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Pinto JO, Pontes D, Peixoto B, Dores AR, Barbosa F. Ecological validity of neuropsychological interventions: A systematic review. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-20. [PMID: 38588721 DOI: 10.1080/23279095.2024.2328694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND The concept of ecological validity (EV) in neuropsychological interventions (NI) has been consistently advocated, but there is a lack of reviews focused on how EV is operationalized in NI programmes. This review aims to address this gap by exploring the outcome measures more commonly used for assessing EV and to understand the main characteristics of programmes with good EV. METHOD A literature search was conducted to identify studies that examined the EV of NI programmes, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Collaboration Guidelines. RESULTS A total of twenty-seven studies were included in this review. Among these, only three studies explicitly described the procedures used to assess EV. Additionally, almost half of the studies assumed that interventions had good EV based on the characteristics of the programmes. The inconsistent assessment of EV of NI programmes prevented the identification of specific characteristics of programmes demonstrating good EV. CONCLUSION This systematic review reveals a significant gap in the literature concerning the operationalization of EV within the field of NI. Further research is required to establish a consistent definition of EV in the context of NI and to develop criteria for its effective operationalization.
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Affiliation(s)
- Joana O Pinto
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- Department of Social, Behavioral Sciences of University Institute of Health Sciences - CESPU, Gandra, Portugal
| | - Diogo Pontes
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Bruno Peixoto
- Department of Social, Behavioral Sciences of University Institute of Health Sciences - CESPU, Gandra, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, University Institute of Health Sciences - CESPU, Gandra, Portugal
- UCIBIO - Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences, (1H-TOXRUN, IUCS-CESPU), Gandra, Portugal
| | - Artemisa R Dores
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- Center for Rehabilitation Research, ESS, Polytechnic of Porto, Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Gott CA, Thomas M, Allan J, Kennedy J, Black Y, Dark F, Lappin JM. Cognitive remediation therapy - implementation and translation into clinical practice in rural and metropolitan New South Wales mental health services. Australas Psychiatry 2023; 31:584-586. [PMID: 37365838 DOI: 10.1177/10398562231186125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Cognitive Remediation Therapy (CRT) is an effective intervention in managing the significant cognitive deficits experienced by those living with psychosis. Given its strong evidence base CRT is recommended in Australian and international guidelines for rehabilitation of people with psychosis, however, access to CRT remains limited. In this commentary, we describe recent efforts to implement CRT programs within NSW mental health services. Development of CRT delivery has been successfully achieved in both rural and metropolitan settings, utilising both face-to-face and telehealth methods. CONCLUSIONS The delivery of CRT in public mental health services is feasible and adaptable to diverse settings. We strongly advocate for sustainable implementation of CRT into routine clinical practice. This will require policy and practice change to enable resources for CRT training and delivery to become embedded in the roles of the clinical workforce.
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Affiliation(s)
- Chloe A Gott
- The Tertiary Referral Service for Psychosis, South Eastern Sydney Local Health District, Sydney, NSW, Australia; and
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia
| | - Matt Thomas
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia
- School of Psychology, Charles Sturt University, Bathurst, NSW, Australia; and
- Marathon Health, Bathurst, NSW, Australia
| | - Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, NSW, Australia
| | - Jessica Kennedy
- Dubbo and Region, Mental Health, Drug & Alcohol Services, Western New South Wales Local Health District, NSW, Australia
| | - Yvette Black
- Bloomfield Hospital, Western New South Wales Local Health District, Orange, NSW, Australia
| | - Frances Dark
- Metro South Addiction and Mental Health Services, Brisbane, Queensland, Australia
| | - Julia M Lappin
- The Tertiary Referral Service for Psychosis, South Eastern Sydney Local Health District, Sydney, NSW, Australia; and
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, NSW, Australia
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Kunita K, Morimoto T, Kotake R, Sato-Nakamura S, Nakamura-Kukuminato N. Effect of combining motivational interviewing with cognitive remediation on personal recovery in patients with schizophrenia. Hong Kong J Occup Ther 2023; 36:20-30. [PMID: 37332296 PMCID: PMC10273794 DOI: 10.1177/15691861231167504] [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: 09/11/2022] [Accepted: 03/18/2023] [Indexed: 09/20/2023] Open
Abstract
Background/objective We have been practising the Neuropsychological and Educational Approach to Remediation (NEAR) as cognitive remediation (CR) in a psychiatric hospital and have implemented it in combination with regular interviews based on Motivational Interviewing (MI) approximately 2 years after launching NEAR. In this study, we investigated whether combining MI with CR affected completion of the programme, cognitive functions, global functioning, and personal recovery of patients with schizophrenia by analysing medical records. Methods In this retrospective observational study, 14 participants were assigned to the NEAR group and 12 participants were assigned to the NEAR + MI group. Fifteen participants in the NEAR group (n = 6) and NEAR + MI group (n = 9) completed the programme. First, the difference in the completion rate between the groups was examined using the chi-squared test. Second, measures of cognitive functions, global functioning, and personal recovery pre-and post-intervention were examined using the Wilcoxon signed-rank tests for those in each group who completed the programme. Third, therapeutic responses for each group were compared using the Mann-Whitney U tests. Results There were no statistically significant differences in completion rates between the groups. In the NEAR group, verbal memory and overall cognition improved after the intervention. On the other hand, not only cognitive functions but also global functioning and personal recovery improved in the NEAR + MI group. Moreover, changes in global functioning and personal recovery were significantly higher in the NEAR + MI group. Conclusion Study findings indicated that combining MI with CR improves cognitive functions, global functioning, and personal recovery in patients with schizophrenia.
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Affiliation(s)
- Koji Kunita
- Department of Rehabilitation, Hayashishita Hospital, Sapporo, Japan
- Forensic Psychiatry Center, Hokkaido University Hospital, Sapporo, Japan
| | - Takafumi Morimoto
- Department of Rehabilitation, Hayashishita Hospital, Sapporo, Japan
- Department of Occupational Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Reiko Kotake
- Department of Rehabilitation, Hayashishita Hospital, Sapporo, Japan
- Hokudai-dori Mental Health Clinic, Sapporo, Japan
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Watanabe Y, Kanata S, Suga M, Inagaki A, Sato S, Hayashi N, Kunugi H, Ikebuchi E. Characteristic association of symbol coding test score with occupational function in Japanese patients with schizophrenia. Neuropsychopharmacol Rep 2023; 43:141-145. [PMID: 36753404 PMCID: PMC10009408 DOI: 10.1002/npr2.12322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/09/2023] Open
Abstract
AIM Studies showed that cognitive function affects occupational function in patients with schizophrenia. This study aimed to determine the effects of cognitive function on occupational function in Japanese patients with schizophrenia using the Brief Assessment of Cognition in Schizophrenia (BACS). METHODS Participants were 198 outpatients with schizophrenia or schizoaffective disorder (66 females; mean age 34.5 ± 6.8 years). Occupational function was assessed using the work subscale of the Life Assessment Scale for Mental Ill (LASMI-w). Multiple regression analysis was performed using the BACS as the independent variable and LASMI-w as the dependent variable. Furthermore, we divided the LASMI-w score into three groups, <11, 11-20, and >21, and performed a multinomial logistic regression analysis. RESULTS Multiple regression analysis revealed that LASMI-w score was negatively associated with BACS composite score (β = -0.20, p < 0.01). Among the sub-items of the BACS, only the symbol-coding score showed a significant negative association (β = -0.19, p < 0.05). Multinomial logistic analysis showed that the better the composite and symbol coding scores, the smaller the impairment of the occupational function (composite score: β = 2.39 between mild and moderate occupational impairments, p < 0.05; symbol coding score: β = 2.44 between mild and severe impairments, p < 0.05). CONCLUSION The occupational function of patients with schizophrenia was associated with overall cognitive function (composite score). In particular, the symbol coding score of the BACS was suggested to be related to work ability. These results might be useful in the assessment and training of cognitive rehabilitation aimed at employment support.
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Affiliation(s)
- Yukako Watanabe
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Sho Kanata
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Motomu Suga
- Graduate School of Clinical Psychology, Teikyo Heisei University, Toshima-ku, Japan
| | - Akiko Inagaki
- Division of Nursing, Faculty of Healthcare, Tokyo Healthcare University, Shinagawa-ku, Japan
| | - Sayaka Sato
- Department of Community Mental Health & Law National Institute of Mental Health, Kodaira, Japan
| | | | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Emi Ikebuchi
- Graduate School of Clinical Psychology, Teikyo Heisei University, Toshima-ku, Japan
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Datta R, Vishwanath R, Shenoy S. Are remote psychotherapy/remediation efforts accessible and feasible in patients with schizophrenia? A narrative review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:136. [PMID: 36415756 PMCID: PMC9673189 DOI: 10.1186/s41983-022-00574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cognitive remediation (CR) therapy provides an effective way to improve cognitive impairments in schizophrenia. With the advent of telehealth services, especially during COVID 19 pandemic, a suitable alternative can be found in computer and cell phone-based mental health interventions. Previous studies have proven that remote mental health interventions have by and large been successful. Remote psychotherapy/CR services can now be accessed through smartphone apps, iPads, laptops and wearable devices. This has the advantage of reaching a wider population in resource-limited settings. The lack of access to technology, difficulty in using these online interventions and lack of privacy provide impediments to the delivery of care through these online platforms. Further, as some previous studies have shown, there may be a high rate of dropout in people using remote mental health resources. We aim to look at the factors, which influence the accessibility of remote mental health interventions in schizophrenia. Additionally, we test the feasibility of these interventions and look at how they compare and the potential they hold for implementation in future clinical settings. Results We found remote cognitive remediation to be both accessible and feasible. Concerning features, however, are the high attrition rates and the concentration of the studies in Western populations. Conclusions Remote interventions are a viable alternative to in-person psychotherapy when in-person resources may not always be present. They are efficacious in improving health outcomes among patients with schizophrenia. Further research into the widespread implementation of remote CR will be beneficial in informing clinical decision-making.
