10.3310/rcti6942] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Economic evaluations provide evidence on whether or not digital interventions offer value for money, based on their costs and outcomes relative to the costs and outcomes of alternatives. OBJECTIVES (1) Evaluate and summarise published economic studies about digital interventions across different technologies, therapies, comparators and mental health conditions; (2) synthesise clinical evidence about digital interventions for an exemplar mental health condition; (3) construct an economic model for the same exemplar mental health condition using the previously synthesised clinical evidence; and (4) consult with stakeholders about how they understand and assess the value of digital interventions. METHODS We completed four work packages: (1) a systematic review and quality assessment of economic studies about digital interventions; (2) a systematic review and network meta-analysis of randomised controlled trials on digital interventions for generalised anxiety disorder; (3) an economic model and value-of-information analysis on digital interventions for generalised anxiety disorder; and (4) a series of knowledge exchange face-to-face and digital seminars with stakeholders. RESULTS In work package 1, we reviewed 76 economic evaluations: 11 economic models and 65 within-trial analyses. Although the results of the studies are not directly comparable because they used different methods, the overall picture suggests that digital interventions are likely to be cost-effective, compared with no intervention and non-therapeutic controls, whereas the value of digital interventions compared with face-to-face therapy or printed manuals is unclear. In work package 2, we carried out two network meta-analyses of 20 randomised controlled trials of digital interventions for generalised anxiety disorder with a total of 2350 participants. The results were used to inform our economic model, but when considered on their own they were inconclusive because of the very wide confidence intervals. In work package 3, our decision-analytic model found that digital interventions for generalised anxiety disorder were associated with lower net monetary benefit than medication and face-to-face therapy, but greater net monetary benefit than non-therapeutic controls and no intervention. Value for money was driven by clinical outcomes rather than by intervention costs, and a value-of-information analysis suggested that uncertainty in the treatment effect had the greatest value (£12.9B). In work package 4, stakeholders identified several areas of benefits and costs of digital interventions that are important to them, including safety, sustainability and reducing waiting times. Four factors may influence their decisions to use digital interventions, other than costs and outcomes: increasing patient choice, reaching underserved populations, enabling continuous care and accepting the 'inevitability of going digital'. LIMITATIONS There was substantial uncertainty around effect estimates of digital interventions compared with alternatives. This uncertainty was driven by the small number of studies informing most comparisons, the small samples in some of these studies and the studies' high risk of bias. CONCLUSIONS Digital interventions may offer good value for money as an alternative to 'doing nothing' or 'doing something non-therapeutic' (e.g. monitoring or having a general discussion), but their added value compared with medication, face-to-face therapy and printed manuals is uncertain. Clinical outcomes rather than intervention costs drive 'value for money'. FUTURE WORK There is a need to develop digital interventions that are more effective, rather than just cheaper, than their alternatives. STUDY REGISTRATION This study is registered as PROSPERO CRD42018105837. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lina Gega
- Department of Health and Social Care Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK.,Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Dina Jankovic
- Centre for Health Economics, University of York, York, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - David Marshall
- Centre for Reviews & Dissemination, University of York, York, UK
| | - Sarah Dawson
- Common Mental Disorders Group, Cochrane Collaboration, University of York, York, UK.,Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Sally Brabyn
- Department of Health and Social Care Sciences, University of York, York, UK
| | | | - Hollie Melton
- Centre for Reviews & Dissemination, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews & Dissemination, University of York, York, UK.,Common Mental Disorders Group, Cochrane Collaboration, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
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10
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Nuño L, Guilera G, Barrios M, Gómez-Benito J, Abdelhamid GSM. Network Analysis of the Brief ICF Core Set for Schizophrenia. Front Psychiatry 2022; 13:852132. [PMID: 35782412 PMCID: PMC9247197 DOI: 10.3389/fpsyt.2022.852132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The International Classification of Functioning, Disability, and Health Core Sets (ICF-CSs) for schizophrenia are a set of categories for assessing functioning in persons with this health condition. This study aimed to: a) estimate the network structure of the Brief ICF-CS for schizophrenia, b) examine the community structure (categories strongly clustered together) underlying this network, and c) identify the most central categories within this network. METHODS A total of 638 health professionals from different backgrounds and with a significant role in the treatment of individuals with schizophrenia participated in a series of Delphi studies. Based on their responses we used the Ising model to estimate the network structure of the 25-category Brief ICF-CS, and then estimated the degree of centrality for all categories. Finally, the community structure was detected using the walktrap algorithm. RESULTS The resulting network revealed strong associations between individual categories within components of the ICF (i.e., Body functions, Activities and participation, and Environmental factors). The results also showed three distinct clusters of categories corresponding to the same three components. The categories e410 Individual attitudes of immediate family members, e450 Individual attitudes of health professionals, d910 Community life, and d175 Solving problems were among the most central categories in the Brief ICF-CS network. CONCLUSION These results demonstrate the utility of a network approach for estimating the structure of the ICF-CSs. Implications of these results for clinical interventions and development of new instruments are discussed.
