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Sampedro A, Peña J, Sánchez P, Ibarretxe-Bilbao N, Iriarte-Yoller N, Pavón C, Ojeda N. Moderators of functional improvement after integrative cognitive remediation in schizophrenia: Toward a personalized treatment approach. Psychiatry Res 2023; 329:115495. [PMID: 37802012 DOI: 10.1016/j.psychres.2023.115495] [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] [Received: 06/05/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023]
Abstract
Cognitive remediation is an effective intervention for improving functional outcome in schizophrenia. However, the factors that moderate this improvement are still poorly understood. The study aimed to identify moderators of functional outcome improvement after integrative cognitive remediation (REHACOP) in schizophrenia. This was a secondary analysis of data from two randomized controlled trials, which included 182 patients (REHACOP group=94; active control group=88). Hierarchical regression analyses were conducted to identify moderators of functional outcome improvement. Two baseline level groups (low-level and high-level) were created to analyze the moderating role of this baseline level cluster using repeated measures ANCOVA. The REHACOP was effective regardless of participants' baseline level, but regression analyses indicated that the effectiveness on functional outcome was higher among those who were older, had fewer years in education, lower scores in baseline cognition and functional outcome, and more negative symptoms. Repeated measures ANOVA showed that the baseline level cluster influenced the improvement in functional outcome, with the low-level group showing greater improvements. The results reinforced the need to implement cognitive remediation programs more broadly as a treatment for schizophrenia in healthcare services. Furthermore, they provided evidence for the development of personalized cognitive remediation plans to improve benefits in different schizophrenia profiles.
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Affiliation(s)
- Agurne Sampedro
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda. Universidades 24, Bilbao 48007, Spain
| | - Javier Peña
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda. Universidades 24, Bilbao 48007, Spain.
| | - Pedro Sánchez
- Osakidetza Basque Health Service, Hospital of Zamudio. Bizkaia Mental Health Network, Bilbao, Spain; Department of Medicine, University of Deusto. Faculty of Health Sciences, Bilbao, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda. Universidades 24, Bilbao 48007, Spain
| | - Nagore Iriarte-Yoller
- Araba Mental Health Service, Alava Psychiatric Hospital, Bioaraba, New Therapies in Mental Health, Vitoria-Gasteiz, Spain, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain
| | - Cristóbal Pavón
- Araba Mental Health Service, Alava Psychiatric Hospital, Bioaraba, New Therapies in Mental Health, Vitoria-Gasteiz, Spain, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain
| | - Natalia Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda. Universidades 24, Bilbao 48007, Spain
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Orloff NC, McGinley K, Lenz K, Mack AS, Timko CA. Adaptations of cognitive remediation therapy for adolescents with anorexia nervosa for delivery via telehealth. Int J Eat Disord 2023; 56:72-79. [PMID: 36401578 PMCID: PMC10207383 DOI: 10.1002/eat.23850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The COVID-19 pandemic hastened a transition to treatment delivery via telehealth. While barriers still exist, the increased uptake of telehealth has the potential to increase access to mental health treatment for all diagnoses, including eating disorders. Delivery of evidence-based treatment as well as adjunctive treatments, including those that are hard to find in-person, have been modified to virtual format to increase accessibility and allow for continuity of care for adolescents with anorexia nervosa. METHOD We describe how to modify and deliver Cognitive Remediation Therapy for youth with anorexia nervosa (CRT-AN) via a telehealth platform. Preliminary and practical guidance for best practice for both group and individual delivery is established. RESULTS With minimal modifications, CRT-AN can be delivered via telehealth for both individual and group delivery. More disengagement in group delivery was noted; however, overall application of the treatment via a remote platform was observed. DISCUSSION As more treatment moves to a telehealth format, highlighting how an adjunctive treatment like CRT-AN can combined with other treatments in a telehealth format has the potential to increase research in its implementation and furthermore increase its dissemination. PUBLIC SIGNIFICANCE Cognitive Remediation Therapy for Anorexia Nervosa (CRT-AN) requires significant manipulation of materials and supplementary human guidance. Suggestions for how to modify CRT-AN for remote delivery via telehealth are provided. Modifications grew out of immediate changes made during the beginning of the COVID-19 pandemic and can be used to inform changes therapists and programs can make to continue to or begin to use CRT-AN in a remote fashion.
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Affiliation(s)
- Natalia C Orloff
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kate McGinley
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Private Practice, Cape May Court House, Cape May County, New Jersey, USA
| | - Katrina Lenz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amy S Mack
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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3
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Sabe M, Chen C, Perez N, Solmi M, Mucci A, Galderisi S, Strauss GP, Kaiser S. Thirty years of research on negative symptoms of schizophrenia: A scientometric analysis of hotspots, bursts, and research trends. Neurosci Biobehav Rev 2023; 144:104979. [PMID: 36463972 DOI: 10.1016/j.neubiorev.2022.104979] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/19/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
Research on negative symptoms of schizophrenia has received renewed interest since the 1980s. A scientometric analysis that objectively maps scientific knowledge, with changes in recent trends, is currently lacking. We searched the Web of Science Core Collection (WOSCC) on December 17, 2021 using relevant keywords. R-bibliometrix and CiteSpace were used to perform the analysis. We retrieved 27,568 references published between 1966 and 2022. An exponential rise in scientific interest was observed, with an average annual growth rate in publications of 16.56% from 1990 to 2010. The co-cited reference network that was retrieved presented 24 different clusters with a well-structured network (Q=0.7921; S=0.9016). Two distinct major research trends were identified: research on the conceptualization and treatment of negative symptoms. The latest trends in research on negative symptoms include evidence synthesis, nonpharmacological treatments, and computational psychiatry. Scientometric analyses provide a useful summary of changes in negative symptom research across time by identifying intellectual turning point papers and emerging trends. These results will be informative for systematic reviews, meta-analyses, and generating novel hypotheses.
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Affiliation(s)
- Michel Sabe
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland.
| | - Chaomei Chen
- College of Computing & Informatics, Drexel University, Philadelphia, PA, USA
| | - Natacha Perez
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ontario, Ottawa; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
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4
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Advances in Cognitive Remediation Training in Schizophrenia: A Review. Brain Sci 2022; 12:brainsci12020129. [PMID: 35203893 PMCID: PMC8870375 DOI: 10.3390/brainsci12020129] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/07/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Cognitive Remediation Training (CRT) in schizophrenia has made great strides since its introduction in the 1990s. CRT was developed with the aim of improving the everyday functioning of individuals living with cognitive impairment. MEDLINE, PsychINFO, and Google Scholar were searched to extract peer-reviewed randomized controlled trials to produce the current review article. The aim of the present review is to summarize CRT effects on addressing cognitive changes in patients undergoing CRT as defined by the Cognitive Remediation Experts Workshop and to describe the areas of greatest impact in specific cognitive domains. Another area of this review aims to summarize the modalities of intervention (paper and pencil; computerized; home bound), the persistence of improvements, and their generalization to other domains of functioning. Finally, this review delineates barriers for wider dissemination of CRT, such as the transfer of research findings into clinical everyday practice and future developments of CRT.