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Abdominal Obesity: An Independent Influencing Factor of Visuospatial and Executive/Language Ability and the Serum Levels of Aβ40/Aβ42/Tau Protein. DISEASE MARKERS 2022; 2022:3622149. [PMID: 35401883 PMCID: PMC8993554 DOI: 10.1155/2022/3622149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/17/2022] [Indexed: 12/25/2022]
Abstract
Background Although obesity affects human health and cognitive function, the influence of abdominal obesity on cognitive function is still unclear. Methods The MoCA scale was used to evaluate the overall cognitive function and the function of each subitem of 196 subjects, as well as the SDMT and TMT-A scales for evaluating the attention and information processing speed. In addition, radioimmunoassay was used to detect the serum levels of Aβ40, Aβ42, and tau protein in 45 subjects. Subjects were divided into abdominal and nonabdominal obesity groups. Before and after correcting confounding factors, the differences in cognitive scale evaluation indexes and three protein levels between the two groups were compared. We also explore further the correlation between various cognitive abilities and the waist circumference/levels of the three proteins. Linear regression was used to identify the independent influencing factors of various cognitive functions and three protein levels. Results After correcting for multiple factors, we observed the lower scores of visuospatial function, execution, and language in the MoCA scale, as well as higher levels of Aβ40 and tau protein in the abdominal obesity group, supported by the results of correlation analysis. Abdominal obesity was identified as an independent negative influencing factor of MoCA visual space, executive power, and language scores and an independent positive influencing factor of Aβ40, Aβ42, and tau protein levels. Conclusion Abdominal obesity may play a negative role in visuospatial, executive ability, and language function and a positive role in the Aβ40, Aβ42, and tau protein serum levels.
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Development and Feasibility Exploration of a Combined Compensatory and Restorative Approach to Addressing Cognitive Challenges in Early Intervention Psychosis. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Otto LKM, Hofstra J, Mullen MG, Malenczak D, Boonstra N, van der Meer L, Veling W, Boerhout C, van Rijsbergen GD, de Vries J, van der Pol B, Pijnenborg GHM, Korevaar L. A cognitive remediation training for young adults with psychotic disorders to support their participation in education - study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2020; 6:54. [PMID: 32355565 PMCID: PMC7187485 DOI: 10.1186/s40814-020-00579-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background Most severe mental disorders have their onset between the age of 17 and 27, a time when many young adults begin participating in secondary or post-secondary education. The cognitive deficits typically associated with psychiatric disorders, especially psychotic disorders, increase the risk of leaving school early, which can lead to a reduction in employment opportunities later on in life and, in turn, a poorer long-term prognosis. Therefore, specific interventions aiming to improve these cognitive functions are needed. Cognitive remediation (CR) aims to improve cognitive functioning and may increase real-world functioning in educational performance. This study aims to examine the feasibility and applicability of a CR training named Mindset for students with psychotic disorders in the Netherlands. Methods/design Sixty students diagnosed with a psychotic disorder and currently reporting cognitive deficits will be included from four Dutch Mental Health Care institutes. Half of the participants (N = 30) will be randomly assigned to the CR training consisting of twelve, individual, weekly 1-h meetings. The other half will be assigned to an active control condition consisting of twelve weekly assignments that will be sent by email aiming to improve school performance. Students will be evaluated at baseline (T0), directly after finishing the CR training or control intervention (T1), and 6 months later (T2). Treatment feasibility will be the primary outcome, using evaluation forms, interviews with trainers and participants, number of study drop outs, and patient eligibility and recruitment rates. School functioning, cognitive functioning, and strategy use will also be assessed to get a preliminary idea of the potential effectiveness of the intervention. Discussion The CR training in this study will provide real-world examples and exercises aimed to teach useful strategies to cope with the cognitive deficits experienced by students with psychotic disorders. Furthermore, since students with other psychiatric disorders might also experience cognitive deficits, the results of this study may also provide some further implications for future studies on the effect of this CR training for students with these disorders. Trial registration The study was registered with Trialregister.nl, no. NL6590 (NTR6764), date registered: September 7, 2017. Register name: Mindset. A cognitive rehabilitation training for young adults with psychotic spectrum disorder in an educational setting: A pilot study. Protocol version: 3, date December 23, 2019
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Affiliation(s)
- Lana K M Otto
- 1Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Zernikeplein 23, 9747 AS Groningen, The Netherlands.,2Faculty of Behavioural and Social Sciences, Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Jacomijn Hofstra
- 1Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Zernikeplein 23, 9747 AS Groningen, The Netherlands
| | - Michelle G Mullen
- 3Transitions to Adulthood Center for Research, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA 01545 USA
| | - Derek Malenczak
- 4Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers University, 675 Hoes Lane West, Piscataway, NJ 08854 USA
| | - Nynke Boonstra
- Department of Research and Education, Friesland Mental Health Services, PO Box 932, 8901 BS Leeuwarden, The Netherlands.,NHL Stenden University of Applied Science, Research group Care & Welfare, Rengerslaan 8, 8917 DD Leeuwarden, The Netherlands
| | - Lisette van der Meer
- 7Department of Rehabilitation, Lentis Psychiatric Institute, E 035, 9471 KA, Zuidlaren, The Netherlands.,8Rob Giel Research Center, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands.,9Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Wim Veling
- 10University Center for Psychiatry, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Cees Boerhout
- 10University Center for Psychiatry, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | | | - Jos de Vries
- 10University Center for Psychiatry, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Boudien van der Pol
- Department of Research and Education, Friesland Mental Health Services, PO Box 932, 8901 BS Leeuwarden, The Netherlands
| | - Gerdina H M Pijnenborg
- 2Faculty of Behavioural and Social Sciences, Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.,11GGz Drenthe Mental Health Institution, Dennenweg 9, 9404 LA Assen, The Netherlands
| | - Lies Korevaar
- 1Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Zernikeplein 23, 9747 AS Groningen, The Netherlands
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The efficacy of computer-based cognitive training for executive dysfunction in schizophrenia. Psychiatry Res 2019; 279:62-70. [PMID: 31302353 DOI: 10.1016/j.psychres.2019.06.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/30/2019] [Accepted: 06/30/2019] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to assess the effect of computer-based cognitive training on executive dysfunction in patients with schizophrenia. Sixty-five patients with schizophrenia were randomly assigned to a training group (n = 33) or a non-training group (n = 32), and compared in terms of executive performance to a healthy control group (n = 33). Executive function was assessed using the Trail Making Test, the Stroop Color and Word Test, and the Wisconsin Card Sorting Test (computer version). Cognitive training was performed using RehaCom software over a course of 16 individual sessions. Primary outcomes were training (performance at three different timepoints) and neuropsychological components (flexibility and cognitive inhibition, high executive processing, and processing speed). In both clinical groups, all aspects of executive function were found to be deficient. In the patient training group, the use of computer-based training alongside pharmacological treatment was more effective in terms of cognitive improvement than pharmacological treatment alone. However, there was no significant effect of cognitive training on processing speed. Cognitive training in schizophrenia patients was effective at improving several aspects of executive function, but did not improve processing speed.
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Reser MP, Slikboer R, Rossell SL. A systematic review of factors that influence the efficacy of cognitive remediation therapy in schizophrenia. Aust N Z J Psychiatry 2019; 53:624-641. [PMID: 31177813 DOI: 10.1177/0004867419853348] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cognitive remediation therapy is a moderately effective intervention for ameliorating cognitive deficits in individuals with schizophrenia-related disorders. With reports of considerable variability in individual response to cognitive remediation therapy, we need to better understand factors that influence cognitive remediation therapy efficacy to realise its potential. A systematic review was conducted to identify and evaluate predictors of cognitive outcome. METHODS An electronic database search was conducted identifying peer-reviewed articles examining predictors of cognitive response to cognitive remediation therapy. RESULTS A total of 40 articles accounting for 1681 cognitive remediation therapy participants were included; 81 distinct predictors of cognitive response were identified. Data synthesis and discussion focused on 20 predictors examined a minimum three times in different studies. Few of the examined predictors of cognitive outcome following cognitive remediation therapy were significant when examined through systematic review. A strong trend was found for baseline cognition, with reasoning and problem solving and working memory being strongly predictive of within-domain improvement. Training task progress was the most notable cross-domain predictor of cognitive outcome. CONCLUSION It remains unclear why a large proportion of participants fail to realise cognitive benefit from cognitive remediation therapy. However, when considering only those variables where a majority of articles reported a statistically significant association with cognitive response to cognitive remediation therapy, three stand out: premorbid IQ, baseline cognition and training task progress. Each of these relates in some way to an individual's capacity or potential for change. There is a need to consolidate investigation of potential predictors of response to cognitive remediation therapy, strengthening the evidence base through replication and collaboration.
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Affiliation(s)
- Maree P Reser
- 1 Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Reneta Slikboer
- 1 Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Susan L Rossell
- 1 Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,2 Psychiatry, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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Vidarsdottir OG, Roberts DL, Twamley EW, Gudmundsdottir B, Sigurdsson E, Magnusdottir BB. Integrative cognitive remediation for early psychosis: Results from a randomized controlled trial. Psychiatry Res 2019; 273:690-698. [PMID: 31207854 DOI: 10.1016/j.psychres.2019.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 01/19/2023]
Abstract
Early application of cognitive remediation may help prevent the development of long-term functional impairments that characterize psychotic disorders. Interventions that encompass both neurocognitive and social-cognitive training may work synergistically to bridge the gap between cognitive gains and functional outcomes in early psychosis. We integrated three cognitive remediation approaches: Neuropsychological Educational Approach to Remediation (NEAR), Compensatory Cognitive Training (CCT), and Social Cognition and Interaction Training (SCIT), and evaluated the effects on cognition, clinical symptoms, self-assessed and informant-assessed social functioning in early psychosis. A total of 49 patients diagnosed with primary psychotic disorder seeking service at an early-intervention service in Iceland were randomized to either a waiting-list control group (n = 24) or a 12-week group-based integrative cognitive remediation (n = 25). Neurocognition, social cognition, community functioning and clinical symptoms were assessed at baseline and post-treatment. The intervention group showed significant improvements in verbal memory, cognitive flexibility, working memory, ToM and a significant reduction in hostile attributions, compared to those receiving standard treatment alone, but there were no differences between groups on measures of social functioning or clinical symptoms. The intervention was well tolerated and received high treatment satisfaction ratings. Findings indicate that integrated cognitive remediation has potential to improve neurocognition and social cognition in early psychosis.
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Affiliation(s)
- Olina G Vidarsdottir
- Landspitali, Department of Psychiatry, National University Hospital, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Vatnsmyrarvegur 16, 101 Reykjavik, Iceland.
| | - David L Roberts
- Department of Psychiatry, Division of Community Recovery, Research and Training, University of Texas Health Science Center, San Antonio, TX, USA.