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Affiliation(s)
- Laura Nuño
- Addictions Unit, Clinical Institute of Neuroscience (ICN), Hospital Clinic, Barcelona, Spain
| | - Georgina Guilera
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain.,Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Maite Barrios
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain.,Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Juana Gómez-Benito
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain.,Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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11
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Vita A, Gaebel W, Mucci A, Sachs G, Barlati S, Giordano GM, Nibbio G, Nordentoft M, Wykes T, Galderisi S. European Psychiatric Association guidance on treatment of cognitive impairment in schizophrenia. Eur Psychiatry 2022; 65:e57. [PMID: 36059103 PMCID: PMC9532218 DOI: 10.1192/j.eurpsy.2022.2315] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Although cognitive impairment is a core symptom of schizophrenia related to poorer outcomes in different functional domains, it still remains a major therapeutic challenge. To date, no comprehensive treatment guidelines for cognitive impairment in schizophrenia are implemented. Methods The aim of the present guidance paper is to provide a comprehensive meta-review of the current available evidence-based treatments for cognitive impairment in schizophrenia. The guidance is structured into three sections: pharmacological treatment, psychosocial interventions, and somatic treatments. Results Based on the reviewed evidence, this European Psychiatric Association guidance recommends an appropriate pharmacological management as a fundamental starting point in the treatment of cognitive impairment in schizophrenia. In particular, second-generation antipsychotics are recommended for their favorable cognitive profile compared to first-generation antipsychotics, although no clear superiority of a single second-generation antipsychotic has currently been found. Anticholinergic and benzodiazepine burdens should be kept to a minimum, considering the negative impact on cognitive functioning. Among psychosocial interventions, cognitive remediation and physical exercise are recommended for the treatment of cognitive impairment in schizophrenia. Noninvasive brain stimulation techniques could be taken into account as add-on therapy. Conclusions Overall, there is definitive progress in the field, but further research is needed to develop specific treatments for cognitive impairment in schizophrenia. The dissemination of this guidance paper may promote the development of shared guidelines concerning the treatment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to achieve recovery in this population.
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12
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Rojas M, Barrios M, Gómez-Benito J, Mikheenkova N, Mosolov S. Functioning Problems in Persons with Schizophrenia in the Russian Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910276. [PMID: 34639576 PMCID: PMC8507701 DOI: 10.3390/ijerph181910276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
Assessing functionality in schizophrenia from a biopsychosocial perspective is essential to generate treatments that respond to the needs of the individual in his/her context. This research aims to assess the prevalence of functioning problems and their association with socio-demographic and clinical variables in a sample of Russian individuals with schizophrenia, using the International Classification of Functioning, Disability, and Health as a framework. An empirical cross-sectional study assessed the functioning of 40 individuals with schizophrenia using the International Classification of Functioning, Disability, and Health Core Set for schizophrenia. For the Body functions component, the highest prevalence of problems was found in b144 Memory functions (75%) and b140 Attention functions (70%). In the Activities and participation component, the greatest limitations were in d770 Intimate relationships (79.3%) and d240 Handling stress and other psychological demands (82.5%). In the Environmental factors, the most frequent problems were in e110 Products or substances for personal consumption (25%) and e460 Societal attitudes (22.5%); when scored as facilitators, the highest rated categories were e125 Products and technology for communication (100%) and e165 Assets (100%). These results may guide the design of specific treatments for these individuals and serve as a starting point for further studies in similar contexts and in other regions in Russia.
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Affiliation(s)
- Manuel Rojas
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain; (M.R.); (J.G.-B.)
- Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neuroscience, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
| | - Maite Barrios
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain; (M.R.); (J.G.-B.)
- Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neuroscience, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
- Correspondence:
| | - Juana Gómez-Benito
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain; (M.R.); (J.G.-B.)
- Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neuroscience, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
| | - Nadezhda Mikheenkova
- Moscow Research Institute of Psychiatry, Poteshnaya ul., 3, 107076 Moscow, Russia; (N.M.); (S.M.)
| | - Sergey Mosolov
- Moscow Research Institute of Psychiatry, Poteshnaya ul., 3, 107076 Moscow, Russia; (N.M.); (S.M.)
- Russian Medical Academy of Continuous Professional Education, Barrikadnaya pl., 2/1, 125993 Moscow, Russia
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13
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Breitborde NJK, Bell EK, Woolverton C, Pine JG, Waslter H, Moe AM. Cost Utility of cognition-enhancing interventions for individuals with first-episode psychosis: a naturalistic evaluation. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:36. [PMID: 34210341 PMCID: PMC8247178 DOI: 10.1186/s12962-021-00292-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although effective treatments are available to address the cognitive deficits experienced by individuals with first-episode psychosis, provision of such treatments within Coordinated Specialty Care (CSC) programs is rare. One factor that may contribute to this is uncertainty about the cost implications of providing cognitive-enhancing treatments within the American mental healthcare system. The aim of this study is to complete a naturalistic evaluation of the cost utility of incorporating two different cognitive-enhancing interventions within an American CSC program. Methods Participants included 66, predominately white (75.38%), individuals with first-episode psychosis (19 women and 47 men) with a mean age of 22.71 years. Quality adjusted life years (QALYs) and cost of care were tracked among these individuals during their participation in a CSC program. These data were compared among three groups of participants during their first six months of care: (i) individuals who participated in metacognitive remediation therapy (MCR), (ii) individuals who participated in computerized cognitive remediation (CCR), and (iii) individuals who participated in no cognitive-enhancing intervention. Results Participation in MCR, but not CCR, was associated with larger gains in QALYs than participation in no cognitive-enhancing intervention within a CSC program. Moreover, data support the cost utility of MCR as compared to CCR or no-cognitive enhancing intervention within a CSC program. Conversely, CCR did not appear to be a cost-effective addition to CSC services. Conclusions Our results highlight the potential cost utility of incorporating MCR within CSC programs for individuals with first-episode psychosis. However, given study limitations, these results should be interpreted cautiously until replicated by large, randomized controlled trials. Trial Registration ClinicalTrials.gov Identifier NCT01570972, registered April 4, 2012, Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01570972?term=breitborde&draw=2&rank=6.
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Affiliation(s)
- Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, USA. .,Department of Psychology, The Ohio State University, Columbus, USA.
| | - Emily K Bell
- 56th Medical Group, Luke Air Force Base, Glendale, USA
| | | | - Jacob G Pine
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, USA
| | - Heather Waslter
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, USA
| | - Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, USA
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14
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Rampino A, Falcone RM, Giannuzzi A, Masellis R, Antonucci LA, Torretta S. Strategies for Psychiatric Rehabilitation and their Cognitive Outcomes in Schizophrenia: Review of Last Five-year Studies. Clin Pract Epidemiol Ment Health 2021; 17:31-47. [PMID: 34249137 PMCID: PMC8227533 DOI: 10.2174/1745017902117010031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/15/2021] [Accepted: 02/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cognitive deficits are core features of Schizophrenia, showing poor response to antipsychotic treatment, therefore non-pharmacological rehabilitative approaches to such a symptom domain need to be identified. However, since not all patients with Schizophrenia exhibit the same cognitive impairment profile, individualized rehabilitative approaches should be set up. OBJECTIVES We explored the last five-year literature addressing the issue of cognitive dysfunction response to rehabilitative methodologies in Schizophrenia to identify possible predictors of response and individualized strategies to treat such a dysfunction. CONCLUSION A total of 76 studies were reviewed. Possible predictors of cognitive rehabilitation outcome were identified among patient-specific and approach-specific variables and a general overview of rehabilitative strategies used in the last five years has been depicted. Studies suggest the existence of multifaced and multi-domain variables that could significantly predict pro-cognitive effects of cognitive rehabilitation, which could also be useful for identifying individual-specific rehabilitation trajectories over time.An individualized rehabilitative approach to cognitive impairment in Schizophrenia is possible if taking into account both patient and approach specific predictors of outcomes.