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Guglietti B, Hobbs D, Collins-Praino LE. Optimizing Cognitive Training for the Treatment of Cognitive Dysfunction in Parkinson's Disease: Current Limitations and Future Directions. Front Aging Neurosci 2021; 13:709484. [PMID: 34720988 PMCID: PMC8549481 DOI: 10.3389/fnagi.2021.709484] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/17/2021] [Indexed: 01/09/2023] Open
Abstract
Cognitive dysfunction, primarily involving impairments in executive function, visuospatial function and memory, is one of the most common non-motor symptoms of Parkinson’s disease (PD). Currently, the only pharmacological treatments available for the treatment of cognitive dysfunction in PD provide variable benefit, making the search for potential non-pharmacological therapies to improve cognitive function of significant interest. One such therapeutic strategy may be cognitive training (CT), which involves the repetition of standardized tasks with the aim of improving specific aspects of cognition. Several studies have examined the effects of CT in individuals with PD and have shown benefits in a variety of cognitive domains, but the widespread use of CT in these individuals may be limited by motor impairments and other concerns in study design. Here, we discuss the current state of the literature on the use of CT for PD and propose recommendations for future implementation. We also explore the potential use of more recent integrative, adaptive and assistive technologies, such as virtual reality, which may optimize the delivery of CT in PD.
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Affiliation(s)
- Bianca Guglietti
- Cognition, Ageing and Neurodegenerative Disease Laboratory, Department of Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - David Hobbs
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia.,Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Lyndsey E Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Laboratory, Department of Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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6
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Cognitive, creative, functional, and clinical symptom improvements in schizophrenia after an integrative cognitive remediation program: a randomized controlled trial. NPJ SCHIZOPHRENIA 2021; 7:52. [PMID: 34711835 PMCID: PMC8553761 DOI: 10.1038/s41537-021-00181-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/01/2021] [Indexed: 01/24/2023]
Abstract
This study analyzed the effectiveness of an integrative cognitive remediation program (REHACOP) in improving neurocognition, social cognition, creativity, functional outcome, and clinical symptoms in patients with schizophrenia. In addition, possible mediators predicting improvement in functional outcomes were explored. The program combined cognitive remediation with social cognitive training and social and functional skill training over 20 weeks. The sample included 94 patients, 47 in the REHACOP group and 47 in the active control group (occupational activities). Significant differences were found between the two groups in change scores of processing speed, working memory, verbal memory (VM), inhibition, theory of mind, emotion processing (EP), figural creative strengths, functional competence, disorganization, excitement, and primary negative symptoms. A mediational analysis revealed that changes in VM, inhibition, and EP partially explained the effect of cognitive remediation on functional competence improvement. This study provides initial evidence of the effect of integrative cognitive remediation on primary negative symptoms and creativity.
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7
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Maes M, Kanchanatawan B. In (deficit) schizophrenia, a general cognitive decline partly mediates the effects of neuro-immune and neuro-oxidative toxicity on the symptomatome and quality of life. CNS Spectr 2021:1-10. [PMID: 33843548 DOI: 10.1017/s1092852921000419] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Schizophrenia and deficit schizophrenia are accompanied by neurocognitive impairments. The aim of this study was to examine whether a general factor underpins impairments in key Cambridge Neuropsychological Test Automated Battery (CANTAB) probes, verbal fluency test (VFT), world list memory (WLM), True Recall, and mini mental state examination (MMSE). METHODS We recruited 80 patients with schizophrenia and 40 healthy controls. All patients were assessed using CANTAB tests, namely paired-association learning, rapid visual information processing, spatial working memory, one touch stockings of Cambridge, intra/extradimensional set-shifting (IED), and emotional recognition test. RESULTS We found that a general factor, which is essentially unidimensional, underlies those CANTAB, VFT, WLM, True Recall, and MMSE scores. This common factor shows excellent psychometric properties and fits a reflective model and, therefore, reflects a general cognitive decline (G-CoDe) comprising deficits in semantic and episodic memory, recall, executive functions, strategy use, rule acquisition, visual sustained attention, attentional set-shifting, and emotional recognition. Partial least squares analysis showed that 40.5% of the variance in G-CoDe is explained by C-C motif ligand 11, IgA to tryptophan catabolites, and increased oxidative toxicity, and that G-CoDe explains 44.8% of the variance in a general factor extracted from psychosis, hostility, excitation, mannerism, negative symptoms, formal thought disorders, and psychomotor retardation, and 40.9% in quality-of-life scores. The G-CoDe is significantly greater in deficit than in nondeficit schizophrenia. CONCLUSIONS A common core shared by a multitude of neurocognitive impairments (G-CoDe) mediates the effects of neurotoxic pathways on the phenome of (deficit) schizophrenia.
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Affiliation(s)
- Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
- IMPACT Strategic Research Center, Deakin University, Geelong, Victoria, Australia
| | - Buranee Kanchanatawan
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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8
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Rakitzi S, Georgila P, Becker-Woitag AP. The Recovery Process for Individuals With Schizophrenia in the Context of Evidence-Based Psychotherapy and Rehabilitation. EUROPEAN PSYCHOLOGIST 2021. [DOI: 10.1027/1016-9040/a000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. This systematic review aimed to evaluate the efficacy of Cognitive Behavioral Therapy (CBT), META Cognitive Therapy (MCT), Metacognitive Training (MCTR), Metacognitive Reflection and Insight Therapy (MERIT), of various rehabilitation programs and of recovery programs in schizophrenia. Medline/Pubmed was searched for studies published in English from January 2010 to August 2018, which were screened against inclusion criteria by two reviewers. The methodological quality of the included studies was evaluated by two independent raters, which are the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies and the fidelity criteria. The study included 41 RCTs and 12 case studies with n = 3,059 persons with schizophrenia. Cognitive Behavioral Therapy (CBT) proved to be superior in terms of the improvement of primary and secondary outcomes. MCT decreased positive symptoms and improved metacognitive capacity and insight. MCTR reduced positive symptoms and socially disruptive behavior. MERIT improved metacognitive capacity and insight. Rehabilitation programs were efficacious in the improvement of cognition, symptoms, and functional outcome. The recovery programs enhanced illness-management knowledge, attitudes toward medication and insights related to negative symptoms. It is recommended to combine the above evidence based psychotherapeutic interventions. Limitations of this systematic review are discussed toward the end of the essay. Some important factors have to be considered in the future have been mentioned.
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Affiliation(s)
| | - Polyxeni Georgila
- Psychiatric Department for Adults, General Hospital G. Gennimatas, Athens, Greece
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9
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Birken M, Wong HT, McPherson P, Killaspy H. A systematic review of the published literature on interventions to improve personal self-care for people with severe mental health problems. Br J Occup Ther 2020. [DOI: 10.1177/0308022620979467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction People with severe mental health problems often struggle to manage everyday tasks such as personal hygiene, housework, shopping, cooking and budgeting. These functional problems result in self-neglect and are associated with specific cognitive impairments and poor outcomes. Despite their importance, little guidance is available for practitioners in how to address these problems. Method We conducted a systematic review of the research literature published since 1990 on the effectiveness of interventions that aim to assist people with severe mental health problems to manage their personal self-care. We searched six major electronic databases and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance in the conduct of the review and reporting of results. Results Our search identified 2808 papers of which only eight met our inclusion criteria. The included papers comprised six randomised controlled trials and two ‘pre-post’ studies reporting on evaluations of five different interventions. We used narrative synthesis to summarise our findings. The strongest evidence was for cognitive adaptation training, comprising environmental supports provided in the home that address the functional problems arising from specific cognitive impairments. Conclusion The paucity of research into interventions to assist personal self-care for people with severe mental health problems is surprising. More research in this area is urgently needed.
