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Wang Z, Pi Y, Tan X, Wang Z, Chen R, Liu Y, Guo W, Zhang J. Effects of Wu Qin Xi exercise on reactive inhibition in Parkinson’s disease: A randomized controlled clinical trial. Front Aging Neurosci 2022; 14:961938. [PMID: 36158558 PMCID: PMC9490077 DOI: 10.3389/fnagi.2022.961938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveMotor symptom in patients with Parkinson’s disease (PD) are related to reduced motor inhibitory ability (proactive and reactive inhibition). Although exercise has been shown to improve this ability, its effects on different levels of motor inhibition have not been determined.Materials and methodsSixty patients with PD aged 55–75 years were allocated randomly to 24-week exercise interventions [Wu Qin Xi exercise (WQX) and stretching exercise (SE)]. The stop signal task and questionnaires were administered pre and post interventions. Twenty-five age-matched healthy controls were recruited to obtain reference values for inhibition.ResultsCompared to healthy controls, patients with PD showed motor inhibition deficits in reactive inhibition, but not in proactive inhibition. Post-intervention, the WQX group showed significant improvement in reactive inhibition compared to the SE group. In both the WQX and SE groups, movement speed was improved post-intervention, accompanied by reduction in negative emotions, stable improvement of sleep quality, and high self-reported satisfaction levels.ConclusionThis study demonstrated that Wu Qin Xi exercise can improve the reactive inhibition of patients with PD. Our results provide theoretical support for the formulation of reasonable and effective exercise prescriptions for PD rehabilitation.Clinical trial registration[http://www.chictr.org.cn], identifier [ChiCTR2000038517].
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Affiliation(s)
- Zhen Wang
- School of Psychology, Shanghai University of Sport, Shanghai, China
- School of Exercise and Healthy Science, Xi’an Physical Education University, Xi’an, China
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Yanling Pi
- Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Xiaoyin Tan
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, Macao SAR, China
| | - Zhen Wang
- School of Martial Arts, Shanghai University of Sport, Shanghai, China
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yu Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Wei Guo
- Shanghai Yishen Health Management Co., Ltd., Shanghai, China
| | - Jian Zhang
- School of Psychology, Shanghai University of Sport, Shanghai, China
- *Correspondence: Jian Zhang,
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Wang Z, Pi YL, Wu Y, Wei J, Li Y, Zhang J, Wang Z. Selective effects of exercise on reactive and proactive inhibition in Parkinson's disease. PeerJ 2022; 10:e13628. [PMID: 35765594 PMCID: PMC9233896 DOI: 10.7717/peerj.13628] [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: 03/02/2022] [Accepted: 06/02/2022] [Indexed: 01/17/2023] Open
Abstract
Objective Patients with Parkinson's disease (PD) have an obvious motor inhibition disorder, which is closely related to their motor symptoms. Although previous studies have shown that exercise can improve their inhibition deficits, the effect of exercise on different types of inhibition (proactive and reactive inhibition) has not been addressed. Methods We used a behavioral paradigm combined with a series of questionnaires to explore the effect of long-term exercise on different types of motor inhibition in 59 patients with PD aged 55-75 years. According to the intensity and frequency of exercise, the participants were divided into regular-exercise and no-exercise groups. To obtain the average reference value for inhibition ability at the same age, we also recruited 30 healthy elderly people as controls. Results The main defect in the motor inhibition of PD is reactive inhibition, while proactive inhibition has no obvious differences compared with healthy controls. Additionally, compared with the non-exercise group, PD in the exercise group showed significantly better reaction speeds and reactive control ability, fewer motor symptoms and negative emotions. Conclusions Taken together, the motor inhibition defects of patients with PD affect only reactive inhibition. In addition, PD with exercise reported fewer negative emotions than that of the non-exercise group, indicating that exercise can relieve negative emotions and improve behavioral symptoms and quality of life in PD to a certain extent. We demonstrate for the first time that exercise has and can improve reactive inhibition in PD patients and has no effect on proactive inhibition.
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Affiliation(s)
- Zhen Wang
- School of Exercise and Health Science, Xi’an Physical Education University, Xi’an, China,School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Yan-Ling Pi
- Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Yin Wu
- School of Economics and Management, Shanghai University of Sport, Shanghai, China
| | - Jianing Wei
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Yuting Li
- School of Psychology, Shanghai University of Sport, Shanghai, China,School of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Jian Zhang
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Zhen Wang
- School of Martial Arts, Shanghai University of Sport, Shanghai, China
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Douglas KM, Inder ML, Crowe MT, Jordan J, Carlye D, Lacey C, Beaglehole B, Mulder R, Eggleston K, Donovan KA, Frampton CMA, Bowie CR, Porter RJ. Randomised controlled trial of Interpersonal and Social Rhythm Therapy and group-based Cognitive Remediation versus Interpersonal and Social Rhythm Therapy alone for mood disorders: study protocol. BMC Psychiatry 2022; 22:115. [PMID: 35164720 PMCID: PMC8845377 DOI: 10.1186/s12888-022-03747-z] [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: 01/11/2022] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with mood disorders frequently experience cognitive impairment, which impacts on the long-term trajectory of the disorders, including being associated with persisting difficulties in occupational and psychosocial functioning, residual mood symptoms, and relapse. Current first-line treatments for mood disorders do little to improve cognitive function. Targeting cognition in clinical research is thus considered a priority. This protocol outlines a prospectively-registered randomised controlled trial (RCT) which examines the impact of adding group-based Cognitive Remediation (CR) to Interpersonal and Social Rhythm Therapy (IPSRT-CR) for individuals with mood disorders. METHODS This is a pragmatic, two-arm, single-blinded RCT comparing IPSRT-CR with IPSRT alone for adults (n = 100) with mood disorders (Major Depressive Disorder or Bipolar Disorder) with subjective cognitive difficulties, on discharge from Specialist Mental Health Services in Christchurch, New Zealand. Both treatment arms will receive a 12-month course of individual IPSRT (full dose = 24 sessions). At 6 months, randomisation to receive, or not, an 8-week group-based CR programme (Action-based Cognitive Remediation - New Zealand) will occur. The primary outcome will be change in Global Cognition between 6 and 12 months (treatment-end) in IPSRT-CR versus IPSRT alone. Secondary outcomes will be change in cognitive, functional, and mood outcomes at 6, 12, 18, and 24 months from baseline and exploratory outcomes include change in quality of life, medication adherence, rumination, and inflammatory markers between treatment arms. Outcome analyses will use an intention-to-treat approach. Sub-group analyses will assess the impact of baseline features on CR treatment response. Participants' experiences of their mood disorder, including treatment, will be examined using qualitative analysis. DISCUSSION This will be the first RCT to combine group-based CR with an evidence-based psychotherapy for adults with mood disorders. The trial may provide valuable information regarding how we can help promote long-term recovery from mood disorders. Many issues have been considered in developing this protocol, including: recruitment of the spectrum of mood disorders, screening for cognitive impairment, dose and timing of the CR intervention, choice of comparator treatment, and choice of outcome measures. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry, ACTRN12619001080112 . Registered on 6 August 2019.
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Affiliation(s)
- Katie M. Douglas
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree L. Inder
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie T. Crowe
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Dave Carlye
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Cameron Lacey
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.29980.3a0000 0004 1936 7830Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Ben Beaglehole
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Roger Mulder
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Kate Eggleston
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Katherine A. Donovan
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Christopher M. A. Frampton
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Christopher R. Bowie
- grid.410356.50000 0004 1936 8331Department of Psychology, Queen’s University, Kingston, ON Canada
| | - Richard J. Porter
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Rocamora-Montenegro M, Compañ-Gabucio LM, Garcia de la Hera M. Occupational therapy interventions for adults with severe mental illness: a scoping review. BMJ Open 2021; 11:e047467. [PMID: 34716157 PMCID: PMC8559113 DOI: 10.1136/bmjopen-2020-047467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To identify the occupational therapy (OT) interventions in adults with severe mental illness (SMI) most investigated in intervention studies and to describe their characteristics. DESIGN Scoping review. DATA SOURCES On 17 January 2020, we searched the following electronic databases: MEDLINE, Scopus, Web of Science and EMBASE. We also performed a manual search of TESEO doctoral thesis database and of the journals indexed in the first quartile of OT according to the SCImago Journal Rank. We updated our search on 10 March 2021, performing a complementary search on ProQuest database and repeating the search in all sources. The terms included in the search strategy were: schizophrenia, schizotypal personality, delusional, schizoaffective, psychotic, bipolar, major depression, obsessive-compulsive, severe mental, OT and intervention. STUDY SELECTION The study screening was peer-reviewed. Inclusion criteria were: (1) OT intervention studies in SMI: experimental, randomised, non-randomised and pilot/exploratory studies; (2) adult population with SMI: schizophrenia, schizotypal personality disorder, delusional disorder, obsessive-compulsive disorder, schizoaffective disorder, psychotic disorder, bipolar disorder, major depressive disorder; (3) OT identified as a discipline involved in the intervention; (4) English or Spanish language and (5) studies with full text available. RESULTS Thirty-five studies met the inclusion criteria. OT interventions were classified in psychosocial, psychoeducational, cognitive and exercise interventions. The most used OT intervention was psychosocial intervention. CONCLUSION Psychosocial intervention was the most investigated OT intervention in SMI, followed by psychoeducational, cognitive and exercise interventions. These interventions are usually group interventions in patients with schizophrenia, performed by a multidisciplinary team (in which an occupational therapist collaborates), with 2-3 weekly 60 min sessions and a duration of 3-6 months.
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Affiliation(s)
- María Rocamora-Montenegro
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
| | - Laura-María Compañ-Gabucio
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Comunidad Valenciana, Spain
| | - Manuela Garcia de la Hera
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Comunidad Valenciana, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Miles A, Crosse C, Jenkins Z, Morgan P, Fossey E, Harvey C, Castle D. Improving Cognitive Skills for People with Mental Illness to Increase Vocational and Psychosocial Outcomes: The Employ Your Mind Program. ACTA ACUST UNITED AC 2021; 8:287-297. [PMID: 34306989 PMCID: PMC8287552 DOI: 10.1007/s40737-021-00225-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
Cognitive impairments contribute to difficulty obtaining employment for people with severe mental illness (SMI). We describe an evaluation of a program, Employ Your Mind (EYM), which integrates cognitive remediation with vocational rehabilitation to improve cognitive skills and psychosocial outcomes relevant to employment. Participants with SMI were referred to WISE Employment and completed the six-month EYM program. Assessments of psychosocial functioning, cognition and vocational data were collected at baseline and completion, and additional vocational outcomes were collected at 12-month follow-up. Psychosocial functioning and cognition were compared pre- and post-EYM and vocational outcomes were compared for the year prior to EYM and for the 12-month follow-up for program completers. Thirty-two participants commenced the EYM program and 21 (65.6%) completed it. Completers reported significant improvements in mental wellbeing, quality of life and enhanced overall perceived working ability. Participants also demonstrated significantly enhanced speed of processing. Of the 15 participants who reported vocational outcomes, four (26.6%) were engaged in competitive paid employment in the year prior to EYM commencement and eight (53.3%) in the year following EYM commencement. The results indicate that EYM helps improve cognitive performance, psychosocial outcomes, and work readiness in people with SMI.
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Affiliation(s)
- Anne Miles
- WISE Employment, 552 Victoria Street, North Melbourne, VIC 3051 Australia
| | - Caroline Crosse
- WISE Employment, 552 Victoria Street, North Melbourne, VIC 3051 Australia
| | - Zoe Jenkins
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC Australia
| | - Paul Morgan
- WISE Employment, 552 Victoria Street, North Melbourne, VIC 3051 Australia
| | - Ellie Fossey
- Department of Occupational Therapy, Monash University, Frankston, VIC Australia
| | - Carol Harvey
- Department of Occupational Therapy, Monash University, Frankston, VIC Australia.,NorthWestern Mental Health, Melbourne, VIC Australia
| | - David Castle
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC Australia.,Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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Cripe CT, Cooper R, Mikulecky P, Huang JH, Hack DC. Improved Mild Closed Head Traumatic Brain Injury Outcomes With a Brain-Computer Interface Amplified Cognitive Remediation Training. Cureus 2021; 13:e14996. [PMID: 34007777 PMCID: PMC8121126 DOI: 10.7759/cureus.14996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This study is a retrospective chart review of 200 clients who participated in a non-verbal restorative cognitive remediation training (rCRT) program between 2012 and 2020. Each client participated in the program for about 16 weeks, and the study as a whole occurred over a five-year period. The program was applied to effect proper neural functional remodeling needed to support resilient, flexible, and adaptable behaviors after encountering a mild closed head traumatic brain injury (mTBI). The rCRT program focused on improving functional performance in executive cognitive control networks as defined by fMRI studies. All rCRT activities were delivered in a semi-game-like manner, incorporating a brain-computer interface (BCI) that provided in-the-moment neural network performance integrity metrics (nPIMs) used to adjust the level of play required to properly engage long-term potentiation (LTP) and long-term depression (LTD) network learning rules. This study reports on t-test and Reliable Change Index (RCI) changes found within individual cognitive abilities’ performance metrics derived from the Woodcock-Johnson Cognitive Abilities III Test. We compared pre- and post-scores from seven cognitive abilities considered dependent on executive cognitive control networks against seven non-executive control abilities. We observed significant improvements (p < 10-4) with large Cohen’s deffect sizes (0.78-1.20) across 13 of 14 cognitive ability domains with a medium effect size (0.49) on the remaining one. The mean percent change for the pooled trained domain was double that observed for the pooled untrained domain, at 17.2% versus 8.3%, respectively. To further adjust for practice effects, practice effect RCI values were computed and further supported the effectiveness of the rCRT (trained RCI 1.4-4.8; untrained RCI 0.08-0.75).