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California, La Jolla, CA, USA; Center of Excellence for Stress and Mental Health and Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Berglind Gudmundsdottir
- Landspitali, Department of Psychiatry, National University Hospital, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Vatnsmyrarvegur 16, 101 Reykjavik, Iceland.
| | - Engilbert Sigurdsson
- Landspitali, Department of Psychiatry, National University Hospital, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Vatnsmyrarvegur 16, 101 Reykjavik, Iceland.
| | - Brynja B Magnusdottir
- Landspitali, Department of Psychiatry, National University Hospital, Reykjavik, Iceland; Department of Psychology, Reykjavik University, Menntavegur 1, 101 Reykjavik, Iceland.
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Abstract
UNLABELLED IntroductionWith the increasing enthusiasm to provide cognitive remediation (CR) as an evidence-based practice, questions arise as to what is involved in implementing CR in a large system of care. This article describes the first statewide implementation of CR in the USA, with the goal of documenting the implementation issues that care providers are likely to face when bringing CR services to their patients. METHODS In 2014, the New York State Office of Mental Health set up a Cognitive Health Service that could be implemented throughout the state-operated system of care. This service was intended to broadly address cognitive health, to assure that the cognitive deficits commonly associated with psychiatric illnesses are recognized and addressed, and that cognitive health is embedded in the vocabulary of wellness. It involved creating a mechanism to train staff to recognize how cognitive health could be prioritized in treatment planning as well as implementing CR in state-operated adult outpatient psychiatry clinics. RESULTS By 2017, CR was available at clinics serving people with serious mental illness in 13 of 16 adult Psychiatric Centers, located in rural and urban settings throughout New York state. The embedded quality assurance program evaluation tools indicated that CR was acceptable, sustainable, and effective. CONCLUSIONS Cognitive remediation can be feasibly implemented in large systems of care that provide a multilevel system of supports, a training program that educates broadly about cognitive health and specifically about the delivery of CR, and embedded, ongoing program evaluation that is linked to staff supervision.
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Sandoval LR, González BL, Stone WS, Guimond S, Rivas CT, Sheynberg D, Kuo SS, Eack S, Keshavan MS. Effects of peer social interaction on performance during computerized cognitive remediation therapy in patients with early course schizophrenia: A pilot study. Schizophr Res 2019; 203:17-23. [PMID: 28882686 PMCID: PMC9671710 DOI: 10.1016/j.schres.2017.08.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/24/2017] [Accepted: 08/27/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies show that computer-based training enhances cognition in schizophrenia; furthermore, socialization has also been found to improve cognitive functions. It is generally believed that non-social cognitive remediation using computer exercises would be a pre-requisite for therapeutic benefits from social cognitive training. However, it is also possible that social interaction by itself enhances non-social cognitive functions; this possibility has scarcely been explored in schizophrenia patients. This pilot study examined the effects of computer-based neurocognitive training, along with social interaction either with a peer (PSI) or without one (N-PSI). We hypothesized that PSI will enhance cognitive performance during computerized exercises in schizophrenia, as compared with N-PSI. METHODS Sixteen adult participants diagnosed with schizophrenia or schizoaffective disorder participating in an ongoing trial of Cognitive Enhancement Therapy completed several computerized neurocognitive remediation training sessions (the Orientation Remedial Module©, or ORM), either with a peer or without a peer. RESULTS We observed a significant interaction between the effect of PSI and performance on the different cognitive exercises (p<0.05). More precisely, when patients performed the session with PSI, they demonstrated better cognitive performances than with N-PSI in the ORM exercise that provides training in processing speed, alertness, and reaction time (the standard Attention Reaction Conditioner, or ARC) (p<0.01, corrected). PSI did not significantly affect other cognitive domains such as target detection and spatial attention. CONCLUSION Our findings suggest that PSI could improve cognitive performance, such as processing speed, during computerized cognitive training in schizophrenia. Additional studies investigating the effect of PSI during cognitive remediation are needed to further evaluate this hypothesis.
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Affiliation(s)
- Luis R. Sandoval
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Betzamel López González
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - William S. Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Synthia Guimond
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Cristina Torres Rivas
- Consorci Sanitari del Maresme, Spain,FPCEE Blanquerna, Universitat Ramon Llull, Spain
| | - David Sheynberg
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, United States
| | | | | | - Matcheri S. Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, United States,Corresponding author at: Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, 330 Brookline Ave., Boston, MA 02115, United States. (M.S. Keshavan)
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Noyes S, Sokolow H, Arbesman M. Evidence for Occupational Therapy Intervention With Employment and Education for Adults With Serious Mental Illness: A Systematic Review. Am J Occup Ther 2018; 72:7205190010p1-7205190010p10. [PMID: 30157005 DOI: 10.5014/ajot.2018.033068] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Many of the estimated 9.8 million American adults with serious mental illness (SMI) want to engage in employment and education, yet the majority report a need for more skills training. This review presents evidence for the effectiveness of interventions that occupational therapy practitioners can provide to help people with SMI improve and maintain performance and participation in employment and education. METHOD Citations, abstracts, and full-text articles in databases including MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were reviewed for inclusion and analysis. RESULTS Fifty-seven articles met criteria for inclusion. For employment, strong evidence was found for the Individual Placement and Support (IPS) model and cognitive interventions. For education, moderate evidence was found for supported education interventions. CONCLUSION This systematic review supports the role of occupational therapy practitioners in promoting the implementation of IPS, cognitive-based, and social skills programs to improve vocational and educational outcomes for adults with SMI.
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Affiliation(s)
- Susan Noyes
- Susan Noyes, PhD, OTR/L, is Assistant Professor, Occupational Therapy Program, University of Southern Maine, Lewiston;
| | - Helena Sokolow
- Helena Sokolow, MOT, OTR, is Adjunct Instructor, Occupational Therapy Program, University of Southern Maine, Lewiston
| | - Marian Arbesman
- Marian Arbesman, PhD, OTR/L, FAOTA, is Adjunct Associate Professor, Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, and President, ArbesIdeas, Inc., Williamsville, NY
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Hergenrather KC, Emmanuel D, McGuire-Kuletz M, Rhodes SD. Employment as a Social Determinant of Health: Exploring the Relationship Between Neurocognitive Function and Employment Status. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2018. [DOI: 10.1891/2168-6653.32.2.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose:To explore employment as a social determinant of health through examining the relationship between neurocognitive function and employment status.Method:The authors explored the causal relationship between employment status and neurocognitive function by conducting a systematic review of 15 longitudinal studies. The identified studies were conducted in Australia, Denmark, Norway, and the United States.Results:Five neurocognitive function domains were identified (i.e., complex attention, executive function, learning and memory, language, perceptual-motor function) across diagnosis (i.e., bipolar disorder, first-episode psychosis, human immunodeficiency virus, major depression, schizophrenia-spectrum disorders, traumatic brain injury). Unemployment was correlated with poorer attention, executive function, learning and memory, perceptual-motor function, and language. Employment was correlated with better attention, executive function, learning and memory, perceptual-motor function.Conclusion:The acknowledgment of the relationship between neurocognitive function and employment status can assist service providers in assessing and developing strategies to enhance and maintain employment outcomes. The assessment of neurocognitive function could be further explored by identifying standard measures and assessment timelines to assess the six domains across diagnosis. Vocational rehabilitation services could integrate cognitive interventions (cognitive rehabilitation, cognitive enhancement therapy, cognitive remediation) to explore the effect on neurocognitive function and employment outcomes. Further longitudinal research studies are needed, for both persons with disabilities and persons without disabilities, to elucidate the relationship between employment status and neurocognitive function.
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Ohi K, Sumiyoshi C, Fujino H, Yasuda Y, Yamamori H, Fujimoto M, Sumiyoshi T, Hashimoto R. A Brief Assessment of Intelligence Decline in Schizophrenia As Represented by the Difference between Current and Premorbid Intellectual Quotient. Front Psychiatry 2017; 8:293. [PMID: 29312019 PMCID: PMC5743746 DOI: 10.3389/fpsyt.2017.00293] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/11/2017] [Indexed: 01/25/2023] Open
Abstract
Patients with schizophrenia elicit several clinical features, such as psychotic symptoms, cognitive impairment, and subtle decline of intelligence. The latter two features become evident around the onset of the illness, although they may exist even before the disease onset in a substantial proportion of cases. Here, we review the literature concerning intelligence decline (ID) during the progression of schizophrenia. ID can be estimated by comparing premorbid and current intellectual quotient (IQ) by means of the Adult Reading Test and Wechsler Adult Intelligence Scale (WAIS), respectively. For the purpose of brief assessment, we have recently developed the WAIS-Short Form, which consists of Similarities and Symbol Search and well reflects functional outcomes. According to the degree of ID, patients were classified into three distinct subgroups; deteriorated, preserved, and compromised groups. Patients who show deteriorated IQ (deteriorated group) elicit ID from a premorbid level (≥10-point difference between current and premorbid IQ), while patients who show preserved or compromised IQ do not show such decline (<10-point difference). Furthermore, the latter patients were divided into patients with preserved and compromised IQ based on an estimated premorbid IQ score >90 or below 90, respectively. We have recently shown the distribution of ID in a large cohort of schizophrenia patients. Consistent with previous studies, approximately 30% of schizophrenia patients had a decline of less than 10 points, i.e., normal intellectual performance. In contrast, approximately 70% of patients showed deterioration of IQ. These results indicate that there is a subgroup of schizophrenia patients who have mild or minimal intellectual deficits, following the onset of the disorder. Therefore, a careful assessment of ID is important in identifying appropriate interventions, including medications, cognitive remediation, and social/community services.
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Affiliation(s)
- Kazutaka Ohi
- Department of Neuropsychiatry, Kanazawa Medical University, Uchinada, Japan
| | - Chika Sumiyoshi
- Faculty of Human Development and Culture, Fukushima University, Fukushima, Japan
| | - Haruo Fujino
- Graduate School of Education, Oita University, Oita, Japan
| | - Yuka Yasuda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidenaga Yamamori
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Michiko Fujimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomiki Sumiyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Ryota Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
- Molecular Research Center for Children’s Mental Development, United Graduate School of Child Development, Osaka University, Suita, Japan
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17
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Katsumi A, Hoshino H, Fujimoto S, Yabe H, Ikebuchi E, Nakagome K, Niwa SI. Effects of cognitive remediation on cognitive and social functions in individuals with schizophrenia. Neuropsychol Rehabil 2017; 29:1475-1487. [PMID: 29212415 DOI: 10.1080/09602011.2017.1409639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Individuals with schizophrenia exhibit cognitive impairments, which are related to impairments in social functions. This study investigated the effects of cognitive remediation on cognitive, social, and daily living impairment. Participants were individuals with schizophrenia between 20 and 60 years old (N = 44). Participants were randomly assigned to two groups: a cognitive remediation intervention group and a non-intervention control group. The control group was provided with conventional drug therapy and either day care or occupational therapy. The intervention group was provided with the "neuropsychological educational approach to cognitive remediation" developed by Medalia and co-workers. We assessed cognitive functions using the brief assessment of cognition in schizophrenia (BACS), and evaluated social and daily living functions using the global assessment of functioning (GAF) scale. Significant group by time interaction effects indicated that verbal memory, working memory, attention, and executive function showed significantly greater improvement at post-intervention for the intervention group than the control group. Social and daily living function also improved in the intervention group and improvements were maintained one year after intervention. These preliminary findings indicate that the combination of cognitive remediation and psychiatric rehabilitation is effective for facilitating improvements in cognitive function and social and daily living functions in individuals with schizophrenia.