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Affiliation(s)
- Antonio Rampino
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
- Azienda Ospedaliero-Universitaria Policlinico di Bari, 70124 Bari, Italy
| | - Rosa M. Falcone
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Arianna Giannuzzi
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Rita Masellis
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Linda A. Antonucci
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, 70122 Bari, Italy
| | - Silvia Torretta
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
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15
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Castiello-de Obeso S, Aguayo Mendoza MA, Ortiz-Orendain J, Itzaman I, Landa-Ramírez E, Carmona J, Murphy RA. Computer-based Cognitive Remediation Therapy plus standard care versus standard care for people with schizophrenia or related disorders. Hippokratia 2020. [DOI: 10.1002/14651858.cd013625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Israel Itzaman
- Department of Mental Health; Secretaria de Salud; Jalisco Mexico
| | - Edgar Landa-Ramírez
- Emergency Psychology Department; Hospital General Dr. Manuel Gea González; Mexico City Mexico
| | - Jaime Carmona
- Department of Physiology; University of Guadalajara; Guadalajara Jalisco Mexico
| | - Robin A. Murphy
- Department of Experimental Psychology; University of Oxford; Oxford UK
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16
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Cella M, Price T, Corboy H, Onwumere J, Shergill S, Preti A. Cognitive remediation for inpatients with psychosis: a systematic review and meta-analysis. Psychol Med 2020; 50:1062-1076. [PMID: 32349802 DOI: 10.1017/s0033291720000872] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cognitive difficulties are common in people with psychosis and associated with considerable disability. Cognitive remediation (CR) can reduce the burden of cognitive difficulties and improve functioning. While mental health care has predominantly shifted to the community, people with greater illness severity and complexity, and those with poor response to treatment and concomitant greater cognitive difficulties, continue to receive inpatient care. The aim of this study is to review and evaluate the acceptability and efficacy of CR for inpatients with psychosis. A systematic search was used to identify randomized controlled trials of CR for inpatients with psychosis. Demographic and clinical information was extracted by independent raters together with therapy outcomes. Study quality was assessed using the Cochrane Collaboration Risk of Bias Assessment tool. Standardized mean change for cognitive and functional outcomes was calculated using Hedges's g and used to infer therapy effects with meta-analysis. Twenty studies were identified considering 1509 participants. Results from random-effect models suggested that CR was effective in improving processing speed (g = 0.48), memory (g = 0.48) and working memory (g = 0.56). While there was an indication of improvements in the levels of vocational, social and global functioning, these were less reliable. On average, 7% of participants dropped-out of treatment. Studies methodological quality was moderate. CR is an acceptable intervention for inpatients with psychosis and can lead to significant cognitive improvements. Evidence for improvement in functioning requires more robust and converging evidence. Future research should extend the evaluation of inpatient CR to subsequent post-discharge community functioning and further need for care.
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Affiliation(s)
- Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Tom Price
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Holly Corboy
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- University College Dublin (UCD), Belfield, Dublin 4, Ireland
| | - Juliana Onwumere
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- National Psychosis Unit, Bethlem Hospital, South London and Maudsley NHS Trust, UK
| | - Sukhi Shergill
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- National Psychosis Unit, Bethlem Hospital, South London and Maudsley NHS Trust, UK
| | - Antonio Preti
- Centro Medico Genneruxi, Cagliari, Italy
- Center for Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
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17
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Rakhshan Rouhakhtar P, Schiffman J. Community Rehabilitation for Youth with Psychosis Spectrum Disorders. Child Adolesc Psychiatr Clin N Am 2020; 29:225-239. [PMID: 31708049 DOI: 10.1016/j.chc.2019.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recovery-oriented treatment for youth with psychosis goes beyond a symptom and deficit-amelioration model, promoting engagement and functioning within the community. Given the challenges young people with psychosis face, early psychosis treatment programs often integrate rehabilitative components targeting functional outcomes. The current article reviews 4 community rehabilitation programs in early psychosis: care coordination, cognitive rehabilitation, supported education and employment, and peer support. For each of these rehabilitative intervention programs, we discuss challenges faced by youth with psychosis, clinical intervention practices, the current state of evidence, and clinical and/or research considerations.