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Affiliation(s)
- Curtis T Cripe
- Graduate School of Social Service, Fordham University, New York City, USA.,Behavioral Medicine NeuroEngineering, NTLGroup, Inc, Scottsdale, USA
| | - Rebecca Cooper
- Behavioral Medicine NeuroEngineering, NTLGroup, Inc, Scottsdale, USA
| | - Peter Mikulecky
- Brain Mapping and Optimization, Neurologics, Inc, Newport Beach, USA
| | - Jason H Huang
- Neurosurgery, Baylor Scott & White Medical Center, Temple, USA
| | - Dallas C Hack
- Brain Mapping and Optimization, Neurologics, Inc, Newport Beach, USA
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7
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Ott CV, Macoveanu J, Bowie CR, Fisher PM, Knudsen GM, Kessing LV, Miskowiak KW. Change in prefrontal activity and executive functions after action-based cognitive remediation in bipolar disorder: a randomized controlled trial. Neuropsychopharmacology 2021; 46:1113-1121. [PMID: 33168945 PMCID: PMC8115100 DOI: 10.1038/s41386-020-00901-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 11/08/2022]
Abstract
Cognitive impairment is prevalent in bipolar disorder (BD) but treatments with pro-cognitive effects are lacking. Insight concerning the neurocircuitry of cognitive improvement could provide a biomarker for pro-cognitive effects to advance treatment development. The dorsal prefrontal cortex (dPFC) is a promising region for such treatment target engagement. The aim of this functional magnetic resonance imaging (fMRI) study was to examine the effects of action-based cognitive remediation (ABCR) on early change in the dPFC blood-oxygen-level-dependent response in patients with BD in remission, and whether the observed neural change predicted improved executive functions following 10 weeks of treatment. Forty-five participants with remitted BD (ABCR: n = 26, control treatment: n = 19) completed a spatial n-back working memory task during fMRI and executive function tasks outside the scanner before and after two weeks of ABCR/control treatment, and an additional assessment of executive function at treatment completion. Thirty-four healthy controls underwent a single fMRI and executive function assessment for baseline comparisons. We found an early reversal of pretreatment hypo-activity in the dorsolateral prefrontal cortex (dlPFC) following ABCR vs. control during both high-load (2-back > 1-back) working memory (WM) (F(1,43) = 5.69, p = 0.02, η2 = 0.12) and general WM (2-back > 0-back) (F(1,43) = 5.61, p = 0.02, η2 = 0.12). This dlPFC activity increase predicted improved executive functions at treatment completion (high-load WM: B = -0.45, p = 0.01, general WM: B = -0.41, p < 0.01), independent of changes in subsyndromal symptoms. In conclusion, early dPFC increase may provide a neurocircuitry-based biomarker for pro-cognitive effects. Future cognition trials should include fMRI assessments to confirm the validity of this putative biomarker model across disorders with cognitive impairment.
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Affiliation(s)
- Caroline V Ott
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Julian Macoveanu
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Patrick M Fisher
- Neurobiology Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla W Miskowiak
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
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Douglas KM, Milanovic M, Porter RJ, Bowie CR. Clinical and methodological considerations for psychological treatment of cognitive impairment in major depressive disorder. BJPsych Open 2020; 6:e67. [PMID: 32594951 PMCID: PMC7345587 DOI: 10.1192/bjo.2020.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cognitive impairment is considered a core feature of major depressive disorder (MDD) and research into psychological treatments aiming to address cognitive impairment are gaining momentum. Compared with the well-established research base of cognitive treatment trials in schizophrenia, including meta-analyses, mood disorder research is much more preliminary. AIMS To focus on identifying the important factors to consider in developing larger-scale psychological treatment trials targeting cognitive impairment in mood disorders. Trial design recommendations have been published for cognitive treatment trials in bipolar disorder. METHOD An in-depth discussion of methodological considerations in the development of cognitive treatment trials for MDD. RESULTS Methodological considerations include: screening for, and defining, cognitive impairment; mood state when cognitive intervention begins; medication monitoring during cognitive interventions; use of concomitant therapy; level of therapist involvement; duration and dose of treatment; choice of specific cognitive training exercises; home practice; improving adherence; appropriate comparison therapies in clinical trials; and choice of primary outcomes. CONCLUSIONS As well as guidance for clinical trial development, this review may be helpful for clinicians wanting to provide cognitive interventions for individuals with MDD.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, New Zealand
| | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago; and Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Riedl L, Nagels A, Sammer G, Straube B. A Multimodal Speech-Gesture Training Intervention for Patients With Schizophrenia and Its Neural Underpinnings - the Study Protocol of a Randomized Controlled Pilot Trial. Front Psychiatry 2020; 11:110. [PMID: 32210849 PMCID: PMC7068208 DOI: 10.3389/fpsyt.2020.00110] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 02/07/2020] [Indexed: 01/02/2023] Open
Abstract
UNLABELLED Dysfunctional social communication is one of the most stable characteristics in patients with schizophrenia that also affects quality of life. Interpreting abstract speech and integrating nonverbal modalities is particularly affected. Considering the impact of communication on social life but failure to treat communication dysfunctions with usual treatment, we will investigate the possibility to improve verbal and non-verbal communication in schizophrenia by applying a multimodal speech-gesture training (MSG training). Here we describe the newly developed MSG training program and the study design for the first clinical investigation. The intervention contains perceptive rating (match/mismatch of sentence and gesture) and memory tasks (n-back tasks), imitation and productive tasks (e.g., SG fluency-similar to verbal fluency where words are accompanied by gesture). In addition, we offer information about gesture as meta-learning element as well as homework for reasons of transfer to everyday life as part of every session. In the MSG training intervention, we offer eight sessions (60 min each) of training. The first pilot study is currently conducted as a single-center, randomized controlled trial of speech-gesture intervention versus wait-list control with a follow-up. Outcomes are measured through pre-post-fMRI and standardized psychological questionnaires comparing two subject groups (30 patients with schizophrenia and 30 healthy controls). Patients and healthy controls are randomized in two intervention groups (with 20 being in the wait-training group and 10 in the training-follow-up group). With our study design we will be able to demonstrate the beneficial effect of the MSG training intervention on behavioral and neural levels. CLINICAL TRIAL REGISTRATION DRKS.de, identifier DRKS00015118.
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Affiliation(s)
- Lydia Riedl
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Arne Nagels
- Department of English and Linguistics, Johannes-Gutenberg-University, Mainz, Germany
| | - Gebhard Sammer
- Department of Psychiatry and Psychotherapy, Justus-Liebig-University, Gießen, Germany
| | - Benjamin Straube
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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10
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Rao N, Northoff G, Tagore A, Rusjan P, Kenk M, Wilson A, Houle S, Strafella A, Remington G, Mizrahi R. Impaired Prefrontal Cortical Dopamine Release in Schizophrenia During a Cognitive Task: A [11C]FLB 457 Positron Emission Tomography Study. Schizophr Bull 2019; 45:670-679. [PMID: 29878197 PMCID: PMC6483585 DOI: 10.1093/schbul/sby076] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Evidence from several lines of research suggests decreased dopamine release in the prefrontal cortex as the neurochemical correlates of cognitive deficits in schizophrenia (SCZ). However, in vivo examination of cortical hypodopaminergia using positron emission tomography (PET) during cognitive task performance in SCZ remains to be investigated. We examined dopamine release in anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (DLPFC), using PET while participants were performing a cognitive task. Thirteen drug-free patients with SCZ and 13 healthy volunteers (HV) matched for age and sex participated in the study. Data were acquired between 2011 and 2015. Two PET scans with [11C]FLB 457 were acquired while the participants were performing the Wisconsin Card Sorting Test (WCST) and a sensorimotor control task (SMCT). A magnetic resonance image was acquired for anatomical delineation. Differences in cortical dopamine release between SCZ and HV, indexed as percentage change in binding potential between WCST and SMCT (ΔBPND), were calculated in ACC and DLPFC. We observed significant differences in the ΔBPND in ACC (HV = 4.40 ± 6.00; SCZ = -11.48 ± 15.08; t = 3.52; P = .003) and a trend-level difference in ΔBPND in DLPFC (HV = -0.58 ± 8.45; SCZ = -7.79 ± 11.28; t = 1.84; P = .079), suggesting dopamine depletion in cortical brain regions in patients with SCZ while performing a cognitive task. These results provide the first in vivo evidence for reduced dopamine release or even dopamine depletion while performing cognitive task in ACC and DLPFC in patients with SCZ. The present results provide support for the frontal hypodopaminergia hypothesis of cognitive symptoms in SCZ.
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Affiliation(s)
- Naren Rao
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Georg Northoff
- Institute of Mental Health Research: Mind, Brain Imaging and Neuroethics, University of Ottawa, Ottawa, ON, Canada
| | - Abanti Tagore
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Pablo Rusjan
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Miran Kenk
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alan Wilson
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sylvain Houle
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Antonio Strafella
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gary Remington
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Romina Mizrahi
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada,To whom correspondence should be addressed; University of Toronto, Focus on Youth Psychosis Prevention (FYPP), Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8 Canada; tel: 416-535-8501 ext. 34508, fax: 416-979-4656, e-mail:
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11
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Jahshan C, Vinogradov S, Wynn JK, Hellemann G, Green MF. A randomized controlled trial comparing a "bottom-up" and "top-down" approach to cognitive training in schizophrenia. J Psychiatr Res 2019; 109:118-125. [PMID: 30529836 PMCID: PMC9199200 DOI: 10.1016/j.jpsychires.2018.11.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/21/2018] [Accepted: 11/30/2018] [Indexed: 12/12/2022]
Abstract
The development of effective cognitive training (CT) interventions is critical for improving the daily lives of people with schizophrenia. At this point, it is unclear whether a so-called "bottom-up" or "top-down" CT approach is more beneficial for inducing cognitive gains and generalization in this population. The aims of this randomized controlled trial were to: 1) Compare the effects of these two types of training approaches on performance-based (MATRICS Consensus Cognitive Battery, MCCB) and neurophysiological (mismatch negativity, MMN) measures of cognition, and 2) Evaluate MMN as a potential predictor of treatment response. Ninety-nine patients with persistent schizophrenia (mean age of 51 and illness duration of 30 years) were randomly assigned in a 2:2:1 ratio to a "bottom-up" intervention that selectively targets basic auditory processing and verbal learning (Brain Fitness), a "top-down" intervention that targets a broad range of higher-order cognitive functions (COGPACK), or a control condition consisting of commercial computer games (Sporcle). Participants completed on average 30 h of training over 12 weeks. Despite demonstrated improvement on training tasks, we found no significant treatment effects on measures of neurocognition (MCCB), MMN, or functional capacity from either intervention. Interestingly, there was an association between an enhanced MMN response at 6 weeks and improved reasoning/problem solving at 12 weeks in the COGPACK group. Although this study had several methodological strengths, the results were mainly negative. It suggests that CT trials in schizophrenia should try to better understand mediators and moderators of treatment response to develop more personalized interventions.