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Affiliation(s)
- Akihiko Katsumi
- Katsumi Clinic , Niigata , Japan.,Department of Neuropsychiatry, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Hiroshi Hoshino
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Satoshi Fujimoto
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine , Fukushima , Japan
| | - Emi Ikebuchi
- Department of Psychiatry, Teikyo University School of Medicine , Tokyo , Japan
| | - Kazuyuki Nakagome
- National Center Hospital, National Center of Neurology and Psychiatry , Tokyo , Japan
| | - Shin-Ichi Niwa
- Department of Psychiatry, Aizu Medical Center, Fukushima Medical University , Aizuwakamatsu , Japan
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18
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Ohi K, Shimada T, Nemoto K, Kataoka Y, Yasuyama T, Kimura K, Okubo H, Uehara T, Kawasaki Y. Cognitive clustering in schizophrenia patients, their first-degree relatives and healthy subjects is associated with anterior cingulate cortex volume. Neuroimage Clin 2017; 16:248-256. [PMID: 28831376 PMCID: PMC5554933 DOI: 10.1016/j.nicl.2017.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/27/2017] [Accepted: 08/07/2017] [Indexed: 12/21/2022]
Abstract
Cognitive impairments are a core feature in schizophrenia patients (SCZ) and are also observed in first-degree relatives (FR) of SCZ. However, substantial variability in the impairments exists within and among SCZ, FR and healthy controls (HC). A cluster-analytic approach can group individuals based on profiles of traits and create more homogeneous groupings than predefined categories. Here, we investigated differences in the Brief Assessment of Cognition in Schizophrenia (BACS) neuropsychological battery (six subscales) among SCZ, unaffected FR and HC. To identify three homogeneous and meaningful cognitive groups regardless of categorical diagnoses (SCZ, FR and HC), cognitive clustering was performed, and differences in the BACS subscales among the cognitive cluster groups were investigated. Finally, the effects of diagnosis and cognition on brain volumes were examined. As expected, there were significant differences in the five BACS subscales among the diagnostic groups. The cluster-analytic approach generated three meaningful subgroups: (i) neuropsychologically normal, (ii) intermediate impaired and (iii) widespread impaired. The cognitive subgroups were mainly affected by the clinical diagnosis, and significant differences in all BACS subscales among clusters were found. The effects of the diagnosis and cognitive clusters on brain volumes overlapped in the frontal, temporal and limbic regions. Frontal and temporal volumes were mainly affected by the diagnosis, whereas the anterior cingulate cortex (ACC) volumes were affected by the additive effects of diagnosis and cognition. Our findings demonstrate a cognitive continuum among SCZ, FR and HC and support the concept of cognitive impairment and the related ACC volumes as intermediate phenotypes in SCZ.
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Affiliation(s)
- Kazutaka Ohi
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Takamitsu Shimada
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Kiyotaka Nemoto
- Department of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuzuru Kataoka
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Toshiki Yasuyama
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Kohei Kimura
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroaki Okubo
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Takashi Uehara
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Yasuhiro Kawasaki
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
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Fisher M, Herman A, Stephens DB, Vinogradov S. Neuroscience-informed computer-assisted cognitive training in schizophrenia. Ann N Y Acad Sci 2017; 1366:90-114. [PMID: 27111135 DOI: 10.1111/nyas.13042] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/29/2016] [Accepted: 02/16/2016] [Indexed: 01/09/2023]
Abstract
Schizophrenia is a heterogeneous psychiatric syndrome characterized by psychosis. It is also a neurodevelopmental disorder. In the earliest phases of the illness, at-risk individuals exhibit subtle, nonspecific symptoms, including cognitive dysfunction and progressive brain volumetric loss. Generally, schizophrenia is characterized by abnormal/inefficient neural system operations and neural oscillatory activity, as well as functional disconnectivity across frontal-temporo parietal and frontal-subcortical networks; it thus may best be described as a widespread neural oscillatory connectomopathy. Despite earlier views of schizophrenia as an inevitably progressive neurodegenerative disease, emerging evidence indicates that endogenous neuroplastic capacity is retained. An active area of research is directed at understanding how best to harness this learning-induced neuroplasticity to enhance neural system functioning, improve cognition, and prevent-and possibly even reverse-disease progression. In this review, we present an overview of results from the most widely used computer-assisted cognitive-training programs in schizophrenia, contrasting a broad neuropsychological rehabilitation approach with a targeted cognitive-training approach. We then review studies on the neurobiological effects of these two training methods. Finally, we discuss future directions with a focus on the "oscillatory connectome" as a key area of investigation for developing the most precise and scientifically informed treatment approaches for this illness.
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Affiliation(s)
- Melissa Fisher
- Department of Psychiatry, University of California, San Francisco, and San Francisco Department of Veterans Affairs Medical Center, San Francisco, California
| | - Alexander Herman
- School of Medicine, University of California, San Francisco, California
| | | | - Sophia Vinogradov
- Department of Psychiatry, University of California, San Francisco, and San Francisco Department of Veterans Affairs Medical Center, San Francisco, California
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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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21
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Best MW, Bowie CR. A review of cognitive remediation approaches for schizophrenia: from top-down to bottom-up, brain training to psychotherapy. Expert Rev Neurother 2017; 17:713-723. [PMID: 28511562 DOI: 10.1080/14737175.2017.1331128] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Individuals with psychotic disorders experience profound impairment in neurocognition, which is consistently found to be the best predictor of independent community functioning. Several diverse behavioural treatments designed to enhance neurocognitive abilities have been developed, with subtle to stark differences among them. Various approaches, to varying degrees, have demonstrated success across diffuse outcomes: improved brain structure and function, performance on neuropsychological tests, and community activities associated with daily living. Areas covered: This paper reviews the different approaches to cognitive remediation and the differential effects these approaches have on neurophysiological function, neurocognitive abilities, and real-world community functioning. Cognitive remediation approaches can be broadly classified along two dimensions: 1) treatment target, and 2) treatment modality. Some approaches target more basic perceptual skills, some target higher level executive processes, while some are non-targeted and seek to improve general cognitive ability. With regard to modality, approaches might have little/no therapist involvement and rely exclusively on computerized practice or they may include intensive therapist involvment to generalize neurocognitive change to community functioning. Expert commentary: Compared to other widely implemented treatments for schizophrenia, cognitive remediation produces better effects on outcome measures. It is time for cognitive remediation to be adopted as a best practice in the treatment of schizophrenia.
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Affiliation(s)
- Michael W Best
- a Department of Psychology , Queen's University , Kingston , ON , Canada
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22
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Mogami T. Cognitive Remediation for Schizophrenia with Focus on NEAR. Front Psychiatry 2017; 8:304. [PMID: 29387019 PMCID: PMC5776134 DOI: 10.3389/fpsyt.2017.00304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tamiko Mogami
- Faculty of Medicine, Tottori University, Yonago, Japan
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Lanfredi M, Deste G, Ferrari C, Barlati S, Magni LR, Rossi R, de Peri L, Bonomi M, Rossi G, Vita A. Effects of cognitive remediation therapy on neurocognition and negative symptoms in schizophrenia: an Italian naturalistic study. Cogn Neuropsychiatry 2017; 22:53-68. [PMID: 27921860 DOI: 10.1080/13546805.2016.1260537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cognitive remediation therapy (CRT) has been reported to positively affect neurocognitive processes among patients with schizophrenia; however, the degree to which changes in cognition is linked to improved clinical symptoms, remains poorly understood. The current study aimed to investigate whether cognitive gains were associated to improvements in negative symptoms' severity in patients with schizophrenia living in two Italian psychiatric facilities. METHODS Patients with a diagnosis of schizophrenia were consecutively assigned to CRT (n = 33) and compared with an historical control group (n = 28). Assessments were performed at baseline and post-treatment using a neuropsychological battery (Trail Making Test A and B, Self-Ordered Pointing Task, California Verbal Learning Test), along with clinical and functioning measures. RESULTS Visual attention (TMT-A score change) was found as the only significant predictor of improvement in negative symptoms subscale of the Positive and Negative Syndrome Scale. Furthermore, a mediation path analysis confirmed that better performance in visual attention acts as mediator of the positive association between CRT intervention and lower post-treatment negative symptoms score. CONCLUSIONS CRT can have a positive impact on a measure of visual attention in patients with schizophrenia and on negative symptoms reduction that is mediated by this significant intervention effect.