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Affiliation(s)
- Mary Birken
- Division of Psychiatry, University College London, London, UK
| | - Hei Ting Wong
- Division of Psychiatry, University College London, London, UK
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong
| | - Peter McPherson
- Division of Psychiatry, University College London, London, UK
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, UK
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10
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Barnicot K, Michael C, Trione E, Lang S, Saunders T, Sharp M, Crawford MJ. Psychological interventions for acute psychiatric inpatients with schizophrenia-spectrum disorders: A systematic review and meta-analysis. Clin Psychol Rev 2020; 82:101929. [PMID: 33126038 DOI: 10.1016/j.cpr.2020.101929] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/18/2020] [Accepted: 10/13/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute inpatient psychiatric wards are important yet challenging environments in which to implement psychological interventions for people with schizophrenia-spectrum disorders. No meta-analysis to date has evaluated whether psychological interventions are effective in this context. METHODS We systematically searched Embase, Medline and PsycInfo databases for randomised controlled trials (RCTs) of psychological interventions implemented in acute inpatient psychiatric settings with individuals with schizophrenia-spectrum disorders. We conducted random effects meta-analyses of between-groups outcomes at post-intervention and relapse/re-hospitalisation rates by follow-up. RESULTS Twenty-nine trials were suitable for meta-analysis. Psychological interventions improved post-intervention positive symptoms, social functioning and treatment compliance and reduced the risk of relapse/ re-hospitalisation, relative to control conditions. Analyses of specific intervention effects found positive effects of psychoeducation on several key outcomes (power > 80%) and preliminary evidence for positive effects of acceptance and commitment therapy (ACT), cognitive behaviour therapy (CBT) and metacognitive training (MCT) on some outcomes (power < 80%). CONCLUSION Psychological interventions can be helpful for acute inpatients with schizophrenia-spectrum disorders. However, risk of bias was often high or unclear, and some analyses were underpowered. Further research should use more rigorous RCT designs and publish meta-analysable data on positive symptoms, general psychopathology, relapse/ re-hospitalisation, social functioning and treatment compliance.
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Affiliation(s)
- K Barnicot
- Division of Psychiatry, Imperial College London, Commonwealth Building, Du Cane Road, London W12 0NN, United Kingdom; School of Health Sciences, City University of London, Myddleton Street Building, 1Myddleton Street, London EC1R 1UW, United Kingdom.
| | - C Michael
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - E Trione
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - S Lang
- St. George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, United Kingdom
| | - T Saunders
- St. George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, United Kingdom
| | - M Sharp
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - M J Crawford
- Division of Psychiatry, Imperial College London, Commonwealth Building, Du Cane Road, London W12 0NN, United Kingdom
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11
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Bitter N, Roeg D, van Nieuwenhuizen C, van Weeghel J. Recovery in Supported Accommodations: A Scoping Review and Synthesis of Interventions for People with Severe Mental Illness. Community Ment Health J 2020; 56:1053-1076. [PMID: 32016620 PMCID: PMC7289772 DOI: 10.1007/s10597-020-00561-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Abstract
Research on the recovery domains beside clinical recovery of people with severe mental illness in need of supported accommodations is limited. The aim of this study was (1) to investigate which recovery interventions exist for this group of people and (2) to explore the scientific evidence. We conducted a scoping review, including studies with different designs, evaluating the effectiveness the recovery interventions available. The search resulted in 53 eligible articles of which 22 focused on societal recovery, six on personal recovery, five on functional recovery, 13 on lifestyle-interventions, and seven on creative and spiritual interventions. About a quarter of these interventions showed added value and half of them initial promising results. The research in this area is still limited, but a number of recovery promoting interventions on other areas than clinical recovery have been developed and evaluated. Further innovation and research to strengthen and repeat the evidence are needed.
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Affiliation(s)
- Neis Bitter
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands
| | - Diana Roeg
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
| | - Chijs van Nieuwenhuizen
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,GGzE Institute for Mental Health Care, PO Box 909, 5600, AX, Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,Phrenos Centre of Expertise, PO Box 1203, 3500, BE, Utrecht, The Netherlands.,Parnassia Group, Dijk en Duin Mental Health Centre, PO Box 305, 1900, AH, Castricum, The Netherlands
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12
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Montoya-Murillo G, Ibarretxe-Bilbao N, Peña J, Ojeda N. Effects of Cognitive Rehabilitation on Cognition, Apathy, Quality of Life, and Subjective Complaints in the Elderly: A Randomized Controlled Trial. Am J Geriatr Psychiatry 2020; 28:518-529. [PMID: 31735487 DOI: 10.1016/j.jagp.2019.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the efficacy of a new-generation integrative cognitive rehabilitation (CR) program (Rehacop) on cognition, clinical symptoms, quality of life (QoL), and subjective complaints in the elderly. DESIGN A randomized controlled trial study with a cohort of elderly people over 55 years of age. SETTING Communities of the Basque Country (Spain). PARTICIPANTS A total of 124 elderly participants (aged 79.00 ± 8.85 years) were randomized in the Rehacop group (RG) (n = 62) and control group (CG) (n = 62). INTERVENTION The RG attended 39 CR sessions for 3 months (3 sessions/week, 60-minute/session) with the Rehacop program. The CG performed occupational tasks with the same frequency and duration as the RG. METHODS Participants underwent a neuropsychological assessment at baseline and post-treatment which included cognitive, clinical, and functional tests. In addition, participants and their formal caregivers completed a subjective complaints questionnaire. The data were analyzed according to the intention to treat analysis and with participants who completed the study. This study was registered at clinicaltrials.gov (NCT03435029). RESULTS The RG showed significant improvements compared to the CG in neurocognition (ANCOVA timexgroup interaction effect size (ηp2)=0.05, 90% confidence interval (CI) = 0.00-0.12). The RG also reduced apathy (ηp2=0.06, 90% CI = 0.01-0.15) and participants' subjective complaints (ηp2=0.11, 90% CI = 0.03-0.21) and improved QoL (ηp2=0.08, 90% CI = 0.01-0.17). CONCLUSIONS Participants who attended the intervention improved their cognition, QoL, and reduced apathy and subjective complaints after treatment. These findings provide a new understanding of the benefits of CR in the elderly.
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Affiliation(s)
- Genoveva Montoya-Murillo
- 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
| | - Javier Peña
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Natalia Ojeda
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain.
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13
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Cella M, Price T, Corboy H, Onwumere J, Shergill S, Preti A. Cognitive remediation for inpatients with psychosis: a systematic review and meta-analysis. Psychol Med 2020; 50:1062-1076. [PMID: 32349802 DOI: 10.1017/s0033291720000872] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cognitive difficulties are common in people with psychosis and associated with considerable disability. Cognitive remediation (CR) can reduce the burden of cognitive difficulties and improve functioning. While mental health care has predominantly shifted to the community, people with greater illness severity and complexity, and those with poor response to treatment and concomitant greater cognitive difficulties, continue to receive inpatient care. The aim of this study is to review and evaluate the acceptability and efficacy of CR for inpatients with psychosis. A systematic search was used to identify randomized controlled trials of CR for inpatients with psychosis. Demographic and clinical information was extracted by independent raters together with therapy outcomes. Study quality was assessed using the Cochrane Collaboration Risk of Bias Assessment tool. Standardized mean change for cognitive and functional outcomes was calculated using Hedges's g and used to infer therapy effects with meta-analysis. Twenty studies were identified considering 1509 participants. Results from random-effect models suggested that CR was effective in improving processing speed (g = 0.48), memory (g = 0.48) and working memory (g = 0.56). While there was an indication of improvements in the levels of vocational, social and global functioning, these were less reliable. On average, 7% of participants dropped-out of treatment. Studies methodological quality was moderate. CR is an acceptable intervention for inpatients with psychosis and can lead to significant cognitive improvements. Evidence for improvement in functioning requires more robust and converging evidence. Future research should extend the evaluation of inpatient CR to subsequent post-discharge community functioning and further need for care.