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Affiliation(s)
- Carol Jahshan
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Sophia Vinogradov
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN
| | - Jonathan K. Wynn
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Gerhard Hellemann
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA,Department of Biostatistics, University of California, Los Angeles, CA
| | - Michael F. Green
- Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA,Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
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12
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Wykes T, Joyce E, Velikonja T, Watson A, Aarons G, Birchwood M, Cella M, Dopson S, Fowler D, Greenwood K, Johnson S, McCrone P, Perez J, Pickles A, Reeder C, Rose D, Singh S, Stringer D, Taylor M, Taylor R, Upthegrove R. The CIRCuiTS study (Implementation of cognitive remediation in early intervention services): protocol for a randomised controlled trial. Trials 2018; 19:183. [PMID: 29544551 PMCID: PMC5856221 DOI: 10.1186/s13063-018-2553-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cognitive problems in people with schizophrenia predict poor functional recovery even with the best possible rehabilitation opportunities and optimal medication. A psychological treatment known as cognitive remediation therapy (CRT) aims to improve cognition in neuropsychiatric disorders, with the ultimate goal of improving functional recovery. Studies suggest that intervening early in the course of the disorder will have the most benefit, so this study will be based in early intervention services, which treat individuals in the first few years following the onset of the disorder. The overall aim is to investigate different methods of CRT. Methods This is a multicentre, randomised, single-blinded, controlled trial based in early intervention services in National Health Service Mental Health Trusts in six English research sites. Three different methods of providing CRT (intensive, group, and independent) will be compared with treatment as usual. We will recruit 720 service users aged between 16 and 45 over 3 years who have a research diagnosis of non-affective psychosis and will be at least 3 months from the onset of the first episode of psychosis. The primary outcome measure will be the degree to which participants have achieved their stated goals using the Goal Attainment Scale. Secondary outcome measures will include improvements in cognitive function, social function, self-esteem, and clinical symptoms. Discussion It has already been established that cognitive remediation improves cognitive function in people with schizophrenia. Successful implementation in mental health services has the potential to change the recovery trajectory of individuals with schizophrenia-spectrum disorders. However, the best mode of implementation, in terms of efficacy, service user and team preference, and cost-effectiveness is still unclear. The CIRCuiTS trial will provide guidance for a large-scale roll-out of CRT to mental health services where cognitive difficulties impact recovery and resilience. Trial registration ISRCTN, ISRCTN14678860, Registered on 6 June 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2553-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK. .,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
| | - Eileen Joyce
- UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Tjasa Velikonja
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Andrew Watson
- UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Gregory Aarons
- University of California, San Diego, 9500 Gilman Dr. (0812), La Jolla, CA, 92093-0812, USA
| | - Max Birchwood
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Sue Dopson
- Saïd Business School, University of Oxford, Park End Street, Oxford, OX1 1HP, UK
| | - David Fowler
- Psychology Department, University of Sussex, Brighton, Sussex, BN1 9RH, UK
| | - Kathy Greenwood
- Sussex Partnership NHS Foundation Trust and University of Sussex, Sussex House, Falmer, Brighton, BN1 9RH, UK
| | - Sonia Johnson
- Division of Psychiatry, UCL, Mental Health Sciences Unit, 2nd Floor Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Jesus Perez
- Cambridge & Peterborough NHS Foundation Trust, CAMEO, Block 7 Ida Darwin, Fulbourn Hospital, Cambridge, CB2 5EE, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Clare Reeder
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Diana Rose
- Health Services and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Swaran Singh
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Matthew Taylor
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Rumina Taylor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Rachel Upthegrove
- College of Medical and Dental Sciences, University of Birmingham, 25 Vincent Drive, Birmingham, B15 2F, UK
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13
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White matter microstructure predicts cognitive training-induced improvements in attention and executive functioning in schizophrenia. Schizophr Res 2018; 193:276-283. [PMID: 28689758 PMCID: PMC5999406 DOI: 10.1016/j.schres.2017.06.062] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 12/11/2022]
Abstract
We examined the relationship between white matter microstructure in schizophrenia using diffusion tensor imaging (DTI) and cognitive improvements induced by 70h (~16weeks) of cognitive training. We measured anatomical connectivity in 48 patients with schizophrenia (SZ) and 28 healthy control participants (HC) at baseline, and then examined the relationship between anatomical connectivity at baseline and training-induced cognitive gains in 30 SZ who performed diffusion imaging after completing 70h of training. Compared with healthy control participants, individuals with schizophrenia showed reduced white matter integrity at baseline, as indexed by fractional anisotropy metrics, in bilateral posterior corona radiata, bilateral retrolenticular internal capsules, bilateral posterior thalamic radiation, left anterior corona radiata, left superior longitudinal fasciculus, left sagittal stratum, right cerebral peduncle and the genu and splenium of the corpus callosum. After training, schizophrenia participants showed significant gains in attention/vigilance, speed of processing, verbal learning, visual learning and executive functioning. White matter integrity within the right fronto-occipital fasciculus predicted training-induced improvements in attention/vigilance, while white matter integrity within the right corticospinal tract and bilateral medial lemnisci predicted cognitive training-induced improvements in executive functioning, areas that did not show white matter tract deficits at baseline. These findings suggest that preserved white matter integrity connecting long-range prefrontal-thalamic-sensorimotor areas may be an important determinant for training-induced neurocognitive plasticity.
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14
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Aguilar EJ, Corripio I, García-Martí G, Grasa E, Martí-Bonmatí L, Gómez-Ansón B, Sanjuán J, Núñez-Marín F, Lorente-Rovira E, Escartí MJ, Brabban A, Turkington D. Emotional fMR auditory paradigm demonstrates normalization of limbic hyperactivity after cognitive behavior therapy for auditory hallucinations. Schizophr Res 2018; 193:304-312. [PMID: 28720416 DOI: 10.1016/j.schres.2017.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/08/2017] [Accepted: 07/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Eduardo J Aguilar
- Department of Medicine, Valencia University, Avda. Blasco Ibáñez 15-17, 46010 Valencia, Spain; INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain; Psychiatry Unit, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain; Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain.
| | - Gracián García-Martí
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain; Radiology Department, Quirón Hospital, Avda. Blasco Ibáñez 14, 46010 Valencia, Spain.
| | - Eva Grasa
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain; Psychiatry Unit, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain; Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain.
| | - Luis Martí-Bonmatí
- Department of Medicine, Valencia University, Avda. Blasco Ibáñez 15-17, 46010 Valencia, Spain; Radiology Department, Quirón Hospital, Avda. Blasco Ibáñez 14, 46010 Valencia, Spain; Radiology Department and GIBI230 Research Group, La Fe University and Polytechnic Hospital, Bulevar Sur, s/n, 46026 Valencia, Spain.
| | - Beatriz Gómez-Ansón
- Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain; Neuroradiology Unit, Radiology Department, Neuroradiology Research Group, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain.
| | - Julio Sanjuán
- Department of Medicine, Valencia University, Avda. Blasco Ibáñez 15-17, 46010 Valencia, Spain; INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - Fidel Núñez-Marín
- Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain; Neuroradiology Unit, Radiology Department, Neuroradiology Research Group, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain.
| | - Esther Lorente-Rovira
- INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - María J Escartí
- INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - Alison Brabban
- Durham University, Stockton Rd, Durham, County Durham DH1, United Kingdom.
| | - Douglas Turkington
- Newcastle University, Newcastle upon Tyne, Tyne and Wear NE1 7RU, United Kingdom.
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15
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Gopal YV, Variend H. First-episode schizophrenia: review of cognitive deficits and cognitive remediation. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.11.1.38] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The presence of cognitive deficits in schizophrenic illness has been extensively documented, and deficits in memory and executive functioning may be related to poor prognosis. Targeting these deficits during the early phase has potential benefits. The neural basis for cognitive deficits in schizophrenia is not well understood, and hence pharmacological interventions alone are insufficient. Future strategies should focus on pharmacological interventions combined with psychological techniques such as cognitive remediation. This review summarises recent findings relating to first-episode schizophrenia.
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16
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Computerized cognitive remediation therapy effects on resting state brain activity and cognition in schizophrenia. Sci Rep 2017; 7:4758. [PMID: 28684776 PMCID: PMC5500543 DOI: 10.1038/s41598-017-04829-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/22/2017] [Indexed: 01/09/2023] Open
Abstract
This study aimed to test how an 8-week training using computerized cognitive remediation therapy (CCRT) would modify resting brain functional activity and improve cognitive function in patients with schizophrenia. Twenty-seven patients with schizophrenia were recruited and randomized into two groups: CCRT or treatment-as-usual (TAU). The CCRT group received 40 sessions of computerized cognitive training over an eight-week period. There was a significant treatment group × time interaction on the processing speed (trail making test: F = 8.14, P = 0.01) and a trend in problem solving (mazes test: P = 0.06). Post-hoc tests showed that CCRT but not TAU significantly improved scores from baseline to end-of-treatment on these two cognitive assessments. For the resting brain functional activity, significant group × time interaction effect was found in the medial prefrontal cortex (mPFC)/anterior cingulate cortex (ACC) and brainstem pons region. Post-hoc tests showed that there was significant increased activity in the mPFC/ACC in CCRT but not TAU group. In this small sample study, computerized cognitive remediation therapy is shown to enhance mPFC/ACC activity even at resting state and improve cognitive function in patients with schizophrenia. If replicated, this community and clinic accessible therapy may assist cognitive remediation effort for people with schizophrenia.
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17
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Wei YY, Wang JJ, Yan C, Li ZQ, Pan X, Cui Y, Su T, Liu TS, Tang YX. Correlation Between Brain Activation Changes and Cognitive Improvement Following Cognitive Remediation Therapy in Schizophrenia: An Activation Likelihood Estimation Meta-analysis. Chin Med J (Engl) 2017; 129:578-85. [PMID: 26904993 PMCID: PMC4804440 DOI: 10.4103/0366-6999.176983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Several studies using functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have indicated that cognitive remediation therapy (CRT) might improve cognitive function by changing brain activations in patients with schizophrenia. However, the results were not consistent in these changed brain areas in different studies. The present activation likelihood estimation (ALE) meta-analysis was conducted to investigate whether cognitive function change was accompanied by the brain activation changes, and where the main areas most related to these changes were in schizophrenia patients after CRT. Analyses of whole-brain studies and whole-brain + region of interest (ROI) studies were compared to explore the effect of the different methodologies on the results. Methods: A computerized systematic search was conducted to collect fMRI and PET studies on brain activation changes in schizophrenia patients from pre- to post-CRT. Nine studies using fMRI techniques were included in the meta-analysis. Ginger ALE 2.3.1 was used to perform meta-analysis across these imaging studies. Results: The main areas with increased brain activation were in frontal and parietal lobe, including left medial frontal gyrus, left inferior frontal gyrus, right middle frontal gyrus, right postcentral gyrus, and inferior parietal lobule in patients after CRT, yet no decreased brain activation was found. Although similar increased activation brain areas were identified in ALE with or without ROI studies, analysis including ROI studies had a higher ALE value. Conclusions: The current findings suggest that CRT might improve the cognition of schizophrenia patients by increasing activations of the frontal and parietal lobe. In addition, it might provide more evidence to confirm results by including ROI studies in ALE meta-analysis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yun-Xiang Tang
- Department of Medical Psychology, Faculty of Mental Health, Second Military Medical University, Shanghai 200433, China
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18
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Térémetz M, Carment L, Brénugat-Herne L, Croca M, Bleton JP, Krebs MO, Maier MA, Amado I, Lindberg PG. Manual Dexterity in Schizophrenia-A Neglected Clinical Marker? Front Psychiatry 2017; 8:120. [PMID: 28740470 PMCID: PMC5502278 DOI: 10.3389/fpsyt.2017.00120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/23/2017] [Indexed: 01/30/2023] Open
Abstract
Impaired manual dexterity is commonly observed in schizophrenia. However, a quantitative description of key sensorimotor components contributing to impaired dexterity is lacking. Whether the key components of dexterity are differentially affected and how they relate to clinical characteristics also remains unclear. We quantified the degree of dexterity in 35 stabilized patients with schizophrenia and in 20 age-matched control subjects using four visuomotor tasks: (i) force tracking to quantify visuomotor precision, (ii) sequential finger tapping to measure motor sequence recall, (iii) single-finger tapping to assess temporal regularity, and (iv) multi-finger tapping to measure independence of finger movements. Diverse clinical and neuropsychological tests were also applied. A patient subgroup (N = 15) participated in a 14-week cognitive remediation protocol and was assessed before and after remediation. Compared to control subjects, patients with schizophrenia showed greater error in force tracking, poorer recall of tapping sequences, decreased tapping regularity, and reduced degree of finger individuation. A composite performance measure discriminated patients from controls with sensitivity = 0.79 and specificity = 0.9. Aside from force-tracking error, no other dexterity components correlated with antipsychotic medication. In patients, some dexterity components correlated with neurological soft signs, Positive and Negative Syndrome Scale (PANSS), or neuropsychological scores. This suggests differential cognitive contributions to these components. Cognitive remediation lead to significant improvement in PANSS, tracking error, and sequence recall (without change in medication). These findings show that multiple aspects of sensorimotor control contribute to impaired manual dexterity in schizophrenia. Only visuomotor precision was related to antipsychotic medication. Good diagnostic accuracy and responsiveness to treatment suggest that manual dexterity may represent a useful clinical marker in schizophrenia.
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Affiliation(s)
- Maxime Térémetz
- FR3636, CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Loïc Carment
- FR3636, CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Lindsay Brénugat-Herne
- SHU, Resource Center for Cognitive Remediation and Psychosocial Rehabilitation, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France.,INSERM U894, GDR3557 Psychiatrie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marta Croca
- SHU, Resource Center for Cognitive Remediation and Psychosocial Rehabilitation, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France.,INSERM U894, GDR3557 Psychiatrie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Marie-Odile Krebs
- SHU, Resource Center for Cognitive Remediation and Psychosocial Rehabilitation, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France.,INSERM U894, GDR3557 Psychiatrie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marc A Maier
- FR3636, CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Isabelle Amado
- SHU, Resource Center for Cognitive Remediation and Psychosocial Rehabilitation, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France.,INSERM U894, GDR3557 Psychiatrie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Påvel G Lindberg
- FR3636, CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM U894, GDR3557 Psychiatrie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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19
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Kani AS, Shinn AK, Lewandowski KE, Öngür D. Converging effects of diverse treatment modalities on frontal cortex in schizophrenia: A review of longitudinal functional magnetic resonance imaging studies. J Psychiatr Res 2017; 84:256-276. [PMID: 27776293 PMCID: PMC5135290 DOI: 10.1016/j.jpsychires.2016.10.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES A variety of treatment options exist for schizophrenia, but the effects of these treatments on brain function are not clearly understood. To facilitate the development of more effective treatment strategies, it is important to identify how brain function in schizophrenia patients is affected by the diverse therapeutic approaches that are currently available. The aim of the present article is to systematically review the evidence for functional brain changes associated with different treatment modalities for schizophrenia. METHODS We searched PubMed for longitudinal functional MRI (fMRI) studies reporting on the effects of antipsychotic medications (APM), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), cognitive remediation therapy (CRT) and cognitive behavioral therapy for psychosis (CBTp) on brain function in schizophrenia. RESULTS Thirty six studies fulfilled the inclusion criteria. Functional alterations were observed in diverse brain regions. Across intervention modalities, changes in fMRI parameters were reported most commonly in frontal brain regions including prefrontal cortex, anterior cingulate and inferior frontal cortex. CONCLUSIONS We conclude that current treatments for schizophrenia commonly induce functional brain alterations in frontal brain regions. However, interpretability is limited by inconsistency in task and region of interest selection, and failures to replicate. Further task independent fMRI studies examining treatment effects with whole brain analysis are needed to deepen our insights.