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Affiliation(s)
- Mariangela Lanfredi
- a Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli , Brescia , Italy
| | - Giacomo Deste
- b Department of Psychiatry , Spedali Civili Hospital , Brescia , Italy
| | - Clarissa Ferrari
- c cService of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli , Brescia , Italy
| | - Stefano Barlati
- b Department of Psychiatry , Spedali Civili Hospital , Brescia , Italy
| | - Laura Rosa Magni
- a Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli , Brescia , Italy
| | - Roberta Rossi
- a Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli , Brescia , Italy
| | - Luca de Peri
- b Department of Psychiatry , Spedali Civili Hospital , Brescia , Italy
| | - Marco Bonomi
- b Department of Psychiatry , Spedali Civili Hospital , Brescia , Italy
| | - Giuseppe Rossi
- a Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli , Brescia , Italy
| | - Antonio Vita
- b Department of Psychiatry , Spedali Civili Hospital , Brescia , Italy
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Peña J, Ibarretxe-Bilbao N, Sánchez P, Iriarte MB, Elizagarate E, Garay MA, Gutiérrez M, Iribarren A, Ojeda N. Combining social cognitive treatment, cognitive remediation, and functional skills training in schizophrenia: a randomized controlled trial. NPJ SCHIZOPHRENIA 2016; 2:16037. [PMID: 27868083 PMCID: PMC5102241 DOI: 10.1038/npjschz.2016.37] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/30/2016] [Accepted: 09/30/2016] [Indexed: 12/27/2022]
Abstract
This study examined the efficacy of an integrative cognitive remediation program (REHACOP) in improving cognition and functional outcome in patients with schizophrenia. The program combines cognitive remediation, social cognitive intervention, and functional skills training. Few studies have attempted this approach. One hundred and eleven patients diagnosed with schizophrenia were randomly assigned to either the cognitive remediation group (REHACOP) or an active control group (occupational activities) for 4 months (three sessions per week, 90 min). Primary outcomes were change on general neurocognitive performance and social cognition, including theory of mind (ToM), emotion perception (EP), attributional style, and social perception (SP). Secondary outcomes included changes on clinical symptoms (Positive and Negative Syndrome Scale) and functional outcome (UCSD Performance-Based Skills Assessment and the Global Assessment of Functioning). The trial was registered with clinicaltrials.gov (NCT02796417). No baseline group differences were found. Significant differences were found in the mean change between the REHACOP group and control group in neurocognition (ηp2=0.138), SP (ηp2=0.082), ToM (ηp2=0.148), EP (ηp2=0.071), negative symptoms (ηp2=0.082), emotional distress (ηp2=0.136), Global Assessment of Functioning (ηp2=0.081), and UCSD Performance-Based Skills Assessment (ηp2=0.154). The combination of cognitive remediation, social cognitive intervention, and functional skills training demonstrated statistically significant and clinically meaningful changes in neurocognition, social cognition, negative, and functional disability.
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Affiliation(s)
- Javier Peña
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto , Bilbao, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto , Bilbao, Spain
| | - Pedro Sánchez
- Refractory Psychosis Unit, Hospital Psiquiátrico de Alava, C/Alava, Vitoria, Spain; Department of Neuroscience, Psychiatry Section, School of Medicine and Odontology, University of the Basque Country, Vizcaya, Spain
| | | | - Edorta Elizagarate
- Refractory Psychosis Unit, Hospital Psiquiátrico de Alava, C/Alava, Vitoria, Spain; Department of Neuroscience, Psychiatry Section, School of Medicine and Odontology, University of the Basque Country, Vizcaya, Spain; CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | | | - Miguel Gutiérrez
- Department of Neuroscience, Psychiatry Section, School of Medicine and Odontology, University of the Basque Country, Vizcaya, Spain; CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Department of Psychiatry, Hospital Universitario Alava-Sede Santiago, C/Olaguibel, Vitoria, Spain
| | | | - Natalia Ojeda
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto , Bilbao, Spain
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Lee P, Lin HY, Liu CH, Lu WS, Hsieh CL. Relative and Absolute Reliabilities of the Conners’ Continuous Performance Test II in Schizophrenia. Arch Clin Neuropsychol 2016; 31:769-779. [DOI: 10.1093/arclin/acw037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 12/17/2022] Open
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Tan S, Zou Y, Wykes T, Reeder C, Zhu X, Yang F, Zhao Y, Tan Y, Fan F, Zhou D. Group cognitive remediation therapy for chronic schizophrenia: A randomized controlled trial. Neurosci Lett 2016; 626:106-11. [DOI: 10.1016/j.neulet.2015.08.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/31/2015] [Accepted: 08/20/2015] [Indexed: 11/27/2022]
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Suenderhauf C, Walter A, Lenz C, Lang UE, Borgwardt S. Counter striking psychosis: Commercial video games as potential treatment in schizophrenia? A systematic review of neuroimaging studies. Neurosci Biobehav Rev 2016; 68:20-36. [PMID: 27090742 DOI: 10.1016/j.neubiorev.2016.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/19/2016] [Accepted: 03/16/2016] [Indexed: 01/01/2023]
Abstract
Schizophrenia is a severe, chronic, and strongly disabling neuropsychiatric disorder, characterized by cognitive decline, positive and negative symptoms. Positive symptoms respond well to antipsychotic medication and psycho-social interventions, in contrast to negative symptoms and neurocognitive impairments. Cognitive deficits have been linked to a poorer outcome and hence specific cognitive remediation therapies have been proposed. Their effectiveness is nowadays approved and neurobiological correlates have been reconfirmed by brain imaging studies. Interestingly, recent MRI work showed that commercial video games modified similar brain areas as these specialized training programs. If gray matter increases and functional brain modulations would translate in better cognitive and every day functioning, commercial video game training could be an enjoyable and economically interesting treatment option for patients with neuropsychiatric disorders. This systematic review summarizes advances in the area with emphasis on imaging studies dealing with brain changes upon video game training and contrasts them to conventional cognitive remediation. Moreover, we discuss potential challenges therapeutic video game development and research would have to face in future treatment of schizophrenia.
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Affiliation(s)
- Claudia Suenderhauf
- Neuropsychiatry and Brain Imaging Group, Department of Psychiatry (UPK), Department of Clinical Research (DKF), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland.
| | - Anna Walter
- Neuropsychiatry and Brain Imaging Group, Department of Psychiatry (UPK), Department of Clinical Research (DKF), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
| | - Claudia Lenz
- Neuropsychiatry and Brain Imaging Group, Department of Psychiatry (UPK), Department of Clinical Research (DKF), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
| | - Undine E Lang
- Neuropsychiatry and Brain Imaging Group, Department of Psychiatry (UPK), Department of Clinical Research (DKF), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
| | - Stefan Borgwardt
- Neuropsychiatry and Brain Imaging Group, Department of Psychiatry (UPK), Department of Clinical Research (DKF), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
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Saperstein AM, Medalia A. The Role of Motivation in Cognitive Remediation for People with Schizophrenia. Curr Top Behav Neurosci 2016; 27:533-546. [PMID: 25772266 DOI: 10.1007/7854_2015_373] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Motivation impairment is an often prominent component of schizophrenia symptomatology that impacts treatment engagement and reduces the functional benefit from psychosocial interventions. Intrinsic motivation in particular has been shown to be impaired in schizophrenia. Nowhere is the role of intrinsic motivation impairment more evident than in cognitive remediation for schizophrenia. This chapter describes the theoretical determinants of motivation to learn and illustrates how those determinants have been translated into therapeutic techniques that enhance intrinsic motivation in a clinical context. We review the extant research that indicates how motivation enhancing techniques yield treatment-related improvements within cognitive remediation therapy and, more broadly, in other behavioral skills-based interventions for schizophrenia.
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Affiliation(s)
- Alice M Saperstein
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Mailbox 104, New York, USA.
| | - Alice Medalia
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Mailbox 104, New York, USA
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Abstract
PURPOSE OF REVIEW This review compares the literature on cognitive remediation therapy (CRT) for eating disorders with findings in the field of schizophrenia, and discusses future directions for CRT for eating disorders. RECENT FINDINGS First studies using a randomized controlled trial design show the added value of CRT for eating disorders. Patients reported lessened symptoms and further improvements in quality of life and cognitive flexibility. Furthermore, the acceptability of the intervention was good and attrition rates for CRT itself were low. Research into the use of cognitive remediation for schizophrenia is extensive and the results on global cognition appeared to be robust at post-treatment and durable at follow-up, with small to medium effect sizes. Recent articles within the field of schizophrenia emphasize the necessity of intrinsic motivation to translate cognitive gains into actual changes in everyday life. SUMMARY A next step is to examine the impact of CRT for eating disorders on motivation. It is also important to focus on the transdiagnostic use of CRT, considering the overlap in cognitive inefficiencies between eating disorders. Another important step may be to develop effective personalized methods of CRT by taking into account individual differences in cognitive processes most relevant to improvement in outcome.
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Affiliation(s)
- Unna N Danner
- aAltrecht Eating Disorders Rintveld, Zeist bUtrecht Research Group Eating Disorders, Utrecht cCenter for Eating Disorders Ursula, Leiden, The Netherlands dDepartment of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, USA
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Carolus A, Popova P, Rockstroh B. Kognitive Defizite bei Schizophren Erkrankten. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2015. [DOI: 10.1026/1616-3443/a000288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Kognitive Funktionseinschränkungen sind zentrales Merkmal schizophrener Erkrankungen und werden entsprechend im Behandlungskonzept berücksichtigt. Kognitive Remediationsprogramme gelten als wirksam, Effektstärken als moderat. Trainingsvarianten werden zur Effektoptimierung erprobt. Fragestellung: Ist gezieltes Funktionstraining in neuroplastizitäts-orientiertem Lernkontext effektiver als breitgefächertes Behandlungsprogramm und werden Effekte durch das Erkrankungsstadium moduliert? Methode: Bei 59 chronisch und 31 ersthospitalisierten schizophren Erkrankten wurden kognitive Defizite über Testleistungen der MATRICS Consensus Cognitive Test Battery gegenüber 25 gesunder Kontrollpersonen erfasst. Testleistungen vor, nach 4-wöchiger Interventionsphase mit zwei spezifischen Trainings oder Standardbehandlung und 3-monatiger Katamnese prüften den Einfluss von Interventionstypus und Erkrankungsstadium auf Leistungsverbesserung. Ergebnisse: Sowohl chronische wie erstmals behandelte Patienten aller Behandlungsgruppen verbesserten sich signifikant über die Messzeitpunkte, obwohl Defizite relativ zu Kontrollen fortbestanden. Schlussfolgerungen: Spezifisches Training verbessert kognitive Funktionen nicht über Zeit/Remissionseffekte hinaus.
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Katsumi A, Hoshino H, Fujimoto S, Niwa SI. Efficacy of Cognitive Remediation in Schizophrenia: A Short Review of Its Variable Effects According to Cognitive Domain. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojpsych.2015.52019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kidd SA, Kaur J, Virdee G, George TP, McKenzie K, Herman Y. Cognitive remediation for individuals with psychosis in a supported education setting: a randomized controlled trial. Schizophr Res 2014; 157:90-8. [PMID: 24893903 DOI: 10.1016/j.schres.2014.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/08/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
Cognitive remediation (CR) has demonstrated good outcomes when paired with supported employment, however little is known about its effectiveness when integrated into a supported education program. This randomized controlled trial examined the effectiveness of integrating CR within a supported education program compared with supported education without CR. Thirty-seven students with psychosis were recruited into the study in the 2012 academic year. Academic functioning, cognition, self-esteem, and symptomatology were assessed at baseline, at 4months following the first academic term in which CR was provided, and at 8months assessing maintenance of gains. The treatment group demonstrated better retention in the academic program and a trend of improvement across a range of academic functional domains. While both treatment and control groups showed improvement in cognitive measures, the outcomes were not augmented by CR training. CR was also associated with significant and sustained improvements in self esteem. Further research, investigating specific intervention components is required to clarify the mixed findings regarding the effectiveness of CR in an education setting.
