The importance of cognitive processes for the integrative treatment of persons with schizophrenia

Psychosocial Services for Individuals With Serious Mental Illness/Severe Emotional Disturbance: Clinical Practice Guideline Toolkit

This article presents a short, easy-to-use guideline for clinicians working with people with serious mental illness, particularly those with schizophrenia, schizoaffective disorder, delusional disorders, other psychotic disorders, or depression with significant impact on functioning, and may be of use for those working with individuals with bipolar disorder. This guideline is not meant to supplant the more detailed, excellent clinical practice guidelines that have been developed and published. Rather, the charts and explanation presented here are designed as a step-by-step tool that clinicians can use to ensure they are following the most appropriate course of action and providing the best psychosocial rehabilitation services possible for persons with these disorders. Program managers can use this tool to evaluate the processes used in their system to ensure that appropriate services are offered for the individuals in their care. This guideline is also not meant as a substitute for comprehensive training in the practice of assessment and treatment for individuals with serious mental illness. Very little detail is provided about the disorders, appropriate assessments, and interventions because clinicians providing services to people with these disorders should have received the specialized training necessary to appropriately deliver the services needed by these individuals.

Schizotypal Traits are Associated with Poorer Executive Functioning in Healthy Adults

Previous research has shown mild forms of the neurocognitive impairments seen in schizophrenia among healthy individuals exhibiting high schizotypal traits. This study aimed to explore associations between schizotypy and cognitive performance in an adult community sample. Ninety-five females and 79 males completed the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), which measures four separable aspects of schizotypy: cognitive disorganization, unusual experiences, introvertive anhedonia, and impulsive non-conformity. Subsequently, participants were administered a neurocognitive battery incorporating measures of executive skills including inhibition, cognitive flexibility, reasoning, and problem solving along with measures of attention and processing speed and both verbal and spatial working memory. In line with predictions, the current study found that higher scores on the subscales of unusual experiences, cognitive disorganization, and impulsive non-conformity related to worse performance on a measure of inhibition. Additionally, as introvertive anhedonia increased, both attention and processing speed and reasoning and problem-solving performance became more impaired. In conclusion, this study extends schizotypy literature by examining the subscales of the O-LIFE, and enables inferences to be drawn in relation to cognitive impairment in schizophrenia.

Changes in aspects of cognitive functioning in young patients with schizophrenia during group psychodynamic psychotherapy: a preliminary study

BACKGROUND

The "Sveti Ivan" psychiatric hospital in Zagreb, Croatia, offers an outpatient Early Intervention Program for psychotic patients. This program consists of psycho-educational workshops and group psychodynamic psychotherapy. Two important objectives of the program are improving and maintaining adequate cognitive functioning.

AIMS

The current study examined changes in aspects of cognitive functioning in young patients with schizophrenia after 18 months and after 3 years of psychodynamic group psychotherapy.

METHODS

The study included 28 patients who attended the Early Intervention Program for young patients with psychotic disorders; 10 patients had completed only the psycho-educational part of the program (comparative group), and 18 patients continued with group psychodynamic psychotherapy (experimental group). All patients completed the Revised Beta Examination.

RESULTS

We observed a trend in the experimental group to achieve higher scores than the comparative group. The results for both groups tended to increase with time, and this increase was greater in the experimental group.

CONCLUSIONS

While acknowledging the limitations of this preliminary study, we conclude that participating in psychodynamic group psychotherapy is related to increases in the cognitive functioning of patients with schizophrenia, and our results provide a sound basis for future research.

Implementing cognitive remediation therapy: lessons from two public mental health services

OBJECTIVE

Neurocognitive deficits are a core symptom domain of schizophrenia, occurring in 75-90% of people with this diagnosis and influencing long term functional outcomes. This article aims to describe the pilot implementation of cognitive remediation therapy in two large public mental health services and detail changes made to the delivery of this therapy after this trial.

CONCLUSIONS

Cognitive remediation therapy provides an evidence-based approach to targeting cognitive deficits but the translation of this therapy from a research setting to clinical practice has not been well evaluated.