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Affiliation(s)
- Ayse Sakalli Kani
- Sivas Numune State Hospital, Department of Psychiatry, Sivas, Turkey.
| | - Ann K. Shinn
- Psychotic Disorders Division, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Harvard Medical School, Department of Psychiatry, Boston, MA 02114, USA.
| | - Kathryn E. Lewandowski
- Psychotic Disorders Division, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA; Harvard Medical School, Department of Psychiatry, Boston, MA 02114, USA.
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, 115 Mill St., Belmont, MA, 02478, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, 02114, USA.
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20
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Kawohl W, Wyss C, Roser P, Brüne M, Rössler W, Juckel G. [Social psychiatry and neurobiology : A long overdue convergence exemplified by schizophrenia]. DER NERVENARZT 2016; 88:510-519. [PMID: 27491537 DOI: 10.1007/s00115-016-0179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The proliferation of biological psychiatry has greatly increased over the last two decades. With the possibility to carry out brain research using modern technical methods, it seemed that social influencing factors would lose importance in the development of mental diseases; however, in actual fact this does not seem to be justified. It is necessary to overcome this separation, in that social factors are incorporated into a conceptual framework in the development of mental diseases, which simultaneously also takes the results of current neurobiological research into consideration. OBJECTIVES AND METHODS The aims of this review article are to summarize the current state of sociopsychiatric research and to emphasize the perspectives of the biological principles and their validity with respect to the social dimensions of psychiatry, as exemplified by schizophrenic disorders. The article presents the options for a biosocial approach in social psychiatry and gives an overview of the currently available literature. RESULTS AND CONCLUSION There is an abundance of neurobiological research approaches, which are closely associated with sociopsychiatric topics, such as social cognition. Social psychiatry and biological psychiatry should no longer be considered as diametrically opposed subdisciplines. On the contrary, the options which could emerge from a synthesis must be used in research and clinical practice.
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Affiliation(s)
- W Kawohl
- Zentrum für Soziale Psychiatrie, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Militärstr. 8, Postfach 1930, 8021, Zürich, Schweiz. .,Universität Zürich, Zürich, Schweiz. .,Leuphana Universität Lüneburg, Lüneburg, Deutschland.
| | - C Wyss
- Zentrum für Soziale Psychiatrie, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Militärstr. 8, Postfach 1930, 8021, Zürich, Schweiz.,Universität Zürich, Zürich, Schweiz
| | - P Roser
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinik, Ruhr-Universität Bochum, Bochum, Deutschland
| | - M Brüne
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinik, Ruhr-Universität Bochum, Bochum, Deutschland.,Forschungsabteilung für Kognitive Neuropsychiatrie und Psychiatrische Präventivmedizin, LWL-Universitätsklinik, Ruhr-Universität Bochum, Bochum, Deutschland
| | - W Rössler
- Universität Zürich, Zürich, Schweiz.,Leuphana Universität Lüneburg, Lüneburg, Deutschland
| | - G Juckel
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinik, Ruhr-Universität Bochum, Bochum, Deutschland
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21
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Shanmugan S, Satterthwaite TD. Neural Markers of the Development of Executive Function: Relevance for Education. Curr Opin Behav Sci 2016; 10:7-13. [PMID: 27182537 DOI: 10.1016/j.cobeha.2016.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Executive functions are involved in the development of academic skills and are critical for functioning in school settings. The relevance of executive functions to education begins early and continues throughout development, with clear impact on achievement. Diverse efforts increasingly suggest ways in which facilitating development of executive function may be used to improve academic performance. Such interventions seek to alter the trajectory of executive development, which exhibits a protracted course of maturation that stretches into young adulthood. As such, it may be useful to understand how the executive system develops normally and abnormally in order to tailor interventions within educational settings. Here we review recent work investigating the neural basis for executive development during childhood and adolescence.
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Affiliation(s)
- Sheila Shanmugan
- Department of Psychiatry, University of Pennsylvania, Philadelphia PA 19104, USA
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22
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Ramsay IS, MacDonald AW. Brain Correlates of Cognitive Remediation in Schizophrenia: Activation Likelihood Analysis Shows Preliminary Evidence of Neural Target Engagement. Schizophr Bull 2015; 41:1276-84. [PMID: 25800249 PMCID: PMC4601705 DOI: 10.1093/schbul/sbv025] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cognitive remediation training (CRT) for schizophrenia has been found to improve cognitive functioning and influence neural plasticity. However, with various training approaches and mixed findings, the mechanisms driving generalization of cognitive skills from CRT are unclear. In this meta-analysis of extant imaging studies examining CRT's effects, we sought to clarify whether varying approaches to CRT suggest common neural changes and whether such mechanisms are restorative or compensatory. We conducted a literature search to identify studies appropriate for inclusion in an activation likelihood estimation (ALE) meta-analysis. Our criteria required studies to consist of training-based interventions designed to improve patients' cognitive or social functioning, including generalization to untrained circumstances. Studies were also required to examine changes in pre- vs posttraining functional activation using functional magnetic resonance imaging or positron emission tomography. The literature search identified 162 articles, 9 of which were appropriate for inclusion. ALE analyses comparing pre- and posttraining brain activation showed increased activity in the lateral and medial prefrontal cortex (PFC), parietal cortex, insula, and the caudate and thalamus. Notably, activation associated with CRT in the left PFC and thalamus partially overlapped with previous meta-analytically identified areas associated with deficits in working memory, executive control, and facial emotion processing in schizophrenia. We conclude that CRT interventions from varying theoretic modalities elicit plasticity in areas that support cognitive and socioemotional processes in this early set of studies. While preliminary, these changes appear to be both restorative and compensatory, though thalamocortical areas previously associated with dysfunction may be common sources of plasticity for cognitive remediation in schizophrenia.
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Affiliation(s)
- Ian S. Ramsay
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Angus W. MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, MN;,Department of Psychiatry, University of Minnesota, Minneapolis, MN,*To whom correspondence should be addressed; Department of Psychology, University of Minnesota, Elliott Hall, 75 East River Road, Minneapolis, MN 55455, US; tel: 612-624-3813, fax: 612-626-2079, e-mail:
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23
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Sacks-Zimmerman A, Duggal D, Liberta T. Cognitive Remediation Therapy for Brain Tumor Survivors with Cognitive Deficits. Cureus 2015; 7:e350. [PMID: 26623205 PMCID: PMC4641743 DOI: 10.7759/cureus.350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cognitive deficits have been widely observed in patients with primary brain tumors consequent to diagnosis and treatment. Given the early onset and the relatively long survival rate of patients, it seems pertinent to study and refine the techniques used to treat these deficits. The purpose of this article is to discuss cognitive deficits that follow neurosurgical treatment for low-grade gliomas as well as to outline a neuropsychological intervention to treat these deficits, specifically working memory and attention. Cognitive remediation therapy is a neuropsychological intervention that aims to enhance attention, working memory, and executive functioning, thereby diminishing the impact of these deficits on daily functioning. Computerized cognitive remediation training programs facilitate access to treatment through providing online participation. The authors include preliminary results of three participants who have completed the computerized training program as part of an ongoing study that is investigating the efficacy of this program in patients who have undergone treatment for low-grade gliomas. The results so far suggest some improvement in working memory and attention from baseline scores. It is the hope of the present authors to highlight the importance of this treatment in the continuity of care of brain tumor survivors.
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24
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Bölte S, Ciaramidaro A, Schlitt S, Hainz D, Kliemann D, Beyer A, Poustka F, Freitag C, Walter H. Training-induced plasticity of the social brain in autism spectrum disorder. Br J Psychiatry 2015; 207:149-57. [PMID: 25792694 DOI: 10.1192/bjp.bp.113.143784] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/27/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is linked to social brain activity and facial affect recognition (FAR). AIMS To examine social brain plasticity in ASD. METHOD Using FAR tests and functional magnetic resonance imaging tasks for FAR, we compared 32 individuals with ASD and 25 controls. Subsequently, the participants with ASD were assigned to FAR computer-aided cognitive training or a control group. RESULTS The ASD group performed more poorly than controls on explicit behavioural FAR tests. In the scanner, during implicit FAR, the amygdala, fusiform gyrus and other regions of the social brain were less activated bilaterally. The training group improved on behavioural FAR tests, and cerebral response to implicit affect processing tasks increased bilaterally post-training in the social brain. CONCLUSIONS Individuals with ASD show FAR impairments associated with hypoactivation of the social brain. Computer-based training improves explicit FAR and neuronal responses during implicit FAR, indicating neuroplasticity in the social brain in ASD.
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Affiliation(s)
- Sven Bölte
- Sven Bölte, Prof, PhD, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden, and Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Angela Ciaramidaro, PhD, Sabine Schlitt, PhD, Daniela Hainz, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Dorit Kliemann, PhD, Cluster of Excellence 'Languages of Emotion' and Department of Education and Psychology, Freie Universität, Berlin, Germany, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, Massachusetts, USA; Fritz Poustka, MD, PhD, Anke Beyer, PhD, Christine Freitag, MD, PhD, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Henrik Walter, MD, PhD, Department of Psychiatry and Psychotherapy, Charité Universitatsmedizin Berlin, Germany
| | - Angela Ciaramidaro
- Sven Bölte, Prof, PhD, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden, and Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Angela Ciaramidaro, PhD, Sabine Schlitt, PhD, Daniela Hainz, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Dorit Kliemann, PhD, Cluster of Excellence 'Languages of Emotion' and Department of Education and Psychology, Freie Universität, Berlin, Germany, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, Massachusetts, USA; Fritz Poustka, MD, PhD, Anke Beyer, PhD, Christine Freitag, MD, PhD, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Henrik Walter, MD, PhD, Department of Psychiatry and Psychotherapy, Charité Universitatsmedizin Berlin, Germany
| | - Sabine Schlitt
- Sven Bölte, Prof, PhD, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden, and Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Angela Ciaramidaro, PhD, Sabine Schlitt, PhD, Daniela Hainz, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Dorit Kliemann, PhD, Cluster of Excellence 'Languages of Emotion' and Department of Education and Psychology, Freie Universität, Berlin, Germany, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, Massachusetts, USA; Fritz Poustka, MD, PhD, Anke Beyer, PhD, Christine Freitag, MD, PhD, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Henrik Walter, MD, PhD, Department of Psychiatry and Psychotherapy, Charité Universitatsmedizin Berlin, Germany
| | - Daniela Hainz
- Sven Bölte, Prof, PhD, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden, and Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Angela Ciaramidaro, PhD, Sabine Schlitt, PhD, Daniela Hainz, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Dorit Kliemann, PhD, Cluster of Excellence 'Languages of Emotion' and Department of Education and Psychology, Freie Universität, Berlin, Germany, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, Massachusetts, USA; Fritz Poustka, MD, PhD, Anke Beyer, PhD, Christine Freitag, MD, PhD, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Henrik Walter, MD, PhD, Department of Psychiatry and Psychotherapy, Charité Universitatsmedizin Berlin, Germany
| | - Dorit Kliemann
- Sven Bölte, Prof, PhD, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden, and Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Angela Ciaramidaro, PhD, Sabine Schlitt, PhD, Daniela Hainz, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Dorit Kliemann, PhD, Cluster of Excellence 'Languages of Emotion' and Department of Education and Psychology, Freie Universität, Berlin, Germany, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, Massachusetts, USA; Fritz Poustka, MD, PhD, Anke Beyer, PhD, Christine Freitag, MD, PhD, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Henrik Walter, MD, PhD, Department of Psychiatry and Psychotherapy, Charité Universitatsmedizin Berlin, Germany
| | - Anke Beyer
- Sven Bölte, Prof, PhD, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden, and Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Angela Ciaramidaro, PhD, Sabine Schlitt, PhD, Daniela Hainz, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Dorit Kliemann, PhD, Cluster of Excellence 'Languages of Emotion' and Department of Education and Psychology, Freie Universität, Berlin, Germany, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, Massachusetts, USA; Fritz Poustka, MD, PhD, Anke Beyer, PhD, Christine Freitag, MD, PhD, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Henrik Walter, MD, PhD, Department of Psychiatry and Psychotherapy, Charité Universitatsmedizin Berlin, Germany
| | - Fritz Poustka
- Sven Bölte, Prof, PhD, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden, and Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Angela Ciaramidaro, PhD, Sabine Schlitt, PhD, Daniela Hainz, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Dorit Kliemann, PhD, Cluster of Excellence 'Languages of Emotion' and Department of Education and Psychology, Freie Universität, Berlin, Germany, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, Massachusetts, USA; Fritz Poustka, MD, PhD, Anke Beyer, PhD, Christine Freitag, MD, PhD, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Henrik Walter, MD, PhD, Department of Psychiatry and Psychotherapy, Charité Universitatsmedizin Berlin, Germany
| | - Christine Freitag
- Sven Bölte, Prof, PhD, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden, and Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Angela Ciaramidaro, PhD, Sabine Schlitt, PhD, Daniela Hainz, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Dorit Kliemann, PhD, Cluster of Excellence 'Languages of Emotion' and Department of Education and Psychology, Freie Universität, Berlin, Germany, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, Massachusetts, USA; Fritz Poustka, MD, PhD, Anke Beyer, PhD, Christine Freitag, MD, PhD, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Henrik Walter, MD, PhD, Department of Psychiatry and Psychotherapy, Charité Universitatsmedizin Berlin, Germany
| | - Henrik Walter
- Sven Bölte, Prof, PhD, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden, and Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Angela Ciaramidaro, PhD, Sabine Schlitt, PhD, Daniela Hainz, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Dorit Kliemann, PhD, Cluster of Excellence 'Languages of Emotion' and Department of Education and Psychology, Freie Universität, Berlin, Germany, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charlestown, Massachusetts, USA; Fritz Poustka, MD, PhD, Anke Beyer, PhD, Christine Freitag, MD, PhD, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Goethe-University, Frankfurt, Germany; Henrik Walter, MD, PhD, Department of Psychiatry and Psychotherapy, Charité Universitatsmedizin Berlin, Germany
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25
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The neuroplastic effect of working memory training in healthy volunteers and patients with schizophrenia: Implications for cognitive rehabilitation. Neuropsychologia 2015; 75:149-62. [PMID: 26032579 DOI: 10.1016/j.neuropsychologia.2015.05.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 01/19/2023]
Abstract
We conducted an activation likelihood estimation (ALE) meta-analysis to quantitatively review the existing working memory (WM) training studies that investigated neural activation changes both in healthy individuals and patients with schizophrenia. ALE analysis of studies in healthy individuals indicates a widespread distribution of activation changes with WM training in the frontal and parietal regions, especially the dorsolateral prefrontal cortex, the medial frontal cortex and the precuneus, as well as subcortical regions such as the insula and the striatum. WM training is also accompanied by activation changes in patients with schizophrenia, mainly in the dorsolateral prefrontal cortex, the precuneus and the fusiform gyrus. Our results demonstrate that WM training is accompanied by changes in neural activation patterns in healthy individuals, which may provide the basis for understanding neuroplastic changes in patients with schizophrenia.