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Affiliation(s)
- Sean A Kidd
- University of Toronto Department of Psychiatry, Toronto Centre for Addiction and Mental Health, 1001 Queen St. W., Toronto, Ontario M6J 1H1Canada.
| | - Jaswant Kaur
- George Brown College, Redirection Through Education Program, St James Campus, 200 King St E, Rm 524A, Toronto, ON, M5A 3W8.
| | - Gursharan Virdee
- Toronto Centre for Addiction and Mental Health, 1001 Queen St. W., Toronto, Ontario M6J 1H1 Canada.
| | - Tony P George
- University of Toronto Department of Psychiatry, Toronto Centre for Addiction and Mental Health, 1001 Queen St. W., Toronto, Ontario M6J 1H1Canada.
| | - Kwame McKenzie
- University of Toronto Department of Psychiatry, Toronto Centre for Addiction and Mental Health, 1001 Queen St. W., Toronto, Ontario M6J 1H1Canada.
| | - Yarissa Herman
- Toronto Centre for Addiction and Mental Health, 1001 Queen St. W., Toronto, Ontario M6J 1H1 Canada.
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Haller CS, Padmanabhan JL, Lizano P, Torous J, Keshavan M. Recent advances in understanding schizophrenia. F1000PRIME REPORTS 2014; 6:57. [PMID: 25184047 PMCID: PMC4108956 DOI: 10.12703/p6-57] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Schizophrenia is a highly disabling disorder whose causes remain to be better understood, and treatments have to be improved. However, several recent advances have been made in diagnosis, etiopathology, and treatment. Whereas reliability of diagnosis has improved with operational criteria, including Diagnostic and Statistical Manual of Mental Disorders, (DSM) Fifth Edition, validity of the disease boundaries remains unclear because of substantive overlaps with other psychotic disorders. Recent emphasis on dimensional approaches and translational bio-behavioral research domain criteria may eventually help move toward a neuroscience-based definition of schizophrenia. The etiology of schizophrenia is now thought to be multifactorial, with multiple small-effect and fewer large-effect susceptibility genes interacting with several environmental factors. These factors may lead to developmentally mediated alterations in neuroplasticity, manifesting in a cascade of neurotransmitter and circuit dysfunctions and impaired connectivity with an onset around early adolescence. Such etiopathological understanding has motivated a renewed search for novel pharmacological as well as psychotherapeutic targets. Addressing the core features of the illness, such as cognitive deficits and negative symptoms, and developing hypothesis-driven early interventions and preventive strategies are high-priority goals for the field. Schizophrenia is a severe, chronic mental disorder and is among the most disabling disorders in all of medicine. It is estimated by the National Institute of Mental Health (NIMH) that 2.4 million people over the age of 18 in the US suffer from schizophrenia. This illness typically begins in adolescence and derails the formative goals of school, family, and work, leading to considerable suffering and disability and reduced life expectancy by about 20 years. Treatment outcomes are variable, and some people are successfully treated and reintegrated (i.e. go back to work). Despite the effort of many experts in the field, however, schizophrenia remains a chronic relapsing and remitting disorder associated with significant impairments in social and vocational functioning and a shortened lifespan. Comprehensive treatment entails a multi-modal approach, including psychopharmacology, psychosocial interventions, and assistance with housing and financial sustenance. Research to date suggests a network of genetic, neural, behavioral, and environmental factors to be responsible for its development and course. This article aims to summarize and explain recent advancements in research on schizophrenia, to suggest how these recent discoveries may lead to a better understanding and possible further development of effective therapies, and to highlight the paradigm shifts that have taken place in our understanding of the diagnosis, etiopathology, and treatment.
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Affiliation(s)
- Chiara S. Haller
- Department of Psychology, Harvard University33 Kirkland street, Cambridge, MA 02138USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center330 Brookline Avenue, Boston, MA 02215USA
| | - Jaya L. Padmanabhan
- Division of Public Psychiatry, Massachusetts Mental Health Center75 Fenwood Road, Boston, MA 02115USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center330 Brookline Avenue, Boston, MA 02215USA
| | - Paulo Lizano
- Division of Public Psychiatry, Massachusetts Mental Health Center75 Fenwood Road, Boston, MA 02115USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center330 Brookline Avenue, Boston, MA 02215USA
| | - John Torous
- Division of Public Psychiatry, Massachusetts Mental Health Center75 Fenwood Road, Boston, MA 02115USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center330 Brookline Avenue, Boston, MA 02215USA
| | - Matcheri Keshavan
- Department of Psychology, Harvard University33 Kirkland street, Cambridge, MA 02138USA
- Harvard Medical SchoolBoston, MA 02115USA
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Paquin K, Wilson AL, Cellard C, Lecomte T, Potvin S. A systematic review on improving cognition in schizophrenia: which is the more commonly used type of training, practice or strategy learning? BMC Psychiatry 2014; 14:139. [PMID: 24885300 PMCID: PMC4055167 DOI: 10.1186/1471-244x-14-139] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 04/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this article was to conduct a review of the types of training offered to people with schizophrenia in order to help them develop strategies to cope with or compensate for neurocognitive or sociocognitive deficits. METHODS We conducted a search of the literature using keywords such as "schizophrenia", "training", and "cognition" with the most popular databases of peer-reviewed journals. RESULTS We reviewed 99 controlled studies in total (though nine did not have a control condition). We found that drill and practice training is used more often to retrain neurocognitive deficits while drill and strategy training is used more frequently in the context of sociocognitive remediation. CONCLUSIONS Hypotheses are suggested to better understand those results and future research is recommended to compare drill and strategy with drill and practice training for both social and neurocognitive deficits in schizophrenia.
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Affiliation(s)
- Karine Paquin
- Psychology Department, University of Montreal, Montreal, Canada.
| | | | | | - Tania Lecomte
- Psychology Department, University of Montreal, Montreal, Canada
| | - Stéphane Potvin
- Psychology Department, University of Montreal, Montreal, Canada
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Sánchez P, Peña J, Bengoetxea E, Ojeda N, Elizagárate E, Ezcurra J, Gutiérrez M. Improvements in negative symptoms and functional outcome after a new generation cognitive remediation program: a randomized controlled trial. Schizophr Bull 2014; 40:707-15. [PMID: 23686130 PMCID: PMC3984510 DOI: 10.1093/schbul/sbt057] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cognitive remediation improves cognition in patients with schizophrenia, but its effect on other relevant factors such as negative symptoms and functional outcome has not been extensively studied. In this hospital-based study, 84 inpatients with chronic schizophrenia were recruited from Alava Hospital (Spain). All of the subjects underwent a baseline and a 3-month assessment that examined neurocognition, clinical symptoms, insight, and functional outcome according to the Global Assessment of Functioning (GAF) scale and Disability Assessment Schedule from World Health Organization (DAS-WHO). In addition to receiving standard treatment, patients were randomly assigned either to receive neuropsychological rehabilitation (REHACOP) or to a control group. REHACOP is an integrative program that taps all basic cognitive functions. The program included experts' latest suggestions about positive feedback and activities of daily living in the patients' environment. The REHACOP group showed significantly greater improvements at 3 months in the areas of neurocognition, negative symptoms, disorganization, and emotional distress compared with the control group (Cohen's effect size for these changes ranged from d = 0.47 for emotional distress to d = 0.58 for disorganization symptoms). The REHACOP group also improved significantly in both the GAF (d = 0.61) and DAS-WHO total scores (d = 0.57). Specifically, the patients showed significant improvement in vocational outcomes (d = 0.47), family contact (d = 0.50), and social competence (d = 0.56). In conclusion, neuropsychological rehabilitation may be useful for the reduction of negative symptoms and functional disability in schizophrenia. These findings support the integration of neuropsychological rehabilitation into standard treatment programs for patients with schizophrenia.
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Affiliation(s)
- Pedro Sánchez
- *To whom correspondence should be addressed; tel: 34 944139000 (ext 2702), fax: 34 944139089, e-mail:
| | - Javier Peña
- Faculty of Psychology and Education, University of Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Eneritz Bengoetxea
- Faculty of Psychology and Education, University of Deusto, Avda. Universidades 24, 48007 Bilbao, Spain
| | - Natalia Ojeda
- Faculty of Psychology and Education, University of Deusto, Avda. Universidades 24, 48007 Bilbao, Spain;,*To whom correspondence should be addressed; tel: 34 944139000 (ext 2702), fax: 34 944139089, e-mail:
| | - Edorta Elizagárate
- Refractory Psychosis Unit, Hospital Psiquiátrico de Alava, Vitoria, Spain;,Department of Neuroscience, Psychiatry Section, School of Medicine and Odontology, University of the Basque Country, Vizcaya, Spain;,CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Jesus Ezcurra
- Refractory Psychosis Unit, Hospital Psiquiátrico de Alava, Vitoria, Spain
| | - Miguel Gutiérrez
- Department of Neuroscience, Psychiatry Section, School of Medicine and Odontology, University of the Basque Country, Vizcaya, Spain;,CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain;,Department of Psychiatry, Hospital Universitario Alava-Sede Santiago, Vitoria, Spain
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Elis O, Caponigro JM, Kring AM. Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions. Clin Psychol Rev 2013; 33:914-28. [PMID: 23988452 PMCID: PMC4092118 DOI: 10.1016/j.cpr.2013.07.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 05/31/2013] [Accepted: 07/08/2013] [Indexed: 01/31/2023]
Abstract
Schizophrenia can be a chronic and debilitating psychiatric disorder. Though advancements have been made in the psychosocial treatment of some symptoms of schizophrenia, people with schizophrenia often continue to experience some level of symptoms, particularly negative symptoms, throughout their lives. Because negative symptoms are associated with poor functioning and quality of life, the treatment of negative symptoms is a high priority for intervention development. However, current psychosocial treatments primarily focus on the reduction of positive symptoms with comparatively few studies investigating the efficacy of psychosocial treatments for negative symptoms. In this article, we review and evaluate the existing literature on three categories of psychosocial treatments--cognitive behavioral therapy (CBT), social skills training (SST), and combined treatment interventions--and their impact on the negative symptoms of schizophrenia. Of the interventions reviewed, CBT and SST appear to have the most empirical support, with some evidence suggesting that CBT is associated with maintenance of negative symptom improvement beyond six months after treatment. It remains unclear if a combined treatment approach provides improvements above and beyond those associated with each individual treatment modality. Although psychosocial treatments show promise for the treatment of negative symptoms, there are many unanswered questions about how best to intervene. We conclude with a general discussion of these unanswered questions, future directions and methodological considerations, and suggestions for the further development of negative symptom interventions.