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Affiliation(s)
- Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Tom Price
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Holly Corboy
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- University College Dublin (UCD), Belfield, Dublin 4, Ireland
| | - Juliana Onwumere
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- National Psychosis Unit, Bethlem Hospital, South London and Maudsley NHS Trust, UK
| | - Sukhi Shergill
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- National Psychosis Unit, Bethlem Hospital, South London and Maudsley NHS Trust, UK
| | - Antonio Preti
- Centro Medico Genneruxi, Cagliari, Italy
- Center for Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
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Obeid S, Hallit S, Sacre H, Kazour GR. Effectiveness of integrated psychological therapy on cognitive function among Lebanese patients with schizophrenia: a pilot study. Int J Psychiatry Clin Pract 2020; 24:43-52. [PMID: 31661346 DOI: 10.1080/13651501.2019.1682615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: The integrated term emphasises the need for cognitive therapy to always be embedded into an extended treatment concept adapted to cognitive resources and deficits and to patient rehabilitation. One of the first approaches is integrated psychological therapy (IPT).Aim: To assess the effect of the IPT Programme compared to the Treatment as Usual (TaU) in terms of cognitive performance and social skills among a group of schizophrenic patients.Methods: This randomised controlled study enrolled 20 patients in each group. Patients attended 60-min sessions, 3 days/week.Results: When considering the TaU group, the bivariate results showed that significantly higher means of attention scores, lower means in social dysfunction and aggression, social adaptation scores were found after IPT compared to before. The effect size for all tests was found to be weak. When considering the IPT group, significantly higher means attention score, lower means cognitive disorders, social dysfunction, aggression and social adaptation scores were found after IPT compared to before. The effect size for all tests was found to be high.Conclusion: The therapeutic combination of the IPT programme with medical treatment has shown additional beneficial effects on the schizophrenic patients' treatment, enabling them, as far as possible, to reintegrate into the community.KEY POINTSIn cases, a significantly higher GZ-F and KL scores and a lower SDAS-9 and SDAS-6 scores were found post-IPT respectively.In controls, a significant increase in the GZ-F and KL subscales and a decrease in all other scales was found post-IPT respectively.This therapeutic combination of the integrative programme with medical treatment has shown additive beneficial effects in patients with schizophreniaThe treatment approach would allow them, as far as possible, to reintegrate within the community.
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Affiliation(s)
- Sahar Obeid
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Science, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Souheil Hallit
- INSPECT-LB, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Hala Sacre
- INSPECT-LB, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Gisèle Rouphaël Kazour
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Human Sciences, Lebanese University, Beirut, Lebanon
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Gómez-Gastiasoro A, Peña J, Ibarretxe-Bilbao N, Lucas-Jiménez O, Díez-Cirarda M, Rilo O, Montoya-Murillo G, Zubiaurre-Elorza L, Ojeda N. A Neuropsychological Rehabilitation Program for Cognitive Impairment in Psychiatric and Neurological Conditions: A Review That Supports Its Efficacy. Behav Neurol 2019; 2019:4647134. [PMID: 31772682 PMCID: PMC6854258 DOI: 10.1155/2019/4647134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/05/2019] [Accepted: 08/05/2019] [Indexed: 11/21/2022] Open
Abstract
Neuropsychological rehabilitation has been the focus of much scientific research over the past decades due to its efficacy in different pathologies. Advances in the neuropsychology field have led to improvements and changes in neuropsychological interventions, which in turn have given rise to different approaches and rehabilitation programs. REHACOP is an integrative neuropsychological rehabilitation program designed by specialist neuropsychologists. With an integrated bottom-up and top-down approach, REHACOP includes neurocognition, social cognition, and daily living tasks hierarchically organized on an increasing level of difficulty. Task arrangement is addressed to maximize improvements and transfer effects into participant's daily living. To date, REHACOP has been implemented on different clinical samples such as patients with schizophrenia, multiple sclerosis (MS), and Parkinson's disease (PD). This manuscript presents the efficacy data of REHACOP across these three populations and discusses it in the context of the available literature. Overall, the magnitude of improvements obtained by means of REHACOP ranged from medium to high across samples. These changes were not restricted to specific neurocognitive domains since participants attending the REHACOP program also showed changes in social cognition and daily functioning variables by means of both direct and transfer effects. Results regarding REHACOP's efficacy in psychiatric and neurological conditions have contributed to expanding the existing evidence about the use of structured neuropsychological rehabilitation. In addition, the results obtained after its implementation highlighted the need and importance of designing and implementing integrative neuropsychological rehabilitation programs that are focused not only on cognition per se but also on participants' performance in daily living.
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Affiliation(s)
- Ainara Gómez-Gastiasoro
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Avenida de las Universidades, 24, 48007 Bilbao, Biscay, Spain
| | - Javier Peña
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Avenida de las Universidades, 24, 48007 Bilbao, Biscay, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Avenida de las Universidades, 24, 48007 Bilbao, Biscay, Spain
| | - Olaia Lucas-Jiménez
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Avenida de las Universidades, 24, 48007 Bilbao, Biscay, Spain
| | - María Díez-Cirarda
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Avenida de las Universidades, 24, 48007 Bilbao, Biscay, Spain
| | - Oiane Rilo
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Avenida de las Universidades, 24, 48007 Bilbao, Biscay, Spain
| | - Genoveva Montoya-Murillo
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Avenida de las Universidades, 24, 48007 Bilbao, Biscay, Spain
| | - Leire Zubiaurre-Elorza
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Avenida de las Universidades, 24, 48007 Bilbao, Biscay, Spain
| | - Natalia Ojeda
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Avenida de las Universidades, 24, 48007 Bilbao, Biscay, Spain
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16
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Seccomandi B, Tsapekos D, Newbery K, Wykes T, Cella M. A systematic review of moderators of cognitive remediation response for people with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100160. [PMID: 31828023 PMCID: PMC6889639 DOI: 10.1016/j.scog.2019.100160] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 01/08/2023]
Abstract
Background There is evidence that cognitive remediation (CR) is moderately effective in improving cognitive and functional difficulties in people with schizophrenia. However, there is still a limited understanding of what influence different treatment responses. Aim To identify moderators influencing CR response in people with schizophrenia. Methods This systematic review follows PRISMA guidelines. Searches were conducted up to January 2019 on PubMed and PsychInfo to identify randomized controlled trials of CR reporting analyses of moderators of treatment response. All papers were assessed for methodological quality and information on sample size, intervention and control condition, moderators, outcomes, effect of moderator on outcomes and demographic characteristics from each study was extracted and critically summarised. Results Thirty-six studies were included, considering 2737 participants. Study participants consisted on average of people in their late-thirties, mostly men, with over 10 years of illness. The review identified moderators that could be grouped into five categories: demographics, biological, cognitive and functional, psychological, and illness-related characteristics. The assessment of methodological quality showed that many studies had a high risk of bias. Conclusions There was no high-quality replicated evidence which identifies reliable moderators of CR response. Many moderators were not replicated or presented in single, underpowered studies. Studies also investigated moderators independently despite their potential to overlap (e.g. age and education). Future research should concentrate on evaluating, with sound studies, the role moderators may play in affecting CR treatment response. This information can inform who will benefit most from the therapy and help to improve the benefits of CR.