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26
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Fett AKJ, Shergill SS, Krabbendam L. Social neuroscience in psychiatry: unravelling the neural mechanisms of social dysfunction. Psychol Med 2015; 45:1145-1165. [PMID: 25335852 DOI: 10.1017/s0033291714002487] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Social neuroscience is a flourishing, interdisciplinary field that investigates the underlying biological processes of social cognition and behaviour. The recent application of social neuroscience to psychiatric research advances our understanding of various psychiatric illnesses that are characterized by impairments in social cognition and social functioning. In addition, the upcoming line of social neuroscience research provides new techniques to design and evaluate treatment interventions that are aimed at improving patients' social lives. This review provides a contemporary overview of social neuroscience in psychiatry. We draw together the major findings about the neural mechanisms of social cognitive processes directed at understanding others and social interactions in psychiatric illnesses and discuss their implications for future research and clinical practice.
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Affiliation(s)
- A K J Fett
- Department of Educational Neuroscience & Research Institute LEARN!,Faculty of Psychology and Education,VU University Amsterdam,Van der Boechorststraat 1,Amsterdam,The Netherlands
| | - S S Shergill
- Department of Psychosis Studies,Institute of Psychiatry, King's College London,De Crespigny Park,London,UK
| | - L Krabbendam
- Department of Educational Neuroscience & Research Institute LEARN!,Faculty of Psychology and Education,VU University Amsterdam,Van der Boechorststraat 1,Amsterdam,The Netherlands
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27
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The effect of cognitive training on evoked potentials in schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2014; 1:180-186. [PMID: 29379751 PMCID: PMC5779133 DOI: 10.1016/j.scog.2014.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/09/2014] [Accepted: 07/21/2014] [Indexed: 11/22/2022]
Abstract
Electrophysiological indices are sensitive to cognitive dysfunction in schizophrenia but have rarely been used to assess benefits of cognitive remediation. Our aim was to evaluate the effect of specific cognitive training approaches on event-related potentials. Forty-six patients with schizophrenia underwent either auditory (AUD) or visuo-spatial (VIS) cognitive training or treatment-as-usual (TAU). Cognitive training was computer-assisted and administered for 10 sessions within two weeks. Event-related potentials during an active odd-ball paradigm together with clinical and neuropsychological variables were assessed before and after training and again at a two-month follow-up. Compared to the TAU group both the AUD and VIS training groups showed decreased P2 latency following training. At follow-up, the P2-latency reduction was stable in the VIS group but the AUD group experienced a relapse. Training resulted in improved digit-span backward among neuropsychological variables. Increased P2 amplitude was related to more positive symptoms and lower social-occupational functioning and longer P2 latency was associated with greater severity of stereotyped thinking. The more general visuo-spatial training appears to have a longer-lasting effect on P2 latency than the specific auditory training. Alternatively, there may be specific auditory discrimination deficits in schizophrenia requiring more extensive training for a stable change.
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28
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Abstract
For many patients with neuropsychiatric illnesses, standard psychiatric treatments with mono or combination pharmacotherapy, psychotherapy, and transcranial magnetic stimulation are ineffective. For these patients with treatment-resistant neuropsychiatric illnesses, a main therapeutic option is electroconvulsive therapy (ECT). Decades of research have found ECT to be highly effective; however, it can also result in adverse neurocognitive effects. Specifically, ECT results in disorientation after each session, anterograde amnesia for recently learned information, and retrograde amnesia for previously learned information. Unfortunately, the neurocognitive effects and underlying mechanisms of action of ECT remain poorly understood. The purpose of this paper was to synthesize the multiple moderating and mediating factors that are thought to underlie the neurocognitive effects of ECT into a coherent model. Such factors include demographic and neuropsychological characteristics, neuropsychiatric symptoms, ECT technical parameters, and ECT-associated neurophysiological changes. Future research is warranted to evaluate and test this model, so that these findings may support the development of more refined clinical seizure therapy delivery approaches and efficacious cognitive remediation strategies to improve the use of this important and widely used intervention tool for neuropsychiatric diseases.
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29
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Subramaniam K, Luks TL, Garrett C, Chung C, Fisher M, Nagarajan S, Vinogradov S. Intensive cognitive training in schizophrenia enhances working memory and associated prefrontal cortical efficiency in a manner that drives long-term functional gains. Neuroimage 2014; 99:281-92. [PMID: 24867353 DOI: 10.1016/j.neuroimage.2014.05.057] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 05/15/2014] [Accepted: 05/17/2014] [Indexed: 12/14/2022] Open
Abstract
We investigated whether intensive computerized cognitive training in schizophrenia could improve working memory performance and increase signal efficiency of associated middle frontal gyri (MFG) circuits in a functionally meaningful manner. Thirty schizophrenia participants and 13 healthy comparison participants underwent fMRI scanning during a letter N-back working memory task. Schizophrenia participants were then randomly assigned to either 80 h (16 weeks) of cognitive training or a computer games control condition. After this intervention, participants completed a second fMRI N-back scanning session. At baseline, during 2-back working memory trials, healthy participants showed the largest and most significant activation in bilateral MFG, which correlated with task performance. Schizophrenia participants showed impaired working memory, hypoactivation in left MFG, and no correlation between bilateral MFG signal and task performance. After training, schizophrenia participants improved their 2-back working memory performance and showed increased activation in left MFG. They also demonstrated a significant association between enhanced task performance and right MFG signal, similar to healthy participants. Both task performance and brain activity in right MFG after training predicted better generalized working memory at 6-month follow-up. Furthermore, task performance and brain activity within bilateral MFG predicted better occupational functioning at 6-month follow-up. No such findings were observed in the computer games control participants. Working memory impairments in schizophrenia and its underlying neural correlates in MFG can be improved by intensive computerized cognitive training; these improvements generalize beyond the trained task and are associated with enduring effects on cognition and functioning 6 months after the intervention.
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Affiliation(s)
- Karuna Subramaniam
- Department of Psychiatry, University of California, San Francisco, CA-94121, USA.
| | - Tracy L Luks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA-94123, USA
| | - Coleman Garrett
- Department of Psychiatry, University of California, San Francisco, CA-94121, USA
| | | | - Melissa Fisher
- Department of Psychiatry, University of California, San Francisco, CA-94121, USA
| | - Srikantan Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA-94123, USA
| | - Sophia Vinogradov
- Department of Psychiatry, University of California, San Francisco, CA-94121, USA
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30
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Abstract
OBJECTIVE This article reviews neuroimaging studies that inform psychotherapy research. An introduction to neuroimaging methods is provided as background for the increasingly sophisticated breadth of methods and findings appearing in psychotherapy research. METHOD We compiled and assessed a comprehensive list of neuroimaging studies of psychotherapy outcome, along with selected examples of other types of studies that also are relevant to psychotherapy research. We emphasized magnetic resonance imaging (MRI) since it is the dominant neuroimaging modality in psychological research. RESULTS We summarize findings from neuroimaging studies of psychotherapy outcome, including treatment for depression, obsessive compulsive disorder (OCD), and schizophrenia. CONCLUSIONS The increasing use of neuroimaging methods in the study of psychotherapy continues to refine our understanding of both outcome and process. We suggest possible directions for future neuroimaging studies in psychotherapy research.
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Affiliation(s)
- Carol P Weingarten
- a Department of Psychiatry and Behavioral Sciences , Duke University , Durham , NC , USA
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31
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Sato S, Iwata K, Furukawa SI, Matsuda Y, Hatsuse N, Ikebuchi E. The effects of the combination of cognitive training and supported employment on improving clinical and working outcomes for people with schizophrenia in Japan. Clin Pract Epidemiol Ment Health 2014; 10:18-27. [PMID: 24600481 PMCID: PMC3942867 DOI: 10.2174/1745017901410010018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 11/27/2022]
Abstract
Background: In Japan, Job assistance for SMI have been not active. Compared with mental retardation, employment rate of SMI was low. The needs of the effective job assistance for SMI are growing. The purpose of this study was to determine the effectiveness of the combination approach of Cognitive Remediation (CR) and Supported Employment (SE) in clinical outcomes, including cognitive functioning and psychiatric symptoms besides vocational outcomes. Methods: The participants diagnosed with schizophrenia or schizoaffective disorder were assigned to CR+SE group (n=52) and SE group (n=57). CR comprised computer based trainings using COGPACK and group works. SE was individualized vocational support provided by employment specialists. Outcome measures included cognitive functioning, psychiatric symptoms, social functioning, performance of tasks as clinical outcomes, employment rate, duration of employment, and earned wage as vocational outcome. Results: CR+SE group displayed significantly better psychiatric symptoms (F=3.490, p<.10), interpersonal relations (F=11.695, p<.01), and social and cognitive functioning including verbal memory (F=9.439, p<.01), digit sequencing (F=5.544, p<.05), token motor tasks (F=6.685, p<.05), and overall cognitive functioning (F=8.136, p<.01). We did not find any significant difference between two groups in terms of employment rate and earned wage. Discussions: This is the first controlled study to determine the effectiveness of CR on vocational outcomes in Japan. The results showed that CR and SE programs were feasible in Japan and that CR using COGPACK had favorable effects on cognitive functioning, psychiatric symptoms, and social functioning, which is consistent with previous researches.
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Affiliation(s)
- Sayaka Sato
- Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan
| | - Kazuhiko Iwata
- Outpatient department, Osaka Psychiatric Medical Center, Japan
| | - Shun-Ichi Furukawa
- Department of Rehabilitation, Faculty of Medicine, University of Tokyo, Japan
| | - Yasuhiro Matsuda
- Department of Psychiatry, Nara Medical University School of Medicine, Japan
| | - Norifumi Hatsuse
- Department of Psychiatry, Teikyo University School of Medicine, Japan
| | - Emi Ikebuchi
- Department of Psychiatry, Teikyo University School of Medicine, Japan
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Sapara A, ffytche DH, Birchwood M, Cooke MA, Fannon D, Williams SC, Kuipers E, Kumari V. Preservation and compensation: the functional neuroanatomy of insight and working memory in schizophrenia. Schizophr Res 2014; 152:201-9. [PMID: 24332795 PMCID: PMC3906535 DOI: 10.1016/j.schres.2013.11.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 11/12/2013] [Accepted: 11/18/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Poor insight in schizophrenia has been theorised to reflect a cognitive deficit that is secondary to brain abnormalities, localized in the brain regions that are implicated in higher order cognitive functions, including working memory (WM). This study investigated WM-related neural substrates of preserved and poor insight in schizophrenia. METHOD Forty stable schizophrenia outpatients, 20 with preserved and 20 with poor insight (usable data obtained from 18 preserved and 14 poor insight patients), and 20 healthy participants underwent functional magnetic resonance imaging (fMRI) during a parametric 'n-back' task. The three groups were preselected to match on age, education and predicted IQ, and the two patient groups to have distinct insight levels. Performance and fMRI data were analysed to determine how groups of patients with preserved and poor insight differed from each other, and from healthy participants. RESULTS Poor insight patients showed lower performance accuracy, relative to healthy participants (p=0.01) and preserved insight patients (p=0.08); the two patient groups were comparable on symptoms and medication. Preserved insight patients, relative to poor insight patients, showed greater activity most consistently in the precuneus and cerebellum (both bilateral) during WM; they also showed greater activity than healthy participants in the inferior-superior frontal gyrus and cerebellum (bilateral). Group differences in brain activity did not co-vary significantly with performance accuracy. CONCLUSIONS The precuneus and cerebellum function contribute to preserved insight in schizophrenia. Preserved insight as well as normal-range WM capacity in schizophrenia sub-groups may be achieved via compensatory neural activity in the frontal cortex and cerebellum.