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Affiliation(s)
- Pamela Rakhshan Rouhakhtar
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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18
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Bowie CR. Cognitive remediation for severe mental illness: state of the field and future directions. World Psychiatry 2019; 18:274-275. [PMID: 31496075 PMCID: PMC6732698 DOI: 10.1002/wps.20660] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Fernández-Sotos P, Fernández-Caballero A, González P, Aparicio AI, Martínez-Gras I, Torio I, Dompablo M, García-Fernández L, Santos JL, Rodriguez-Jimenez R. Digital Technology for Internet Access by Patients With Early-Stage Schizophrenia in Spain: Multicenter Research Study. J Med Internet Res 2019; 21:e11824. [PMID: 30950798 PMCID: PMC6533031 DOI: 10.2196/11824] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/03/2018] [Accepted: 12/12/2018] [Indexed: 12/18/2022] Open
Abstract
Background Digital technology and social networks are part of everyday life in the current internet age, especially among young people. To date, few studies have been published worldwide on the pattern of use of digital technology devices and applications in patients with early-stage schizophrenia and even fewer comparing them with healthy participants (not using data from general population surveys) from the same demographic areas. In Spain, no such study has been carried out. Objective The aim of this study was to analyze how patients with early-stage schizophrenia use internet and social networks compared with healthy participants matched by age and gender and also to examine which devices are utilized to access internet resources. Methods A cross-sectional, multicentric study was carried out through a semistructured interview asking about the use of digital technology devices and internet. The sample comprised 90 patients and 90 healthy participants. The semistructured interview was conducted on 30 outpatients and 30 healthy subjects in each of the 3 different cities (Madrid, Alicante, and Cuenca). Student t test was used for continuous variables and chi-square test for categorical variables. In the case of ordinal variables, nonparametric Mann-Whitney U and Kruskal-Wallis H tests for independent samples were performed to compare groups. Results The results indicated that a large proportion of patients with early-stage schizophrenia have access to different digital devices and use them frequently. In addition, both groups coincide in the order of preference and the purpose for which they use the devices. However, a lower frequency of use of most digital technology devices was detected in patients compared with healthy participants. In the case of some devices, this was due to the impossibility of access and not a lack of interest. Conclusions To our knowledge, this is the first study to analyze patterns of internet access and use of digital technology devices and applications in Spanish patients with early-stage schizophrenia compared with healthy participants from the same demographic areas. The results on significant access and use of digital technology and internet shown in this cross-sectional study will allow enhanced and more efficient treatment strategies to be planned, utilizing digital technology devices, for patients with early-stage schizophrenia.
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Affiliation(s)
- Patricia Fernández-Sotos
- Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain
| | - Antonio Fernández-Caballero
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Instituto de Investigación en Informática, Albacete, Spain.,Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Pascual González
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Instituto de Investigación en Informática, Albacete, Spain.,Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Ana Isabel Aparicio
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Servicio de Psiquiatría del "Hospital Virgen de la Luz", Cuenca, Spain
| | - Isabel Martínez-Gras
- Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Iosune Torio
- Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Universidad Rey Juan Carlos, Madrid, Spain
| | - Mónica Dompablo
- Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain
| | - Lorena García-Fernández
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Hospital Universitario San Juan, Alicante, Spain
| | - José Luis Santos
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Servicio de Psiquiatría del "Hospital Virgen de la Luz", Cuenca, Spain
| | - Roberto Rodriguez-Jimenez
- Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,CogPsy-Group, Universidad Complutense de Madrid, Madrid, Spain
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20
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Horvath G, Liszli P, Kekesi G, Büki A, Benedek G. Cognitive training improves the disturbed behavioral architecture of schizophrenia-like rats, “Wisket”. Physiol Behav 2019; 201:70-82. [DOI: 10.1016/j.physbeh.2018.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/26/2018] [Accepted: 12/10/2018] [Indexed: 01/17/2023]
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21
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Pawełczyk A, Łojek E, Żurner N, Gawłowska-Sawosz M, Pawełczyk T. Higher-order language dysfunctions as a possible neurolinguistic endophenotype for schizophrenia: Evidence from patients and their unaffected first degree relatives. Psychiatry Res 2018; 267:63-72. [PMID: 29885556 DOI: 10.1016/j.psychres.2018.05.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/21/2018] [Accepted: 05/26/2018] [Indexed: 12/30/2022]
Abstract
The purpose of the study was to examine the presence of pragmatic dysfunctions in first episode (FE) subjects and their healthy first degree relatives as a potential endophenotype for schizophrenia. Thirty-four FE patients, 34 parents of the patients (REL) and 32 healthy controls (HC) took part in the study. Pragmatic language functions were evaluated with the Right Hemisphere Language Battery, attention and executive functions were controlled, as well as age and education level. The parents differed from HC but not from their FE offspring with regard to overall level of language and communication and the general knowledge component of language processing. The FE participants differed from HC in comprehension of inferred meaning, emotional prosody, discourse dimensions, overall level of language and communication, language processing with regard to general knowledge and communication competences. The FE participants differed from REL regarding discourse dimensions. Our findings suggest that pragmatic dysfunctions may act as vulnerability markers of schizophrenia; their assessment may help in the diagnosis of early stages of the illness and in understanding its pathophysiology. In future research the adoptive and biological parents of schizophrenia patients should be compared to elucidate which language failures reflect genetic vulnerability and which ones environmental factors.