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Affiliation(s)
- Benedetta Seccomandi
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Dimosthenis Tsapekos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Katie Newbery
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London SE5 8AZ, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London SE5 8AZ, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London SE5 8AZ, UK
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17
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D'Amico ML, Jaffe LE, Gardner JA. Evidence for Interventions to Improve and Maintain Occupational Performance and Participation for People With Serious Mental Illness: A Systematic Review. Am J Occup Ther 2018; 72:7205190020p1-7205190020p11. [PMID: 30157006 DOI: 10.5014/ajot.2018.033332] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This systematic review evaluates the evidence for the effectiveness of interventions within the scope of occupational therapy to improve and maintain performance and participation for people with serious mental illness. Areas included in this review are activities of daily living, instrumental activities of daily living, leisure, social participation, and rest and sleep. METHOD Databases searched included MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. Reviewers read and assessed citations, abstracts, and full-text articles for inclusion and analysis. RESULTS Sixty-one articles were selected for inclusion. The review yielded strong evidence for psychoeducation and occupation- and cognitive-based interventions, moderate evidence for skills-based interventions, and limited evidence for technology-supported interventions. CONCLUSION Results of this review support use of evidence-based practice within the scope of occupational therapy, inclusion of occupational therapy practitioners as mental health service providers, and continued research.
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Affiliation(s)
- Mariana L D'Amico
- Mariana L. D'Amico, EdD, OTR/L, FAOTA, is Associate Professor, Nova Southeastern University-Tampa, FL;
| | - Lynn E Jaffe
- Lynn E. Jaffe, ScD, OTR/L, FAOTA, is Professor and Program Director, Florida Gulf State University, Fort Myers
| | - Jennifer A Gardner
- Jennifer A. Gardner, OTD, OTR, is Associate Professor, Kean University, Union, NJ
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18
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Lindenmayer JP, Khan A, McGurk SR, Kulsa MKC, Ljuri I, Ozog V, Fregenti S, Capodilupo G, Buccellato K, Thanju A, Goldring A, Parak M, Parker B. Does social cognition training augment response to computer-assisted cognitive remediation for schizophrenia? Schizophr Res 2018; 201:180-186. [PMID: 29910120 DOI: 10.1016/j.schres.2018.06.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/08/2018] [Accepted: 06/08/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cognitive remediation therapy (CRT) has shown significant improvement in cognition in schizophrenia. However, effect sizes of CRT have been reported to be modest raising the issue how to augment the effects of CRT on neurocognition and social cognition. Our aim was to examine whether the addition of computerized social cognition training would enhance the effects on neurocognition and social cognition as compared to CRT alone. METHODS This is a 12-week, parallel group trial of 131 in- and out-patients with schizophrenia randomized to CRT (COGPACK or Brain Fitness) with computerized social cognition training (MRIGE), or CRT alone for 36 sessions. Participants were assessed at baseline and after 12 weeks of treatment. Assessments included neurocognition, social cognition, psychopathology, and functioning. RESULTS The combined intervention, CRT + MRIGE, showed greater improvements in the MCCB indices of Visual Learning, Working Memory, Reasoning and Problem-Solving, and the neurocognitive composite score compared to CRT alone (Bonferroni adjusted p = 0.004, p = 0.005, p = 0.01, respectively), as did social cognition measures (Bonferroni adjusted p = 0.006, p = 0.005, respectively). CONCLUSIONS Supplementing CRT with computerized social cognition training produced greater benefits in neurocognition, including visual learning, memory, executive functions, and social cognition relative to cognitive training alone. These findings favoring the combined training may be contributed to both the greater overall amount of cognitive practice, as well as the specific cognitive functions engaged by the social cognition training.
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Affiliation(s)
- Jean-Pierre Lindenmayer
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; New York University School of Medicine, 550 1st Avenue, New York, NY 10016, United States.
| | - Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; NeuroCog Trials, 3211 Shannon Road #300, Durham, NC 27707, United States.
| | - Susan R McGurk
- Boston University, 1 Silber Way, Boston, MA 02215, United States.
| | - Mila Kirstie C Kulsa
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Teachers College Columbia University, 525 West 120th Street, New York, NY 10027, United States.
| | - Isidora Ljuri
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States.
| | - Veronica Ozog
- Adelphi University, 1 South Avenue, Garden City, NY 11530, United States.
| | - Samantha Fregenti
- Mental Health Service Corps, 425 East 25th Street, New York, NY 10010, United States.
| | - Gianna Capodilupo
- MedAvante-ProPhase, 3 Park Avenue, New York, NY 10016, United States
| | - Kiara Buccellato
- Henry Jackson Foundation at The Walter Reed National Military Medical Center, 901 Rockville Pike, Bethesda, MD 20889, United States
| | - Amod Thanju
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States.
| | - Abraham Goldring
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States.
| | - Mohan Parak
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States.
| | - Benedicto Parker
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States.
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19
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García-Guerrero MA, Sánchez Gómez P, Peña Lasa J, Portu Zapirain J, Elizagárate Zabala E, Gorria Bernal V, Ojeda Del Pozo N. Effect of psychiatric symptoms and quality of life on cognitive performance in HCV patients. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 13:22-30. [PMID: 30082230 DOI: 10.1016/j.rpsm.2018.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/17/2018] [Accepted: 06/16/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Reduced performance in several cognitive domains has been repeatedly related to hepatitis C virus (HCV). Nevertheless, there is no consensus about the severity or cognitive profile. Moreover, other possible influential variables are scarcely controlled. The aim of this study is to define the specific cognitive profile in HCV after controlling for confounding variables. METHODS Forty-two HCV patients were distributed in 2groups according to the presence of co-infection with human immunodeficiency virus; a third group with 22 healthy controls was also included. The neuropsychological assessment included tests that assess processing speed, executive functioning, verbal memory, visual memory and working memory. Measures of depression (BDI), anxiety (HAM-A), fatigue (MAF), anhedonia (PAS), insomnia (ISI), quality of life (SF-36) and history of drug abuse (DAST-20) were taken in order to explore differences among groups and to control for their possible influence on cognitive performance. RESULTS HCV patients (including human immunodeficiency virus-coinfection) performed significantly worse in all cognitive measures. However, when the effect of BDI, HAM-A, MAF, ISI, SF-36 & DAST-20 was controlled, only verbal memory of HCV patients differed among groups. Coinfected patients performed worse in verbal memory. CONCLUSIONS According to previous studies verbal memory is the unique cognitive domain related to the effect of HCV. The present study does not support that the neurovirulence effect of HCV is decreasing cognitive performance in HCV patients. Nevertheless, the present study cannot relate the fronto-striatal disruption with the cognitive performance in HCV patients.
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Affiliation(s)
- M Acebo García-Guerrero
- Departamento de Métodos y Psicología Experimental, Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, España.