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Affiliation(s)
- Adegboyega Sapara
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Dominic H. ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, London, UK,Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - Max Birchwood
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Michael A. Cooke
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Dominic Fannon
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Steven C.R. Williams
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Veena Kumari
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
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Thorsen AL, Johansson K, Løberg EM. Neurobiology of cognitive remediation therapy for schizophrenia: a systematic review. Front Psychiatry 2014; 5:103. [PMID: 25177300 PMCID: PMC4133649 DOI: 10.3389/fpsyt.2014.00103] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/01/2014] [Indexed: 12/13/2022] Open
Abstract
Cognitive impairment is an important aspect of schizophrenia, where cognitive remediation therapy (CRT) is a promising treatment for improving cognitive functioning. While neurobiological dysfunction in schizophrenia has been the target of much research, the neural substrate of cognitive remediation and recovery has not been thoroughly examined. The aim of the present article is to systematically review the evidence for neural changes after CRT for schizophrenia. The reviewed studies indicate that CRT affects several brain regions and circuits, including prefrontal, parietal, and limbic areas, both in terms of activity and structure. Changes in prefrontal areas are the most reported finding, fitting to previous evidence of dysfunction in this region. Two limitations of the current research are the few studies and the lack of knowledge on the mechanisms underlying neural and cognitive changes after treatment. Despite these limitations, the current evidence suggests that CRT is associated with both neurobiological and cognitive improvement. The evidence from these findings may shed light on both the neural substrate of cognitive impairment in schizophrenia, and how better treatment can be developed and applied.
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Affiliation(s)
| | - Kyrre Johansson
- Department of Psychosocial Science, University of Bergen , Bergen , Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital , Bergen , Norway ; Department of Biological and Medical Psychology, University of Bergen , Bergen , Norway
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De Benedictis L, Dumais A, Nicole L, Grou C, Lesage AD. A patient with medication-resistant epilepsy featuring psychosensorial and psychotic symptoms presenting with significant functional improvement on psychotherapeutic treatment: a case report. J Med Case Rep 2013; 7:259. [PMID: 24215787 PMCID: PMC3834551 DOI: 10.1186/1752-1947-7-259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/14/2013] [Indexed: 12/04/2022] Open
Abstract
Background Partial complex epilepsy with psychosensorial and psychotic symptoms remains a relatively rare condition that can sometimes be mistaken for an axis I psychiatric disorder. There is no specific treatment for this particular type of epilepsy, anti-epileptic medication being the cornerstone of therapeutic intervention with the occasional addition of neuroleptics. Lack of response to anti-epileptic agents is often a sign of poor prognosis and requires risky and sometimes invasive interventions with high morbidity for patients. Case presentation We report the case of a 21-year-old right-handed Caucasian man of French-Canadian descent who was living with his mother immediately before being hospitalized in a psychiatric setting for the first time. He seemed obsessed with developing new concepts to reach a more ‘perfect’ existence. He also claimed feeling odd sensations in his mind and in his body that could be linked to some sort of ‘evolutionary’ process resulting from spiritual uplift. He reported non-specific visual hallucinations and what sounded like auditory hallucinations and telepathic powers. The first diagnosis was a possible schizophreniform disorder and our patient was hospitalized. Shortly afterwards, an electroencephalogram showed an important subcortical epileptic activity, compatible with partial complex epilepsy with psychosensorial and psychotic symptoms. Despite a negative response to medication, symptoms proper to this type of epilepsy were substantially alleviated using a psychotherapeutical treatment intended for patients with psychotic disorders, namely integrated psychological therapy (IPT). Significant functional improvement in our patient has been achieved since then. Conclusions This case report illustrates that despite a negative response to medication, symptoms proper to this type of epilepsy could be substantially alleviated using psychotherapeutical treatment modalities. To the best of our knowledge, this is the first time such a finding has been reported in the scientific literature. This could open the way for new research themes and therapeutic interventions for such patients.
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Affiliation(s)
- Luigi De Benedictis
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, 7401, Rue Hochelaga, Montréal, Québec H1N 3M5, Canada.
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Abstract
In this paper, I will review why psychotherapy is relevant to the question of how consciousness relates to brain plasticity. A great deal of the research and theorizing on consciousness and the brain, including my own on hallucinations for example (Collerton and Perry, 2011) has focused upon specific changes in conscious content which can be related to temporal changes in restricted brain systems. I will argue that psychotherapy, in contrast, allows only a focus on holistic aspects of consciousness; an emphasis which may usefully complement what can be learnt from more specific methodologies.
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Affiliation(s)
- Daniel Collerton
- Clinical Psychology, Northumberland, Tyne and Wear NHS Foundation Trust Gateshead, UK ; Newcastle upon Tyne Newcastle University, UK
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Hooker CI, Bruce L, Fisher M, Verosky SC, Miyakawa A, D'Esposito M, Vinogradov S. The influence of combined cognitive plus social-cognitive training on amygdala response during face emotion recognition in schizophrenia. Psychiatry Res 2013; 213:99-107. [PMID: 23746615 PMCID: PMC6999046 DOI: 10.1016/j.pscychresns.2013.04.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 12/12/2012] [Accepted: 04/05/2013] [Indexed: 12/18/2022]
Abstract
Both cognitive and social-cognitive deficits impact functional outcome in schizophrenia. Cognitive remediation studies indicate that targeted cognitive and/or social-cognitive training improves behavioral performance on trained skills. However, the neural effects of training in schizophrenia and their relation to behavioral gains are largely unknown. This study tested whether a 50-h intervention which included both cognitive and social-cognitive training would influence neural mechanisms that support social ccognition. Schizophrenia participants completed a computer-based intervention of either auditory-based cognitive training (AT) plus social-cognition training (SCT) (N=11) or non-specific computer games (CG) (N=11). Assessments included a functional magnetic resonance imaging (fMRI) task of facial emotion recognition, and behavioral measures of cognition, social cognition, and functional outcome. The fMRI results showed the predicted group-by-time interaction. Results were strongest for emotion recognition of happy, surprise and fear: relative to CG participants, AT+SCT participants showed a neural activity increase in bilateral amygdala, right putamen and right medial prefrontal cortex. Across all participants, pre-to-post intervention neural activity increase in these regions predicted behavioral improvement on an independent emotion perception measure (MSCEIT: Perceiving Emotions). Among AT+SCT participants alone, neural activity increase in right amygdala predicted behavioral improvement in emotion perception. The findings indicate that combined cognition and social-cognition training improves neural systems that support social-cognition skills.
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Affiliation(s)
- Christine I Hooker
- Department of Psychology, Harvard University, 33 Kirkland St., Cambridge, MA 02138, United States.
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37
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Cognitive remediation in schizophrenia: current status and future perspectives. SCHIZOPHRENIA RESEARCH AND TREATMENT 2013; 2013:156084. [PMID: 24455253 PMCID: PMC3877646 DOI: 10.1155/2013/156084] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 12/19/2022]
Abstract
Objectives. This study is aimed to review the current scientific literature on cognitive remediation in schizophrenia. In particular, the main structured protocols of cognitive remediation developed for schizophrenia are presented and the main results reported in recent meta-analyses are summarized. Possible benefits of cognitive remediation in the early course of schizophrenia and in subjects at risk for psychosis are also discussed. Methods. Electronic search of the relevant studies which appeared in the PubMed database until April 2013 has been performed and all the meta-analyses and review articles on cognitive remediation in schizophrenia have been also taken into account. Results. Numerous intervention programs have been designed, applied, and evaluated, with the objective of improving cognition and social functioning in schizophrenia. Several quantitative reviews have established that cognitive remediation is effective in reducing cognitive deficits and in improving functional outcome of the disorder. Furthermore, the studies available support the usefulness of cognitive remediation when applied in the early course of schizophrenia and even in subjects at risk of the disease. Conclusions. Cognitive remediation is a promising approach to improve real-world functioning in schizophrenia and should be considered a key strategy for early intervention in the psychoses.
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Abbs B, Achalia RM, Adelufosi AO, Aktener AY, Beveridge NJ, Bhakta SG, Blackman RK, Bora E, Byun MS, Cabanis M, Carrion R, Castellani CA, Chow TJ, Dmitrzak-Weglarz M, Gayer-Anderson C, Gomes FV, Haut K, Hori H, Kantrowitz JT, Kishimoto T, Lee FHF, Lin A, Palaniyappan L, Quan M, Rubio MD, Ruiz de Azúa S, Sahoo S, Strauss GP, Szczepankiewicz A, Thompson AD, Trotta A, Tully LM, Uchida H, Velthorst E, Young JW, O’Shea A, DeLisi LE. The 3rd Schizophrenia International Research Society Conference, 14-18 April 2012, Florence, Italy: summaries of oral sessions. Schizophr Res 2012; 141:e1-e24. [PMID: 22910407 PMCID: PMC3877922 DOI: 10.1016/j.schres.2012.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/23/2012] [Indexed: 01/30/2023]
Abstract
The 3rd Schizophrenia International Research Society Conference was held in Florence, Italy, April 14-18, 2012 and this year had as its emphasis, "The Globalization of Research". Student travel awardees served as rapporteurs for each oral session and focused their summaries on the most significant findings that emerged and the discussions that followed. The following report is a composite of these summaries. We hope that it will provide an overview for those who were present, but could not participate in all sessions, and those who did not have the opportunity to attend, but who would be interested in an update on current investigations ongoing in the field of schizophrenia research.