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Affiliation(s)
- Agnieszka Pawełczyk
- Chair of Psychiatry, Department of Affective and Psychotic Disorders, Medical University of Łódź, Poland.
| | - Emila Łojek
- Chair of Neuropsychology, Faculty of Psychology, University of Warsaw, Poland
| | - Natalia Żurner
- Chair of Psychiatry, Adolescent Ward, Central Clinical Hospital, Medical University of Łódź, Poland
| | | | - Tomasz Pawełczyk
- Chair of Psychiatry, Department of Affective and Psychotic Disorders, Medical University of Łódź, Poland
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22
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Independent Computerized Cognitive Remediation for Psychosis: An Investigation of Patient Experiences. J Nerv Ment Dis 2018; 206:606-613. [PMID: 30020205 DOI: 10.1097/nmd.0000000000000852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cognitive remediation (CR) training improves cognition and functioning in patients with psychosis. To date, however, few studies have investigated CR from a subjective patient perspective. We recently conducted a randomized control trial demonstrating the effectiveness of a new, low therapist support, computer-based training program. This study aims to assess the service user experience of this program. Twenty CR completers with psychosis were interviewed using both rated and open-ended questions. Thematic analysis identified three broad themes: a) benefits of doing CR, b) costs of doing CR, and c) experience of doing CR. Positive experiences of therapy participation included improved cognition, improved positive self-regard, a development of life skills, and a transfer of benefits to everyday life. Negative experiences included therapy being difficult and tiring, leading to frustration and anxiety. These findings demonstrate the feasibility of low therapist support CR and point to variables that might impact therapy adherence.
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23
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Harvey PD, McGurk SR, Mahncke H, Wykes T. Controversies in Computerized Cognitive Training. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:907-915. [PMID: 30197048 DOI: 10.1016/j.bpsc.2018.06.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
Computerized cognitive training (CCT) to improve cognitive functioning is of enormous interest and has been applied in a broad range of populations with goals of improving both cognition and community functioning. Recent reviews presenting negative conclusions about CCT efficacy have inconsistent definitions of the treatment targets and cognitive improvement. They do not present an accurate representation of the typical process of CCT and cognitive remediation (CR), especially as delivered in major mental illnesses such as schizophrenia. This review provides guidance on the definitions of CCT and CR, the uses of CCT and CR, and the definitions and measurements of cognitive and functional gains. The review focuses on schizophrenia and healthy aging, with each population receiving unique CCT or CR approaches and substantial extant literature with which to elucidate fundamental CCT and CR concepts and research findings. It is our conclusion that CCT has been shown in most studies to improve cognitive performance on untrained tests in healthy older people and in people with schizophrenia. Functional gains in schizophrenia appear to be limited to CR studies. Clearly defining CCT, CR, and levels of treatment-related gains will be critical for understanding the benefits of these widely used treatment programs.
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Affiliation(s)
- Philip D Harvey
- University of Miami Miller School of Medicine, Miami VA Medical Center, Miami, Florida.
| | - Susan R McGurk
- Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts
| | - Henry Mahncke
- Posit Science Corporation, San Francisco, California
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, and South London, London, United Kingdom; Maudsley NHS Foundation Trust, London, United Kingdom
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24
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Mental health assessment in rehabilitation: a descriptive study through an international internet survey. Int J Rehabil Res 2018; 41:368-372. [PMID: 29912785 DOI: 10.1097/mrr.0000000000000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This cross-sectional study assessed international rehabilitation practitioners' views of mental health assessment (MHA), related specifically to assessment tools and needs in the field. We delivered an anonymous web-based survey capturing rehabilitation practioners' perspectives on MHA practices, assessment tools, and needs through the American Congress of Rehabilitation Medicine in the USA and through national rehabilitation networks in Finland and Norway. Altogether, 355 rehabilitation professionals answered the survey. Unmet MHA needs, most often attributed to insufficient time (112/269 responders), were recognized among rehabilitation professionals irrespective of the country of practice. When professional experience was weighed against barriers to conducting MHA, cost was statistically significantly linked to professional experience, with those with less experience viewing cost more as a barrier (P=0.019). Rehabilitation professionals from different professions, in different countries, and working with a variety of clinical populations recognize defined barriers to MHA in rehabilitation.
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