| | - Pedro Sánchez Gómez
- Unidad de Psicosis Refractaria, Hospital Psiquiátrico de Álava, Vitoria, España; Departamento de Neurociencia, Sección de Psiquiatría, Escuela de Medicina y Odontología, Universidad del País Vasco, Vizcaya, España
| | - Javier Peña Lasa
- Departamento de Métodos y Psicología Experimental, Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, España
| | - Joseba Portu Zapirain
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Álava-Hospital Txagorritxu, Vitoria, España
| | - Edorta Elizagárate Zabala
- Unidad de Psicosis Refractaria, Hospital Psiquiátrico de Álava, Vitoria, España; Departamento de Neurociencia, Sección de Psiquiatría, Escuela de Medicina y Odontología, Universidad del País Vasco, Vizcaya, España; CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, España
| | - Victoria Gorria Bernal
- Departamento de Métodos y Psicología Experimental, Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, España
| | - Natalia Ojeda Del Pozo
- Departamento de Métodos y Psicología Experimental, Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, España
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20
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Lahera G, Gálvez JL, Sánchez P, Martínez-Roig M, Pérez-Fuster JV, García-Portilla P, Herrera B, Roca M. Functional recovery in patients with schizophrenia: recommendations from a panel of experts. BMC Psychiatry 2018; 18:176. [PMID: 29871616 PMCID: PMC5989342 DOI: 10.1186/s12888-018-1755-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 05/22/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The management of schizophrenia is evolving towards a more comprehensive model based on functional recovery. The concept of functional recovery goes beyond clinical remission and encompasses multiple aspects of the patient's life, making it difficult to settle on a definition and to develop reliable assessment criteria. In this consensus process based on a panel of experts in schizophrenia, we aimed to provide useful insights on functional recovery and its involvement in clinical practice and clinical research. METHODS After a literature review of functional recovery in schizophrenia, a scientific committee of 8 members prepared a 75-item questionnaire, including 6 sections: (I) the concept of functional recovery (9 items), (II) assessment of functional recovery (23 items), (III) factors influencing functional recovery (16 items), (IV) psychosocial interventions and functional recovery (8 items), (V) pharmacological treatment and functional recovery (14 items), and (VI) the perspective of patients and their relatives on functional recovery (5 items). The questionnaire was sent to a panel of 53 experts, who rated each item on a 9-point Likert scale. Consensus was achieved in a 2-round Delphi dynamics, using the median (interquartile range) scores to consider consensus in either agreement (scores 7-9) or disagreement (scores 1-3). Items not achieving consensus in the first round were sent back to the experts for a second consideration. RESULTS After the two recursive rounds, consensus was achieved in 64 items (85.3%): 61 items (81.3%) in agreement and 3 (4.0%) in disagreement, all of them from section II (assessment of functional recovery). Items not reaching consensus were related to the concepts of functional recovery (1 item, 1.3%), functional assessment (5 items, 6.7%), factors influencing functional recovery (3 items, 4.0%), and psychosocial interventions (2 items, 5.6%). CONCLUSIONS Despite the lack of a well-defined concept of functional recovery, we identified a trend towards a common archetype of the definition and factors associated with functional recovery, as well as its applicability in clinical practice and clinical research.
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Affiliation(s)
- Guillermo Lahera
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, Plaza de San Diego, s/n, 28801 Alcalá de Henares, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - José L Gálvez
- Unidad de Salud Mental Comunitaria del Hospital Universitario Virgen del Rocio, Av. Manuel Siurot, S/N, 41013, Sevilla, Spain
| | - Pedro Sánchez
- Unidad de Psicosis Refractaria, Hospital Psiquiátrico de Álava-Osakidetza, C/ Álava, n°45, 01006, Vitoria - Gasteiz, Spain
- Facultad de Medicina, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Leioa, Spain
| | | | - J V Pérez-Fuster
- Centro de Salud Mental Fuente San Luis, Hospital Universitario Doctor Peset, Av. de Gaspar Aguilar, 90, 46017, València, Spain
| | - Paz García-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Área de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, Av. Julián Clavería, s/n, 33006, Oviedo, Asturias, Spain
| | - Berta Herrera
- Medical Affairs Department, Janssen-Cilag, Avenida Partenón, 16 1 (Campo de las Naciones), S. A, 28042, Madrid, Spain
| | - Miquel Roca
- Institut Universitari d'Investigació en Ciencies de la Salut (IUNIS), RedIAPP, Hospital Juan March, Universidad de las Islas Baleares, Cra. de Valldemossa, km 7.5., Palma de Mallorca, (Illes Balears), Spain.
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21
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Peña J, Ibarretxe-Bilbao N, Sánchez P, Uriarte JJ, Elizagarate E, Gutierrez M, Ojeda N. Mechanisms of functional improvement through cognitive rehabilitation in schizophrenia. J Psychiatr Res 2018. [PMID: 29525739 DOI: 10.1016/j.jpsychires.2018.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Whereas the efficacy of cognitive rehabilitation in schizophrenia is widely known, studies examining mechanisms for functional improvement are still scarce. The aim of the study was to examine the mediational mechanisms through which cognitive rehabilitation improves functioning in schizophrenia. One hundred and eleven schizophrenia patients were randomly assigned to either a 4-month cognitive rehabilitation group or an active control group. Patients underwent a neurocognitive battery (including processing speed, verbal memory, working memory and executive functioning) and social cognition assessment (emotion perception, theory of mind and social perception). Functioning was assessed by the combined use of a performance-based instrument, the UCSD Performance-based Skills Assessment (UPSA) and an observer-rated instrument, the Global Assessment of Functioning (GAF). The trial was registered in clinicaltrials.gov (NCT02796417). Multiple mediational analyses revealed that the effect of cognitive rehabilitation on functional improvement was partially mediated by changes in processing speed and verbal memory, but not by the domains of social cognition and negative symptoms. More specifically, verbal memory partially mediated the treatment's effect on performance-based functioning (UPSA), whereas processing speed acted as a partial mediator for observer-rated functioning (GAF). The effect of rehabilitation on functioning did not take place through all the domains that showed significant improvement. Verbal memory and processing speed emerged as the most crucial factors. However, these complex interactions need further research.
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Affiliation(s)
- J Peña
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Basque Country, Spain.
| | - N Ibarretxe-Bilbao
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Basque Country, Spain
| | - P Sánchez
- Refractory Psychosis Unit, Hospital Psiquiátrico de Álava, Red de Salud Mental de Araba, Osakidetza, Vitoria, Spain; Department of Neuroscience, School of Medicine, University of the Basque Country, Vizcaya, Spain
| | - J J Uriarte
- Red de Salud Mental de Bizkaia Osakidetza, Bilbao, Spain
| | - E Elizagarate
- Refractory Psychosis Unit, Hospital Psiquiátrico de Álava, Red de Salud Mental de Araba, Osakidetza, Vitoria, Spain; Department of Neuroscience, School of Medicine, University of the Basque Country, Vizcaya, Spain; CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental Madrid, Spain
| | - M Gutierrez
- Department of Neuroscience, School of Medicine, 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
| | - N Ojeda
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Basque Country, Spain
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22
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Cella M, Stahl D, Morris S, Keefe RSE, Bell MD, Wykes T. Effects of cognitive remediation on negative symptoms dimensions: exploring the role of working memory. Psychol Med 2017; 47:2593-2601. [PMID: 28866985 PMCID: PMC5647678 DOI: 10.1017/s0033291717000757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent theories suggest that poor working memory (WM) may be the cognitive underpinning of negative symptoms in people with schizophrenia. In this study, we first explore the effect of cognitive remediation (CR) on two clusters of negative symptoms (i.e. expressive and social amotivation), and then assess the relevance of WM gains as a possible mediator of symptom improvement. METHOD Data were accessed for 309 people with schizophrenia from the NIMH Database of Cognitive Training and Remediation Studies and a separate study. Approximately half the participants received CR and the rest were allocated to a control condition. All participants were assessed before and after therapy and at follow-up. Expressive negative symptoms and social amotivation symptoms scores were calculated from the Positive and Negative Syndrome Scale. WM was assessed with digit span and letter-number span tests. RESULTS Participants who received CR had a significant improvement in WM scores (d = 0.27) compared with those in the control condition. Improvements in social amotivation levels approached statistical significance (d = -0.19), but change in expressive negative symptoms did not differ between groups. WM change did not mediate the effect of CR on social amotivation. CONCLUSIONS The results suggest that a course of CR may benefit behavioural negative symptoms. Despite hypotheses linking memory problems with negative symptoms, the current findings do not support the role of this cognitive domain as a significant mediator. The results indicate that WM improves independently from negative symptoms reduction.