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Affiliation(s)
- Brandon Abbs
- Brigham and Women’s Hospital, Department of Medicine, Connors Center for Women’s Health, Harvard Medical School, Department of Psychiatry, 1620 Tremont Street BC 3-34 Boston, MA 02120, Phone: 617-525-8641, Fax: 617-525-7900
| | - Rashmin M Achalia
- Department of Psychiatry, Government Medical College, Aurangabad, Maharashtra, India. Phone: + 91 9028851672, Fax: + 91 0240 2402418
| | - Adegoke O Adelufosi
- Dbepartment of Psychiatry, Ladoke Akintola University, Teaching Hospital (LAUTECH), Ogbomoso, Oyo State, Nigeria. P.O. Box 2210, Sapon, Abeokuta, Ogun State, Nigeria, Phone: +234 803 5988 054
| | - Ahmet Yiğit Aktener
- Göksun State Hospital, Göksun, Kahramanmaraş, Turkey, Phone: (0090) 532 4465832
| | - Natalie J Beveridge
- School of Biomedical Sciences & Pharmacy, Schizophrenia Research Institute, Room 616 Medical Sciences Building, University of Newcastle, Callaghan NSW 2308, Phone: (02) 4921 8748, Fax: (02) 4921 7903
| | - Savita G Bhakta
- Hofstra-NSLIJHS School of Medicine/The Zucker Hillside Hospital, address: 75 59 263rd street, Glen Oaks, NY-11004, Phone: 718-470-8232, Fax: 718-831-0368
| | - Rachael K Blackman
- University of Minnesota Medical Scientist Training Program (MD/PhD), University of Minnesota Neuroscience Department, and Brain Sciences Center VA Medical Center, Minneapolis, MN, University of Minnesota, Medical Scientist Training Program (MD/PhD), B681 Mayo, 420 Delaware St. SE, Minneapolis, MN 55455, Phone: 612-467-5077
| | - Emre Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, VIC, Australia. Alan Gilbert Building NNF level 3 University of Melbourne, VIC, Australia, Phone: 61 3 8345 5611, Fax: 61 3 8345 5610
| | - MS Byun
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea, address: Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul 110-744, Republic of Korea. Phone: +82-2-2072-2457 Fax: +82-2-747-9063
| | - Maurice Cabanis
- Department of Psychiatry and Psychotherapy, Philipps-University, Rudolf-Bultmann-Straße 8, D-35039 Marburg, Germany, Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Rudolf-Bultmann-Str. 8, D-35039 Marburg, Germany Phone: +49(0)6421-58-66932, Fax: +49(0)6421-58-68939
| | - Ricardo Carrion
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System (NS-LIJHS), Glen Oaks, NY, USA, 2. Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, New York, 11030, USA, Phone: 718-470-8878, Fax: 718-470-8131
| | - Christina A Castellani
- Molecular Genetics Unit, Department of Biology, The University of Western Ontario, London, Ontario, Canada, Phone: 519-661-2111 x86928, Fax: 519-661-3935
| | - Tze Jen Chow
- Universiti Tunku Abdul Rahman, Jalan Genting Kelang, Setapak 53300, Kuala Lumpur, Malaysia, Phone: +603-41079802
| | - M Dmitrzak-Weglarz
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Szpitalna St. 27/33, Poznan, 60-572, Poland, Phone: +48 618491311, Fax: +48 61484392
| | - Charlotte Gayer-Anderson
- Institute of Psychiatry, King’s College London, De Crespigny Park, London, United Kingdom, SE5 8AF, Phone: 0207 848 5060
| | - Felipe V Gomes
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto/SP 14049-900, Brazil
| | - Kristen Haut
- University of California, Los Angeles, 1285 Franz Hall, University of California, Los Angeles, CA, 90095, Phone: 310-794-9673, Fax: 310-794-9740
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan, Phone: +81 42 341 2711, Fax: +81 42 346 1744
| | - Joshua T Kantrowitz
- New York State Psychiatric Institute/Nathan Kline Institute for Psychiatric Research 1051 Riverside Drive, Room 5807, New York, NY 10023, Phone: 212-543-6711, Fax: 212-543-1350
| | - Taishiro Kishimoto
- (1) The Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd street, Glen Oaks, NY 11004 USA (2) Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan, Phone: +1-718-470-8386, Fax: +718-343-1659
| | - Frankie HF Lee
- 1. Centre for Addiction and Mental Health, 250 College St. Toronto, Ontario, Canada, M5T 1R8, 2. Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada, M5S 1A8, Phone: +1416-535-8501 ext. 4084, Fax: +1416-979-4663
| | - Ashleigh Lin
- School of Psychology, University of Birmingham, Edgbaston, B152TT, United Kingdom, Phone: +44 121 414 6241, Fax: +44 121 414 4897
| | - Lena Palaniyappan
- Translational Neuroimaging, Division of Psychiatry, University of Nottingham address: C09, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, Phone: 01157430407, Fax: 01157430422
| | - Meina Quan
- 1. Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, 1249 Boylston Street, Boston, MA, 02215. 2. Laboratory of Neuroscience, Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, 940 Belmont Street, Brockton, MA, 02301, Phone: 617-525-6264, Fax: 617-525-6150
| | - Maria D Rubio
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, 1719 6th Ave S Rm 590, Birmingham, AL 35233, Phone: 205-996-6229
| | - Sonia Ruiz de Azúa
- CIBERSAM (Biomedical Research Center in Mental Health Net), University Hospital of Alava, University of the Basque Country, 29 Olaguibel St., 01004, Vitoria, Spain. Phone: 0034 945007664, Fax: 0034 945007664
| | - Saddichha Sahoo
- Clinical Fellow, Dept of Psychiatry, University of British Columbia, Vancouver, BC, Canada V6T1Z3
| | - Gregory P Strauss
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228, Phone: (410) 402-6104, Fax: (410) 402-7198
| | - Aleksandra Szczepankiewicz
- Laboratory of Molecular and Cell Biology, Department of Psychiatric Genetics, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznan, Poland, Phone: +48-618491311, Fax: +48-61-8480111
| | - Andrew D Thompson
- Orygen Youth Health Research Centre, 35 Poplar Rd, Parkville, VIC 3052, Australia Phone: +61 3 93422800, Fax: +61 3 9342 2941
| | - Antonella Trotta
- Psychosis Studies, Institute of Psychiatry, King’s College London, United Kingdom, PO52 Psychosis Studies, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, United Kingdom, Phone: +44 (0)743 5214863, Fax: +44 (0)20 7848 0287
| | - Laura M Tully
- Harvard University, Address: 33 Kirkland St., Cambridge MA 02138, Phone: 857-207-5509
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan, Phone: +81.3.3353.1211(x62454), Fax: +81.3.5379.0187
| | - Eva Velthorst
- Academic Medical Center, Department of Early Psychosis, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands, Phone: +31 (0)20 89 13671, Fax: +31 (0)20 89 13635
| | - Jared W Young
- University of California San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA, 92093-0804, Phone: 619 543 3582, Fax: 619 543 2493
| | - Anne O’Shea
- Coordinator of reports. Harvard Medical School, VA Boston Healthcare System, 940 Belmont Street, Brockton, MA 02301, Phone: 774-826-1374
| | - Lynn E. DeLisi
- Corresponding Author, VA Boston Healthcare System and Harvard Medical School, 940 Belmont Street, Brockton, MA 02301, Phone: 774-826-1355, Fax: 774-826-1758, Address all correspondence to Lynn E DeLisi, MD,
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Harvey PD, Bowie CR. Cognitive enhancement in schizophrenia: pharmacological and cognitive remediation approaches. Psychiatr Clin North Am 2012; 35:683-98. [PMID: 22929873 PMCID: PMC3430871 DOI: 10.1016/j.psc.2012.06.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article discusses the measurement of cognition in schizophrenia, its role as a determinant of disability, and treatment efforts to date, including pharmacological and behavioral interventions as well as effective treatments that lead to improved outcomes. The measurement of functioning when patients with schizophrenia receive treatment in the office is addressed. The review focuses on new developments in the creation and adoption of a consensus method for the assessment of cognitive functioning in treatment studies, on the increased appreciation for assessment of functional skills in the prediction of everyday outcomes, and on developments in the basic neuroscience of cognition.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 North West 14th Street, Suite 1450, Miami, FL 33136, USA.
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Neural activity during emotion recognition after combined cognitive plus social cognitive training in schizophrenia. Schizophr Res 2012; 139:53-9. [PMID: 22695257 PMCID: PMC4346150 DOI: 10.1016/j.schres.2012.05.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 05/03/2012] [Accepted: 05/10/2012] [Indexed: 12/12/2022]
Abstract
Cognitive remediation training has been shown to improve both cognitive and social cognitive deficits in people with schizophrenia, but the mechanisms that support this behavioral improvement are largely unknown. One hypothesis is that intensive behavioral training in cognition and/or social cognition restores the underlying neural mechanisms that support targeted skills. However, there is little research on the neural effects of cognitive remediation training. This study investigated whether a 50 h (10-week) remediation intervention which included both cognitive and social cognitive training would influence neural function in regions that support social cognition. Twenty-two stable, outpatient schizophrenia participants were randomized to a treatment condition consisting of auditory-based cognitive training (AT) [Brain Fitness Program/auditory module ~60 min/day] plus social cognition training (SCT) which was focused on emotion recognition [~5-15 min per day] or a placebo condition of non-specific computer games (CG) for an equal amount of time. Pre and post intervention assessments included an fMRI task of positive and negative facial emotion recognition, and standard behavioral assessments of cognition, emotion processing, and functional outcome. There were no significant intervention-related improvements in general cognition or functional outcome. fMRI results showed the predicted group-by-time interaction. Specifically, in comparison to CG, AT+SCT participants had a greater pre-to-post intervention increase in postcentral gyrus activity during emotion recognition of both positive and negative emotions. Furthermore, among all participants, the increase in postcentral gyrus activity predicted behavioral improvement on a standardized test of emotion processing (MSCEIT: Perceiving Emotions). Results indicate that combined cognition and social cognition training impacts neural mechanisms that support social cognition skills.
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41
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Cognitive remediation therapy for schizophrenia: what is it and does it work? Ir J Psychol Med 2011; 28:217-221. [PMID: 30200011 DOI: 10.1017/s0790966700011691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Impaired cognition is a core feature of schizophrenia (SZ) that precedes, accompanies, and often outlasts a patient's clinical symptoms. The success of new generation antipsychotics, as well as their failure to ameliorate the persistent disabilities associated with the disorder are well documented. Consequently, a number of psychosocial and cognitive interventions have been developed to address specific aspects of disability not adequately alleviated by medication. Among these, interventions adapted from the acquired brain literature that target cognitively based disability (cognitive remediation therapy; CRT) have received significant empirical support both for ameliorating specific deficits in memory, attention and executive function, and improving real world outcome. CRT strategies have focused either on providing drill-based training aimed at increasing capacity or providing behavioural strategies for compensating for cognitive deficits, or a mixture of both. Nonetheless, these interventions have varied widely and several questions remain. This review provides a brief overview of cognitive remediation therapies in psychosis, discusses evidence for its success, and outlines a number of questions that remain about its implementation. Given the current unavailability of cognitive remediation as part of standard care in Irish mental health services, we conclude by describing one such intervention developed within our clinical research group and the questions we hope to address in making this programme more widely available to Irish patients.
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Klingberg S, Wittorf A, Meisner C, Wölwer W, Wiedemann G, Herrlich J, Bechdolf A, Müller BW, Sartory G, Wagner M, Kircher T, König HH, Engel C, Buchkremer G. Cognitive behavioural therapy versus supportive therapy for persistent positive symptoms in psychotic disorders: the POSITIVE Study, a multicenter, prospective, single-blind, randomised controlled clinical trial. Trials 2010; 11:123. [PMID: 21190574 PMCID: PMC3022781 DOI: 10.1186/1745-6215-11-123] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 12/29/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been demonstrated that cognitive behavioural therapy (CBT) has a moderate effect on symptom reduction and on general well being of patients suffering from psychosis. However, questions regarding the specific efficacy of CBT, the treatment safety, the cost-effectiveness, and the moderators and mediators of treatment effects are still a major issue. The major objective of this trial is to investigate whether CBT is specifically efficacious in reducing positive symptoms when compared with non-specific supportive therapy (ST) which does not implement CBT-techniques but provides comparable therapeutic attention. METHODS/DESIGN The POSITIVE study is a multicenter, prospective, single-blind, parallel group, randomised clinical trial, comparing CBT and ST with respect to the efficacy in reducing positive symptoms in psychotic disorders. CBT as well as ST consist of 20 sessions altogether, 165 participants receiving CBT and 165 participants receiving ST. Major methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, analysis by intention to treat, data management using remote data entry, measures of quality assurance (e.g. on-site monitoring with source data verification, regular query process), advanced statistical analysis, manualized treatment, checks of adherence and competence of therapists. Research relating the psychotherapy process with outcome, neurobiological research addressing basic questions of delusion formation using fMRI and neuropsychological assessment and treatment research investigating adaptations of CBT for adolescents is combined in this network. Problems of transfer into routine clinical care will be identified and addressed by a project focusing on cost efficiency. DISCUSSION This clinical trial is part of efforts to intensify psychotherapy research in the field of psychosis in Germany, to contribute to the international discussion on psychotherapy in psychotic disorders, and to help implement psychotherapy in routine care. Furthermore, the study will allow drawing conclusions about the mediators of treatment effects of CBT of psychotic disorders.
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Affiliation(s)
- Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Germany
| | | | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Germany
| | - Georg Wiedemann
- Department of Psychiatry and Psychotherapy, University of Frankfurt/Main, Germany
- Clinical Center Fulda, Clinic for Psychiatry and Psychotherapy, Fulda, Germany
| | - Jutta Herrlich
- Department of Psychiatry and Psychotherapy, University of Frankfurt/Main, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany
| | - Bernhard W Müller
- Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany
| | - Gudrun Sartory
- Department of Clinical Psychology, University of Wuppertal, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Germany
| | - Hans-Helmut König
- Department of Medical Sociology and Health Economics, Center for Psycho-social Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Corinna Engel
- Institute for Medical Biometry, University of Tuebingen, Germany
| | - Gerhard Buchkremer
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Germany
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Maïza O, Mazoyer B, Hervé PY, Razafimandimby A, Dollfus S, Tzourio-Mazoyer N. Impact of cognitive performance on the reproducibility of fMRI activation in schizophrenia. J Psychiatry Neurosci 2010; 35:378-89. [PMID: 20731962 PMCID: PMC2964368 DOI: 10.1503/jpn.090103] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 02/23/2010] [Accepted: 05/03/2010] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Longitudinal functional magnetic resonance imaging (fMRI) studies in patients with schizophrenia allow exploration of the course of the illness and brain activity after therapy. A crucial question, however, is whether fMRI findings are reliable, because they can be affected by performance deficits in patients with schizophrenia. Our aim was to evaluate the reproducibility of fMRI activations in highly integrated language areas in patients with schizophrenia, taking into account task performance. METHODS Ten patients with schizophrenia and 10 matched healthy controls were scanned twice, 21 months apart, while performing a story comprehension task. The reproducibility of the activations in each participant was evaluated globally by the percentage of spatial overlap between the 2 sessions and locally by a voxel-wise computation of the between-session relative standard deviation. We performed between-group comparisons both with and without the inclusion of comprehension scores (measuring task performance) as a covariate. RESULTS On average, patients with schizophrenia had significantly lower comprehension scores than controls (4.5/12 v. 7.8/12, p = 0.002). The mean spatial overlap between fMRI sessions was 30.6% in the patient group and 47.0% in the control group (p = 0.017). Locally, the lower reproducibility in patients was most prominent in the left posterior middle temporal gyrus, inferior frontal gyrus and medial prefrontal cortex (p < 0.001 uncorrected for multiple comparisons). Comprehension scores were positively correlated with both reproducibility measures in patients (overlap: r = 0.82, p = 0.004; relative standard deviation: several significant clusters at p < 0.001). When we included the comprehension scores as a covariate, most of the local between-group differences in reproducibility were removed, and the difference in overlap was not significant. LIMITATIONS Owing to the small sample size, we could not investigate the impact of clinical subtypes and different types of medications on reproducibility. CONCLUSION Our findings suggest that the greater variability in activation in patients with schizophrenia compared with controls concerns high-level areas and is mainly attributable to deficient task performance. Consequently, cognitive performance must be carefully controlled when longitudinal fMRI studies are undertaken.