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Affiliation(s)
| | - Janelle M. Caponigro
- Corresponding author at: Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, CA 94720, USA. Tel.: +1 510 643 4098; fax: +1 510 642 5293. (J.M. Caponigro)
| | - Ann M. Kring
- Department of Psychology, University of California, Berkeley, USA
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Tan BL, King R. The effects of cognitive remediation on functional outcomes among people with schizophrenia: a randomised controlled study. Aust N Z J Psychiatry 2013; 47:1068-80. [PMID: 23785044 DOI: 10.1177/0004867413493521] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Cognitive remediation is an intervention to overcome cognitive deficits through drills and use of strategies. Previous studies have reported positive effects for cognitive remediation on neurocognition, but researchers' allegiance effects are not always adequately controlled. Furthermore, its efficacy amongst the Asian population has not been established. Hence, this study aimed to determine if cognitive remediation would have positive effects on neurocognition and functioning within an English-speaking Asian population, when compared against the effects of a credible and balanced control provided by therapists blinded to the study hypothesis. METHOD A total of 70 participants with schizophrenia who attended vocational training or day rehabilitation programmes were randomised to receive a 60-hour programme of either cognitive remediation or physical exercise. Neurocognition and functional outcomes were measured at baseline, upon completion of treatment, 6 months after treatment and 1 year after treatment. RESULTS Participants who received cognitive remediation had significantly greater improvement in all neurocognitive domains. Furthermore, the cognitive remediation group achieved greater attainment of vocational or independent living skills and better functional outcomes at post-intervention and at the end of the 1-year follow-up. CONCLUSIONS When compared against a credible intervention such as physical exercise, cognitive remediation was able to show significant positive effects on both neurocognition and functional outcomes among the Asian population of schizophrenia patients.
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Affiliation(s)
- Bhing-Leet Tan
- 1Occupational Therapy Department, Institute of Mental Health, Singapore
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Garrido G, Barrios M, Penadés R, Enríquez M, Garolera M, Aragay N, Pajares M, Vallès V, Delgado L, Alberni J, Faixa C, Vendrell JM. Computer-assisted cognitive remediation therapy: cognition, self-esteem and quality of life in schizophrenia. Schizophr Res 2013; 150:563-9. [PMID: 24035402 DOI: 10.1016/j.schres.2013.08.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/08/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Quality of life (QoL) is an important outcome in the treatment of schizophrenia. Cognitive deficits have an impact on functional outcomes. Cognitive remediation therapy is emerging as a psychological intervention that targets cognitive impairment, but the effect of computer-assisted cognitive remediation on neuropsychology and social functioning and wellbeing remains unclear. The aim of the current study is to investigate the neurocognitive outcomes of computer-assisted cognitive remediation (CACR) therapy in a sample of schizophrenia patients, and to measure the quality of life and self-esteem as secondary outcomes. METHODS Sixty-seven people with schizophrenia were randomly assigned to computer-assisted cognitive remediation or an active control condition. The main outcomes were neuropsychological measures and secondary outcomes (self-esteem and quality of life). Measurements were recorded at baseline and post-treatment. RESULTS The CACR therapy group improved in speed of processing, working memory and reasoning and problem-solving cognitive domains. QoL and self-esteem measures also showed significant improvements over time in this group. CONCLUSIONS Computer-assisted cognitive remediation therapy for people with schizophrenia achieved improvements in neuropsychological performance and in QoL and self-esteem measurements.
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Affiliation(s)
- Gemma Garrido
- Department of Mental Health, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain.
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Dark F, Cairns A, Harris A. Cognitive remediation: the foundation of psychosocial treatment of schizophrenia. Aust N Z J Psychiatry 2013; 47:505-7. [PMID: 23567636 DOI: 10.1177/0004867413484524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Frances Dark
- Metro South Health District, MacGregor, Australia.
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Lee RSC, Redoblado-Hodge MA, Naismith SL, Hermens DF, Porter MA, Hickie IB. Cognitive remediation improves memory and psychosocial functioning in first-episode psychiatric out-patients. Psychol Med 2013; 43:1161-1173. [PMID: 23237010 PMCID: PMC3642720 DOI: 10.1017/s0033291712002127] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/27/2012] [Accepted: 08/13/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cognitive remediation (CR) is an effective treatment for several psychiatric disorders. To date, there have been no published studies examining solely first-episode psychiatric cohorts, despite the merits demonstrated by early intervention CR studies. The current study aimed to assess the effectiveness of CR in patients with a first-episode of either major depression or psychosis. Method Fifty-five patients (mean age = 22.8 years, s.d. = 4.3) were randomly assigned to either CR (n = 28) or treatment as usual (TAU; n = 27). CR involved once-weekly 2-h sessions for a total of 10 weeks. Patients were comprehensively assessed before and after treatment. Thirty-six patients completed the study, and analyses were conducted using an intent-to-treat (ITT) approach with all available data. RESULTS In comparison to TAU, CR was associated with improved immediate learning and memory controlling for diagnosis and baseline differences. Similarly, CR patients demonstrated greater improvements than TAU patients in psychosocial functioning irrespective of diagnosis. Delayed learning and memory improvements mediated the effect of treatment on psychosocial functioning at a marginal level. CONCLUSIONS CR improves memory and psychosocial outcome in first-episode psychiatric out-patients for both depression and psychosis. Memory potentially mediated the functional gains observed. Future studies need to build on the current findings in larger samples using blinded allocation and should incorporate longitudinal follow-up and assessment of potential moderators (e.g. social cognition, self-efficacy) to examine sustainability and the precise mechanisms of CR effects respectively.
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Affiliation(s)
- R S C Lee
- Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
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Feasibility, safety, and efficacy of the combination of D-serine and computerized cognitive retraining in schizophrenia: an international collaborative pilot study. Neuropsychopharmacology 2013; 38:492-503. [PMID: 23093223 PMCID: PMC3547200 DOI: 10.1038/npp.2012.208] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The combination of pharmacotherapy and cognitive retraining (CRT) for the cognitive deficits of schizophrenia may be more efficacious than either approach alone, but this has not yet been tested. This study evaluated the feasibility, safety, tolerability, and efficacy of 12 weeks of D-serine, combined with CRT in the treatment of cognitive deficits in schizophrenia at two academic sites in parallel, in India and the United States. In a randomized, partial double-blind, placebo-controlled, parallel-group design, 104 schizophrenia subjects (US site=22, Indian site=82) were randomized to: (1) D-serine (30 mg/kg)+CRT (5 h/week), (2) D-serine+control CRT, (3) CRT+placebo D-serine, and (4) placebo+control CRT. Completion rates were 84 and 100% in the Indian and US samples, respectively. On various outcome measures of safety and tolerability, the interventions were well tolerated. D-Serine and CRT did not show any significant effect on the Global Cognitive Index, although both interventions showed differential site effects on individual test performance. CRT resulted in a significant improvement in Verbal Working Memory, and a trend toward improvement in Attention/Vigilance. This is the first study to demonstrating the feasibility, safety, and tolerability of combination pharmacotherapy and CRT in a multicenter international clinical trial. These preliminary findings provide support for future studies using higher doses of D-serine that have been shown to be efficacious or other pharmacotherapies, along with the newer cognitive remediation strategies that are individualized and that target basic information processing.
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Kluwe-Schiavon B, Sanvicente-Vieira B, Kristensen CH, Grassi-Oliveira R. Executive functions rehabilitation for schizophrenia: a critical systematic review. J Psychiatr Res 2013; 47:91-104. [PMID: 23122645 DOI: 10.1016/j.jpsychires.2012.10.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 09/30/2012] [Accepted: 10/02/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Consistent evidences suggest that poor functional outcomes in schizophrenia are associated with deficits in executive functions (EF). As result cognitive training, remediation and/or rehabilitation (CR) programs have been developed and many theories, methods and approaches have emerged in support of them. This article presents a systematic review of randomized controlled trials (RCT), including EF rehabilitation interventions, with a focus on methodological issues and evidences of EF improvements. METHOD Electronic databases (Medline, Web of Science, PsycINFO and Embase) were searched for articles on schizophrenia, EF and cognitive rehabilitation terms. The methodological quality of each article was measured by 5-point JADAD scale. RESULTS A total of 184 articles were initially identified, but after exclusion criteria, 30 RCT remained in this review. A proportion of 23% of studies scored higher than 4 points in JADAD scale, 40% scored 3 points, 33% scored 2 points and one study scored only 1 point. The average length of interventions was approximately 80 h distributed around 3.42 h/week. CONCLUSION The reviewed articles corroborate the literature pointing that CR could be a promising therapeutic option for cognitive deficits in schizophrenia. In general, CR could improve cognitive domains and social adjustment either using computerized or paper-and-pencil programs. Additionally, CR combined with cognitive behavioral therapy and/or group sessions is particularly effective. In this paper, we also speculated and discussed optimal doses of treatment and the differences regarding modalities and approaches.
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Affiliation(s)
- B Kluwe-Schiavon
- Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul, Brazil.
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Anaya C, Martinez Aran A, Ayuso-Mateos JL, Wykes T, Vieta E, Scott J. A systematic review of cognitive remediation for schizo-affective and affective disorders. J Affect Disord 2012; 142:13-21. [PMID: 22840620 DOI: 10.1016/j.jad.2012.04.020] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 04/02/2012] [Accepted: 04/29/2012] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cognitive remediation is accepted as an important therapeutic intervention in schizophrenia, but few studies provide data on whether the benefits extend to affective disorders. OBJECTIVES To review quantitatively studies of cognitive remediation with samples that included cases of schizoaffective disorder, affective psychosis, unipolar and/or bipolar disorders. METHODS Twenty one studies met preliminary inclusion criteria, comprising a total of 940 participants of which 35% had an affective or schizoaffective disorder. Effect sizes (ES) for pre- to post-intervention change in cognitive performance were estimated. RESULTS A meta-analysis of 16 studies gave a pooled ES for change in cognitive function of 0.32 (95% Confidence Intervals 0.20 to 0.43) and produced statistical homogeneity. Overall, ES were significantly positively correlated with higher proportion of schizo-affective and affective cases (r=0.61; p=0.007), even when age, gender and duration of therapy were included as covariates in the analysis (r=.59, p=0.017). LIMITATIONS The quality of and small number of affective disorder only studies mean the findings must be treated with caution. CONCLUSIONS The estimated ES reflect those reported in the literature on cognitive remediation for schizophrenia. As such a conservative interpretation is that cognitive remediation has at least equivalent benefits in affective and schizo-affective disorder as demonstrated in schizophrenia. Further studies are urgently required to examine the durability of any gains with cognitive remediation in affective populations and to determine if any changes in cognitive deficits lead to improvements in symptoms or functioning and/or whether post-intervention cognitive changes differ in character or magnitude from those reported in schizophrenia.