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Affiliation(s)
- M. Cella
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - D. Stahl
- Department of Biostatistics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - S. Morris
- Division of Adult Translational Research, National Institute of Mental Health, North Bethesda, MD, USA
| | - R. S. E. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - M. D. Bell
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - T. Wykes
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Cognitive remediation and occupational outcome in schizophrenia spectrum disorders: A 2year follow-up study. Schizophr Res 2017; 185:122-129. [PMID: 28041917 DOI: 10.1016/j.schres.2016.12.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 01/31/2023]
Abstract
Neurocognitive impairment is prominent in schizophrenia and a significant predictor of poor occupational outcomes. Vocational rehabilitation (VR) is frequently implemented to counteract high unemployment rates. Individuals with schizophrenia however face numerous challenges such as neurocognitive impairments and psychotic symptoms. Hence, augmenting VR to address illness-related factors may optimize occupational outcomes. The aim of this study was to examine the effects of Cognitive Remediation (CR) combined with VR(CR+VR) compared to techniques from Cognitive Behavioral Therapy (CBT) combined with VR(CBT+VR) on neurocognition and occupational functioning over a 2year period. A total of 131participants underwent assessment with the MATRICS Consensus Cognitive Battery (MCCB) at baseline, post treatment (after 10months) and follow-up (2years after randomization). Occupational status and number of hours worked were recorded at all assessment points. Both groups improved on several neurocognitive domains. All improvements were however in favor of the CR group. There was a significant increase in number of participants working and hours worked in both groups throughout the project period, with no between-group differences. Number of hours worked at follow-up was predicted by change in Working Memory and the Composite Score in the CR group. CR-augmented VR improved several domains, particularly Verbal Learning and Working Memory, which were central in the CR program. The combination of VR and CR or CBT thus enabled a significant proportion of participants to attain and maintain work.
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24
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Linke M, Jankowski KS, Wichniak A, Jarema M, Wykes T. Effects of cognitive remediation therapy versus other interventions on cognitive functioning in schizophrenia inpatients. Neuropsychol Rehabil 2017; 29:477-488. [PMID: 28457189 DOI: 10.1080/09602011.2017.1317641] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Computerised cognitive remediation therapy (CCRT) has been shown to improve cognitive function in individuals with schizophrenia beyond effects of other forms of therapy. However, results vary between studies, and most are aimed at individuals who are living in the community. Very few studies have investigated its efficacy in psychiatric wards in order to assess whether or not this is a suitable site to start the therapy. This study evaluated CCRT efficacy among schizophrenia inpatients who received a broad range of therapeutic interventions in a psychiatric ward. A randomised controlled trial of CCRT versus an active control in 66 young inpatients with a diagnosis of schizophrenia was conducted. The intervention lasted for 6 weeks and its efficacy was assessed with the composite score of the MATRICS Consensus Cognitive Battery. Both groups improved similarly in cognitive function and psychopathological symptoms. However, the CCRT group improved more than the controls in negative symptoms. This result shows that providing a drill and practice cognitive remediation to inpatients does not produce benefits for cognitive functioning substantially greater than other forms of therapy provided in a ward, but it is more efficient in reduction of negative symptoms. Our results suggest that CRT might be considered as a promising intervention for reducing negative symptoms in schizophrenia individuals.
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Affiliation(s)
- Magdalena Linke
- a Third Department of Psychiatry , Institute of Psychiatry and Neurology , Warsaw , Poland
| | | | - Adam Wichniak
- a Third Department of Psychiatry , Institute of Psychiatry and Neurology , Warsaw , Poland
| | - Marek Jarema
- a Third Department of Psychiatry , Institute of Psychiatry and Neurology , Warsaw , Poland
| | - Til Wykes
- c Department of Psychology , Institute of Psychiatry, King's College London , London , United Kingdom
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25
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Lutgens D, Gariepy G, Malla A. Psychological and psychosocial interventions for negative symptoms in psychosis: systematic review and meta-analysis. Br J Psychiatry 2017; 210:324-332. [PMID: 28302699 DOI: 10.1192/bjp.bp.116.197103] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/10/2016] [Accepted: 01/27/2017] [Indexed: 01/15/2023]
Abstract
BackgroundNegative symptoms observed in patients with psychotic disorders undermine quality of life and functioning. Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence for the effectiveness of specific non-biological interventions warrants detailed examination.AimsTo conduct a meta-analytic and systematic review of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders.MethodWe searched for randomised controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardised mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure.ResultsA total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive-behavioural therapy (pooled SMD -0.34, 95% CI -0.55 to -0.12), skills-based training (pooled SMD -0.44, 95% CI -0.77 to -0.10), exercise (pooled SMD -0.36, 95% CI -0.71 to -0.01), and music treatments (pooled SMD -0.58, 95% CI -0.82 to -0.33) provide significant benefit. Integrated treatment models are effective for early psychosis (SMD -0.38, 95% CI -0.53 to -0.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high level of heterogeneity.ConclusionsSpecific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be developed.
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Affiliation(s)
- Danyael Lutgens
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Genevieve Gariepy
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Ashok Malla
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
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26
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Otsuka S, Uono S, Yoshimura S, Zhao S, Toichi M. Emotion Perception Mediates the Predictive Relationship Between Verbal Ability and Functional Outcome in High-Functioning Adults with Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:1166-1182. [PMID: 28194554 PMCID: PMC5357301 DOI: 10.1007/s10803-017-3036-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of this study was to identify specific cognitive abilities that predict functional outcome in high-functioning adults with autism spectrum disorder (ASD), and to clarify the contribution of those abilities and their relationships. In total, 41 adults with ASD performed cognitive tasks in a broad range of neuro- and social cognitive domains, and information concerning functional outcomes was obtained. Regression analyses revealed that emotion perception and verbal generativity predicted adaptive functioning directly, and the former mediated between the other two. These findings provide the first evidence of a triadic relationship among neuro- and social cognition and functional outcome in this population. Our results suggest that psychosocial interventions targeting these cognitive abilities could benefit social adaptation in adults with ASD.
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Affiliation(s)
- Sadao Otsuka
- Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
- The Organization for Promoting Neurodevelopmental Disorder Research (OPNDR), 40 Shogoin Sanno-cho, Sakyo-ku, Kyoto, 606-8392, Japan.
| | - Shota Uono
- Department of Neurodevelopmental Psychiatry, Habilitation and Rehabilitation, Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sayaka Yoshimura
- Department of Neurodevelopmental Psychiatry, Habilitation and Rehabilitation, Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuo Zhao
- Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- International Research Fellow of the Japan Society for the Promotion of Science (JSPS), 5-3-1, Kojimachi, Chiyoda-ku, 102-0083, Tokyo, Japan
| | - Motomi Toichi
- Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- The Organization for Promoting Neurodevelopmental Disorder Research (OPNDR), 40 Shogoin Sanno-cho, Sakyo-ku, Kyoto, 606-8392, Japan
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27
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Lee WH, Lee WK. Cognitive rehabilitation for patients with schizophrenia in Korea. Asian J Psychiatr 2017; 25:109-117. [PMID: 28262129 DOI: 10.1016/j.ajp.2016.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 07/31/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022]
Abstract
Psychosocial rehabilitation programs received mental health professional support in addition to traditional medication therapy. Many psychosocial programs were developed since the 1990s, including cognitive remediation therapy. In this review, we focus on cognitive remediation therapy in Korea since the 1990s. We review several cognitive rehabilitation programs developed in Korea and their outcome studies and suggest future research directions and prospects. We reviewed cognitive rehabilitation programs including social cognitive training as well as more recent forms of computerized cognitive rehabilitation. Although there are differences in cognitive domains by training targets, almost all neurocognitive remediation trainings in Korea have beneficial effects on early visual processing, various attention types, and executive function. Future studies need to investigate the mechanisms and various mediators underlying the relationships between cognitive functions and functional outcomes. With more comprehensive cognitive and social cognitive programs, we can enhance both cognition and functional outcomes of the patients with schizophrenia.