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Affiliation(s)
- Olivier Maïza
- Maïza, Mazoyer, Hervé, Razafimandimby, Dollfus, Tzourio-Mazoyer — Centre d’imagerie–neurosciences et applications aux pathologies, Universités de Caen et Paris Descartes; Maïza, Mazoyer, Dollfus — Centre Hospitalier Universitaire de Caen, Caen; Mazoyer — Institut universitaire de France, Paris, France
| | - Bernard Mazoyer
- Maïza, Mazoyer, Hervé, Razafimandimby, Dollfus, Tzourio-Mazoyer — Centre d’imagerie–neurosciences et applications aux pathologies, Universités de Caen et Paris Descartes; Maïza, Mazoyer, Dollfus — Centre Hospitalier Universitaire de Caen, Caen; Mazoyer — Institut universitaire de France, Paris, France
| | - Pierre-Yves Hervé
- Maïza, Mazoyer, Hervé, Razafimandimby, Dollfus, Tzourio-Mazoyer — Centre d’imagerie–neurosciences et applications aux pathologies, Universités de Caen et Paris Descartes; Maïza, Mazoyer, Dollfus — Centre Hospitalier Universitaire de Caen, Caen; Mazoyer — Institut universitaire de France, Paris, France
| | - Annick Razafimandimby
- Maïza, Mazoyer, Hervé, Razafimandimby, Dollfus, Tzourio-Mazoyer — Centre d’imagerie–neurosciences et applications aux pathologies, Universités de Caen et Paris Descartes; Maïza, Mazoyer, Dollfus — Centre Hospitalier Universitaire de Caen, Caen; Mazoyer — Institut universitaire de France, Paris, France
| | - Sonia Dollfus
- Maïza, Mazoyer, Hervé, Razafimandimby, Dollfus, Tzourio-Mazoyer — Centre d’imagerie–neurosciences et applications aux pathologies, Universités de Caen et Paris Descartes; Maïza, Mazoyer, Dollfus — Centre Hospitalier Universitaire de Caen, Caen; Mazoyer — Institut universitaire de France, Paris, France
| | - Nathalie Tzourio-Mazoyer
- Maïza, Mazoyer, Hervé, Razafimandimby, Dollfus, Tzourio-Mazoyer — Centre d’imagerie–neurosciences et applications aux pathologies, Universités de Caen et Paris Descartes; Maïza, Mazoyer, Dollfus — Centre Hospitalier Universitaire de Caen, Caen; Mazoyer — Institut universitaire de France, Paris, France
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Prefrontal cortical changes following cognitive training in patients with chronic schizophrenia: effects of practice, generalization, and specificity. Neuropsychopharmacology 2010; 35:1850-9. [PMID: 20428109 PMCID: PMC3055638 DOI: 10.1038/npp.2010.52] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cognitive training is increasingly used in the treatment of schizophrenia, but it remains unknown how this training affects functional neuroanatomy. Practice on specific cognitive tasks generally leads to automaticity and decreased prefrontal cortical activity, yet broad-based cognitive training programs may avoid automaticity and increase prefrontal cortex (PFC) activity. This study used quasi-randomized, placebo-control design and pre/post neuroimaging to examine functional plasticity associated with attention and working memory-focused cognitive training in patients with schizophrenia. Twenty-one participants with schizophrenia or schizoaffective disorder split into two demographically and performance matched groups (nine scanned per group) and nine control participants were tested 6-8 weeks apart. Compared with both patient controls and healthy controls, patients receiving cognitive training increased activation significantly more in attention and working memory networks, including dorsolateral prefrontal cortex, anterior cingulate and frontopolar cortex. The extent to which activity increased in a subset of these regions predicted performance improvements. Although this study was not designed to speak to the efficacy of cognitive training as a treatment, it is the first study to show that such training can increase the ability of patients to activate the PFC regions subserving attention and working memory.
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Eack SM, Hogarty GE, Cho RY, Prasad KMR, Greenwald DP, Hogarty SS, Keshavan MS. Neuroprotective effects of cognitive enhancement therapy against gray matter loss in early schizophrenia: results from a 2-year randomized controlled trial. ARCHIVES OF GENERAL PSYCHIATRY 2010; 67:674-82. [PMID: 20439824 PMCID: PMC3741671 DOI: 10.1001/archgenpsychiatry.2010.63] [Citation(s) in RCA: 269] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Cognitive rehabilitation has shown efficacy in improving cognition in patients with schizophrenia but the underlying neurobiologic changes that occur during these treatments and support cognitive improvement are not well known. OBJECTIVE To examine differential changes in brain morphology in early course schizophrenia during cognitive rehabilitation vs supportive therapy. DESIGN Randomized controlled trial. SETTING An outpatient research clinic at a university-based medical center that provides comprehensive care services for patients with severe mental illness. PATIENTS A total of 53 symptomatically stable but cognitively disabled outpatients in the early course of schizophrenia or schizoaffective disorder. INTERVENTIONS A 2-year trial with annual structural magnetic resonance imaging and cognitive assessments. Cognitive enhancement therapy is an integrated approach to the remediation of cognitive impairment in schizophrenia that uses computer-assisted neurocognitive training and group-based social-cognitive exercises. Enriched supportive therapy is an illness management approach that provides psychoeducation and teaches applied coping strategies. MAIN OUTCOME MEASURES Broad areas of frontal and temporal gray matter change were analyzed with longitudinal, voxel-based morphometry methods using mixed-effects models followed by volumetric analyses of regions that demonstrated significant differential changes between treatment groups. RESULTS Patients who received cognitive enhancement therapy demonstrated significantly greater preservation of gray matter volume over 2 years in the left hippocampus, parahippocampal gyrus, and fusiform gyrus, and significantly greater gray matter increases in the left amygdala (all corrected P < .04) compared with those who received enriched supportive therapy. Less gray matter loss in the left parahippocampal and fusiform gyrus and greater gray matter increases in the left amygdala were significantly related to improved cognition and mediated the beneficial cognitive effects of cognitive enhancement therapy. CONCLUSION Cognitive enhancement therapy may offer neurobiologic protective and enhancing effects in early schizophrenia that are associated with improved long-term cognitive outcomes.
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Affiliation(s)
- Shaun M Eack
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, USA
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Choi J, Medalia A. Intrinsic motivation and learning in a schizophrenia spectrum sample. Schizophr Res 2010; 118:12-9. [PMID: 19716270 PMCID: PMC2856796 DOI: 10.1016/j.schres.2009.08.001] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Revised: 08/01/2009] [Accepted: 08/03/2009] [Indexed: 11/30/2022]
Abstract
A motivation is a telling hallmark of negative symptomatology in schizophrenia, and it impacts nearly every facet of behavior, including inclination to attempt the difficult cognitive tasks involved in cognitive remediation therapy. Experiences of external reward, reinforcement, and hedonic anticipatory enjoyment are diminished in psychosis, so therapeutics which instead target intrinsic motivation for cognitive tasks may enhance task engagement, and subsequently, remediation outcome. We examined whether outpatients could attain benefits from an intrinsically motivating instructional approach which (a) presents learning materials in a meaningful game-like context, (b) personalizes elements of the learning materials into themes of high interest value, and (c) offers choices so patients can increase their control over the learning process. We directly compared one learning method that incorporated the motivational paradigm into an arithmetic learning program against another method that carefully manipulated out the motivational variables in the same learning program. Fifty-seven subjects with schizophrenia or schizoaffective disorder were randomly assigned to one of the two learning programs for 10 thirty-minute sessions while an intent-to-treat convenience subsample (n=15) was used to account for practice effect. Outcome measures were arithmetic learning, attention, motivation, self competency, and symptom severity. Results showed the motivational group (a) acquired more arithmetic skill, (b) possessed greater intrinsic motivation for the task, (c) reported greater feelings of self competency post-treatment, and (d) demonstrated better post-test attention. Interestingly, baseline perception of self competency was a significant predictor of post-test arithmetic scores. Results demonstrated that incorporating intrinsically motivating instructional techniques into a difficult cognitive task promoted greater learning of the material, higher levels of intrinsic motivation to attempt the demanding task, and greater feelings of self efficacy and achievement to learn.
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Affiliation(s)
- Jimmy Choi
- Department of Psychiatry, Division of Mental Health Services and Policy Research, Columbia University Medical Center, New York 10032, USA.
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Rowland LM, Griego JA, Spieker EA, Cortes CR, Holcomb HH. Neural changes associated with relational learning in schizophrenia. Schizophr Bull 2010; 36:496-503. [PMID: 20418447 PMCID: PMC2879675 DOI: 10.1093/schbul/sbq037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Relational learning, which is learning the relationship among items, is impaired in schizophrenia but can be improved with training. This study investigated neural changes with functional magnetic resonance imaging before and after training on a relational learning task in schizophrenia and healthy control subjects. Despite their acquiring similar relational learning performance, the groups exhibited different neural activation patterns before and following training. Controls engaged regions within the relational learning network that included frontal, parietal, and medial temporal lobe, before and following training. Controls also exhibited activation reductions in region and spatial extent with relational learning proficiency, a commonly observed phenomenon in successful learning. In contrast, subjects with schizophrenia displayed no positive activations compared with the control condition before training. After training, subjects with schizophrenia displayed bilateral inferior parietal region activation as predicted. Contrary to hypothesis, hippocampal activation was not observed following training in schizophrenia. These findings suggest that the parietal lobe may be receptive to cognitive training interventions and that successful relational learning may be achieved in schizophrenia through the use of alternative extrahippocampal brain regions.
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Affiliation(s)
- Laura M Rowland
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228, USA.
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Mochizuki-Kawai H, Yamakawa Y, Mochizuki S, Anzai S, Arai M. Structured floral arrangement programme for improving visuospatial working memory in schizophrenia. Neuropsychol Rehabil 2010; 20:624-36. [PMID: 20467963 PMCID: PMC2913326 DOI: 10.1080/09602011003715141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Several cognitive therapies have been developed for patients with schizophrenia. However, little is known about the outcomes of these therapies in terms of non-verbal/visuospatial working memory, even though this may affect patients' social outcomes. In the present pilot study, we investigated the effect of a structured floral arrangement (SFA) programme, where participants were required to create symmetrical floral arrangements. In this programme, the arrangement pattern and the order of placing each of the natural materials was predetermined. Participants have to identify where to place each material, and memorise the position temporarily to complete the floral arrangement. The schizophrenic patients who participated in this programme showed significant improvement in their scores for a block-tapping task backward version; whereas, non-treated control patients did not show such an improvement. The present results suggest that the SFA programme may positively stimulate visuospatial working memory in patients.
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Affiliation(s)
- Hiroko Mochizuki-Kawai
- National Institute of Floricultural Science, National Agriculture and Food Research Organization (NIFS-NARO), Tsukuba, Ibaraki, Japan.
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Edwards BG, Barch DM, Braver TS. Improving prefrontal cortex function in schizophrenia through focused training of cognitive control. Front Hum Neurosci 2010; 4:32. [PMID: 20461148 PMCID: PMC2866566 DOI: 10.3389/fnhum.2010.00032] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 03/25/2010] [Indexed: 12/13/2022] Open
Abstract
Previous research has shown that individuals with schizophrenia show deficits in cognitive control functions thought to depend on the lateral prefrontal cortex (PFC), and its interactions with related regions. The current study explored the effects of instructed strategy training on improving cognitive control functioning in patients with schizophrenia. Event-related fMRI was used to test whether effects of such training were associated with changes in brain activity dynamics during task performance. Patients with schizophrenia (N = 22) performed the AX-CPT cognitive control task in two-sessions, with the first occurring pre-training and second following strategy training. The training protocol emphasized direct encoding of contextual cues and updating response selection goals in accordance with cue information. A matched group of healthy controls (N = 14) underwent the same protocol but were only scanned in the pre-training session. In the pre-training session, patients exhibited behavioral evidence of impaired utilization of contextual cue information, along with reduced cue-related activity – but increased activation during probe and response periods – in a network of regions associated with cognitive control, centered on the lateral PFC. Following training, this pattern of activation dynamics significantly shifted, normalizing towards the pattern observed in controls. These activation effects were associated with both clinical symptoms and behavioral performance improvements. The results suggest that focused strategy training may facilitate cognitive task performance in patients with schizophrenia by changing the dynamics of activity within critical control-related brain regions.
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Hodge MAR, Siciliano D, Withey P, Moss B, Moore G, Judd G, Shores EA, Harris A. A randomized controlled trial of cognitive remediation in schizophrenia. Schizophr Bull 2010; 36:419-27. [PMID: 18718884 PMCID: PMC2833118 DOI: 10.1093/schbul/sbn102] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Individuals with schizophrenia have consistently been found to exhibit cognitive deficits, which have been identified as critical mediators of psychosocial functional outcomes. Recent reviews of cognitive remediation (CRT) have concluded that these deficits respond to training. This multi-site community study examined 40 individuals with schizophrenia who underwent cognitive remediation using the Neuropsychological Educational Approach to Remediation(1) (NEAR). Assessments using the same neuropsychological tests and measures of psychosocial outcome were made at four time points: baseline, before start of active intervention, end of active intervention and 4 months after end of active intervention. Dose of antipsychotic medication remained constant throughout the study period. After participating in NEAR, individuals showed significant improvements in verbal and visual memory, sustained attention and executive functioning. This effect persisted 4 months after the treatment ceased. The average effect size was mild to moderate. Social and occupational outcomes also improved from baseline to post-treatment, which persisted 4 months later. Our findings replicate those of previous studies that suggest that NEAR is effective in improving cognition in individuals with schizophrenia in a naturalistic and ecologically valid setting. Further it extends such findings to show a generalisation of effects to social/occupational outcomes and persistence of effects in the short term.
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Affiliation(s)
| | | | - Pamela Withey
- Prevention Early Intervention and Recovery Services, Sydney West Area Health Service
| | - Beverley Moss
- Ryde Community Mental Health, Northern Sydney and Central Coast Area Health Service
| | | | - Gaby Judd
- Early Psychosis Intervention Services, Northern Sydney and Central Coast Area Health Services
| | | | - Anthony Harris
- Psychological Medicine, The University of Sydney,The Brain Dynamics Centre, The University of Sydney
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