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Affiliation(s)
- Celia Anaya
- Department of Psychiatry, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria Hospital de la Princesa, Madrid, Spain
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Cognitive remediation for individuals with psychosis in a supported education setting: a pilot study. Rehabil Res Pract 2012; 2012:715176. [PMID: 22666598 PMCID: PMC3362214 DOI: 10.1155/2012/715176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 03/07/2012] [Accepted: 03/11/2012] [Indexed: 11/18/2022] Open
Abstract
Cognitive remediation (CR) is a treatment approach that is being increasingly examined as a means through which the cognitive impacts of schizophrenia might be ameliorated. While CR has demonstrated good outcomes when paired with supported employment, little is known regarding how it might be integrated within supported education contexts. In this study CR was examined in a supported education context with 16 individuals with psychosis. The findings indicated that CR aligned well with the academic curriculum with very low attrition, was found useful by students, and showed similar pre-post differences on cognitive measures as those found in previous work.
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Bhatia T, Agarwal A, Shah G, Wood J, Richard J, Gur RE, Gur RC, Nimgaonkar VL, Mazumdar S, Deshpande SN. Adjunctive cognitive remediation for schizophrenia using yoga: an open, non-randomized trial. Acta Neuropsychiatr 2012; 24:91-100. [PMID: 22661830 PMCID: PMC3361970 DOI: 10.1111/j.1601-5215.2011.00587.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND: Yoga therapy (YT) improves cognitive function in healthy individuals, but its impact on cognitive function among persons with schizophrenia (SZ) has not been investigated. AIMS: Evaluate adjunctive YT for cognitive domains impaired in SZ. METHODS: Patients with SZ received YT or treatment as usual (TAU; n = 65, n = 23, respectively). Accuracy and speed for seven cognitive domains were assessed using a computerized neurocognitive battery (CNB), thus minimizing observer bias. Separately, YT was evaluated among patients with Bipolar I disorder (n = 40), Major Depressive Disorder (n = 37), and cardiology outpatients (n = 68). All patients also received routine pharmacotherapy. Patients were not randomized to YT or TAU. RESULTS: Compared with the SZ/TAU group, the SZ/YT group showed significantly greater improvement with regard to measures of attention following corrections for multiple comparisons; the changes were more prominent among the men. In the other diagnostic groups, differing patterns of improvements were noted with small to medium effect sizes. CONCLUSIONS: Our initial analyses suggest nominally significant improvement in cognitive function in schizophrenia with adjunctive therapies such as YT. The magnitude of the change varies by cognitive domain and may also vary by diagnostic group.
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Affiliation(s)
- Triptish Bhatia
- Training Program for Psychiatric Genetics in India, Post-graduate Institute for Medical Education and Research, Dr Ram Manohar Lohia Hospital, Delhi, India
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Keefe RSE, Vinogradov S, Medalia A, Silverstein SM, Bell MD, Dickinson D, Ventura J, Marder SR, Stroup TS. Report from the working group conference on multisite trial design for cognitive remediation in schizophrenia. Schizophr Bull 2011; 37:1057-65. [PMID: 20194249 PMCID: PMC3160227 DOI: 10.1093/schbul/sbq010] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The National Institute of Mental Health (NIMH)-Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Project and related efforts have stimulated the initiation of several studies of pharmacologic treatments for cognitive impairment in schizophrenia. Cognitive remediation may provide an excellent platform for the provision of new learning opportunities and the acquisition of new skills for patients who are engaged in pharmacologic trials to improve cognition. However, it is not clear how a cognitive remediation intervention would be employed in multisite clinical trials. A meeting of experts on cognitive remediation and related methodological topics was convened to address the feasibility and study design issues for the development of a multisite trial of cognitive remediation in schizophrenia called the Cognitive Remediation in the Schizophrenia Trials Network study. This report details the findings from this meeting, which included the following 4 conclusions. (1) A multisite trial of a cognitive remediation intervention using a network of diverse research sites would be of great scientific value. (2) Various interventions could be employed for this multisite trial. (3) Programs that do not address key motivational and interpersonal aspects of cognitive remediation may benefit from supplementation with "bridging groups" that allows patients to meet with others and to apply their newly acquired cognitive skills to everyday life. (4) Before a multisite efficacy trial is initiated, a pilot study could demonstrate the feasibility of conducting a trial using a cognitive remediation intervention.
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Affiliation(s)
- Richard S. E. Keefe
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC,To whom correspondence should be addressed; Box 3270, Duke University Medical Center, Durham, NC 27710; tel: 919-684-4306, fax: 919-684-2632, e-mail:
| | - Sophia Vinogradov
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | - Alice Medalia
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
| | - Steven M. Silverstein
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Piscataway, NJ
| | - Morris D. Bell
- Department of Psychiatry, Veterans Affairs Rehabilitation Research and Development Service, West Haven, CT,Department of Psychiatry, Yale University School of Medicine, West Haven, CT
| | - Dwight Dickinson
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Joseph Ventura
- Department of Psychiatry & Behavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at University of California, Los Angeles, CA
| | - Stephen R. Marder
- Department of Psychiatry, Semel Institute at University of California, Los Angeles, CA,Department of Psychiatry, Veterans Affairs Desert Pacific Mental Illness Research, Educational, and Clinical Center, Los Angeles, CA
| | - T. Scott Stroup
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
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Neuropsychological clustering highlights cognitive differences in young people presenting with depressive symptoms. J Int Neuropsychol Soc 2011; 17:267-76. [PMID: 21208478 DOI: 10.1017/s1355617710001566] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Early stages of affective or psychotic disorders may be accompanied by neuropsychological changes that help to predict risk of developing more severe disorders. A comprehensive set of neuropsychological measures was collected in 109 help-seeking young people (16 to 30 years; 54 females), recently diagnosed with an affective or psychotic disorder and presenting with current depression. Hierarchical cluster analysis determined three clusters: one deemed to have a "poor memory" profile (n = 40); another with a "poor mental flexibility" profile (n = 38) and a third with widespread difficulties plus "impaired attention and memory" (n = 31). In general, the three clusters were comparable in demographic, functional and clinical factors suggesting some unique role for neurocognitive impairments. A discriminant function analysis confirmed that the clusters were best characterized by performance in "attentional" versus "learning/memory" measures. Furthermore, profiles of independent neuropsychological variables validated the original solution for two of the clusters, distinguishing all cluster-groups on an attentional measure. The findings of this study suggest that despite presenting with very similar levels of current depressive symptomatology, young help-seeking individuals in the early stages of illness have underlying neuropsychological heterogeneity. Distinct neuropsychological profiling may help to predict later psychiatric outcomes and enhance individually-tailored early intervention strategies.
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Bartholomeusz CF, Proffitt TM, Savage G, Simpson L, Markulev C, Kerr M, McConchie M, McGorry PD, Pantelis C, Berger GE, Wood SJ. Relational memory in first episode psychosis: implications for progressive hippocampal dysfunction after illness onset. Aust N Z J Psychiatry 2011; 45:206-13. [PMID: 21438746 DOI: 10.3109/00048674.2010.547456] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Verbal episodic memory deficits are prominent in schizophrenia and have also been found in first episode psychosis (FEP) and individuals at clinical risk of the disorder. The central role of the hippocampus in verbal memory processing and the consistent findings of hippocampal volume reductions in chronic patients have prompted the suggestion that impaired verbal memory performance may be a biomarker of schizophrenia. However, it is currently unclear as to when, during the early phase of psychosis, verbal memory performance becomes significantly impaired. The current study investigated verbal relational memory in FEP using a novel verbal paired associate task, and tested whether performance was dependent on phase of illness within FEP, where patients with a diagnosis of schizophrenia were considered to be in a more advanced stage than those with schizophreniform disorder. METHOD Forty-seven currently psychotic FEP patients and 36 healthy non-psychiatric controls, aged 15-25 years old, completed a test comprising four trials of learning and cued recall of word pairs (denoted AB pairs), an interference phase comprising two trials with new second words (AC pairs), and finally cued recall for the original AB pairings. RESULTS FEP patients performed similarly to controls on the relational memory task. There was no difference in performance between FEP patients who had a diagnosis of schizophrenia and those with a diagnosis of schizophreniform disorder. CONCLUSIONS Verbal relational memory appears to be intact in FEP. This finding, along with chronic patient literature, suggests that decline in hippocampal and medial temporal lobe functioning occurs during later illness stages. Further research is needed to aid in the development of intervention strategies that may prevent decline in such cognitive domains at this crucial early stage of the illness.
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Affiliation(s)
- Cali F Bartholomeusz
- National Neuroscience Facility, Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Carlton South, Victoria, Australia.
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Enhancing memory in late-life depression: the effects of a combined psychoeducation and cognitive training program. Am J Geriatr Psychiatry 2011; 19:240-8. [PMID: 20808114 DOI: 10.1097/jgp.0b013e3181dba587] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a multifactorial cognitive training (CT) program for older people with a lifetime history of depressive disorder. METHODS This was a single-blinded waitlist control design. The study was conducted in the Healthy Brain Ageing Clinic, a specialist outpatient clinic at the Brain & Mind Research Institute, Sydney, Australia. Forty-one participants (mean age = 64.8 years, sd = 8.5) with a lifetime history of major depression were included. They were stabilized on medication and had depressive symptoms in the normal to mild range. The intervention encompassed both psychoeducation and CT. Each component was 1-hour in duration and was delivered in a group format over a 10-week period. Psychoeducation was multifactorial, was delivered by health professionals and targeted cognitive strategies, as well depression, anxiety, sleep, vascular risk factors, diet and exercise. CT was computer-based and was conducted by Clinical Neuropsychologists. Baseline and follow-up neuropsychological assessments were conducted by Psychologists who were blinded to group allocation. The primary outcome was memory whilst secondary outcomes included other aspects of cognition and disability. RESULTS CT was associated with significant improvements in visual and verbal memory corresponding to medium to large effect sizes. CONCLUSION CT may be a viable secondary prevention technique for late-life depression, a group who are at risk of further cognitive decline and progression to dementia.
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