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Affiliation(s)
| | - Woo Kyeong Lee
- Department of Counseling Psychology, Seoul Cyber University, 193-15, Mia Dong, Gang Buk Gu, Seoul, 142-700 Korea.
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28
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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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Rilo O, Peña J, Ojeda N, Rodríguez-Antigüedad A, Mendibe-Bilbao M, Gómez-Gastiasoro A, DeLuca J, Chiaravalloti N, Ibarretxe-Bilbao N. Integrative group-based cognitive rehabilitation efficacy in multiple sclerosis: a randomized clinical trial. Disabil Rehabil 2016; 40:208-216. [PMID: 27927036 DOI: 10.1080/09638288.2016.1250168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Oiane Rilo
- Department of Methods and Experimental Psychology, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Department of Methods and Experimental Psychology, University of Deusto, Bilbao, Spain
| | - Natalia Ojeda
- Department of Methods and Experimental Psychology, University of Deusto, Bilbao, Spain
| | | | | | | | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nancy Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
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Cella M, Preti A, Edwards C, Dow T, Wykes T. Cognitive remediation for negative symptoms of schizophrenia: A network meta-analysis. Clin Psychol Rev 2016; 52:43-51. [PMID: 27930934 DOI: 10.1016/j.cpr.2016.11.009] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/01/2016] [Accepted: 11/22/2016] [Indexed: 01/15/2023]
Abstract
Cognitive remediation (CR) is a treatment targeting cognitive difficulties in people with schizophrenia. Recent research suggested that CR may also have a positive effect on negative symptoms. This meta-analysis investigates the effect of CR on negative symptoms. A systematic search was used to identify all randomized-controlled trials of CR in people with schizophrenia reporting negative symptoms outcomes. Levels of negative symptoms at baseline, post-therapy and follow-up, sample demographics and treatment length were extracted. Study methodological quality and heterogeneity were addressed. Negative symptoms standardized mean change was calculated using Hedges's g and used as the main outcome. The search identified 45 studies reporting results for 2511 participants; 15 studies reported follow-up outcomes. CR was associated with a reduction of negative symptoms (most conservative model g=-0.30; 95% CI: -0.36, -0.22) at post-therapy compared with treatment as usual and this effect was larger at follow-up (g=-0.36; 95% CI: -0.51, -0.21). Drop-out rate was comparable between conditions. Network meta-analysis confirmed CR was superior to TAU and TAU plus active control or adjunctive treatment. No evidence of publication bias was found. Studies with more rigorous methodology were associated with larger negative symptom reduction (g=-0.40; 95% CI: -0.51 to -0.30). Although negative symptoms have not been considered a primary target for CR, this intervention can have small to moderate beneficial effects on this symptom cluster. Future research should explore in detail the active mechanisms responsible for negative symptom reduction and the relationship between cognitive and negative symptoms in schizophrenia.
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Affiliation(s)
- Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | - Antonio Preti
- Genneruxi Medical Center, Cagliari, Italy; Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy
| | - Clementine Edwards
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Tabitha Dow
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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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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Raffard S, Gutierrez LA, Yazbek H, Larue A, Boulenger JP, Lançon C, Benoit M, Faget C, Norton J, Capdevielle D. Working Memory Deficit as a Risk Factor for Severe Apathy in Schizophrenia: A 1-Year Longitudinal Study. Schizophr Bull 2016; 42:642-51. [PMID: 26834026 PMCID: PMC4838112 DOI: 10.1093/schbul/sbw002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Apathy, described as impaired motivation and goal-directed behavior, is a common yet often overlooked multidimensional psychopathological state in schizophrenia. Its underlying cognitive processes remain largely unexplored. Data was drawn from a longitudinal hospital study of patients with a DSM-IV diagnosis of schizophrenia; 137 (82.5%) participated at the 1-month follow-up and 81 (59.1%) at the 1-year follow-up. Apathy was assessed with the Lille Apathy Rating Scale, validated in French and in schizophrenia. Severe apathy, overall (total score > -13) and on 4 previously identified distinct dimensions, was considered. Episodic verbal learning was assessed with the California Verbal Learning Test, executive functioning with the Trail Making Test, the Six Element Test and the Stop Signal Paradigm and working memory with the Letter-Number Sequencing Test. After controlling for confounding variables, only episodic verbal learning was associated with severe overall apathy in the cross-sectional study. At 1 year, working memory was associated with an increased risk of severe overall apathy, adjusting for baseline apathy. Using a dimensional approach to apathy, specific types of cognition were found to be associated with specific dimensions of apathy. Our findings confirm the need for a multidimensional approach of negative symptoms in schizophrenia. Moreover, cognitive functioning could be a risk factor for developing severe apathy. Cognitive remediation may thus be a useful non-pharmacological intervention for treating apathy in schizophrenia patients.
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Affiliation(s)
- Stéphane Raffard
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, Montpellier, France; Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, University of Montpellier 3, Montpellier, France;
| | - Laure-Anne Gutierrez
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, Montpellier, France; U1061: Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France; U1061: Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
| | - Hanan Yazbek
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, Montpellier, France; Epsylon Laboratory Dynamic of Human Abilities & Health Behaviors, University of Montpellier 3, Montpellier, France
| | - Aurore Larue
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, Montpellier, France
| | - Jean-Philippe Boulenger
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, Montpellier, France
| | - Christophe Lançon
- Aix-Marseille University, EA 3279-Public Health, Chronic Diseases and Quality of Life-Research Unit, Marseille, France
| | - Michel Benoit
- Psychiatry-Clinical Neuroscience Department, Pasteur Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Catherine Faget
- Aix-Marseille University, EA 3279-Public Health, Chronic Diseases and Quality of Life-Research Unit, Marseille, France
| | - Joanna Norton
- U1061: Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France; U1061: Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHRU Montpellier, Montpellier, France; U1061: Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France; U1061: Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
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Lewandowski KE, Sperry SH, Ongur D, Cohen BM, Norris LA, Keshavan MS. Cognitive remediation versus active computer control in bipolar disorder with psychosis: study protocol for a randomized controlled trial. Trials 2016; 17:136. [PMID: 26969299 PMCID: PMC4788830 DOI: 10.1186/s13063-016-1275-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 03/03/2016] [Indexed: 11/04/2022] Open
Abstract
Background Cognitive dysfunction is a major feature of bipolar disorder with psychosis and is strongly associated with functional outcomes. Computer-based cognitive remediation has shown promise in improving cognition in patients with schizophrenia. However, despite similar neurocognitive deficits between patients with schizophrenia and bipolar disorder, few studies have extended neuroscience-based cognitive remediation programs to this population. Methods/Design The Treatment to Enhance Cognition in Bipolar Disorder study is an investigator-initiated, parallel group, randomized, blinded clinical trial of an Internet-based cognitive remediation protocol for patients with bipolar disorder I with psychosis (n = 100). We also describe the development of our dose-matched active control paradigm. Both conditions involve 70 sessions of computer-based activities over 24 weeks. The control intervention was developed to mirror the treatment condition in dose and format but without the neuroplasticity-based task design and structure. All participants undergo neuropsychological and clinical assessment at baseline, after approximately 25 hours of study activities, post treatment, and after 6 months of no study contact to assess durability. Neuroimaging at baseline and post treatment are offered in an “opt-in” format. The primary outcomes are scores on the MATRICS battery; secondary and exploratory outcomes include measures of clinical symptoms, community functioning, and neuroimaging changes. Associations between change in cognitive measures and change in community functioning will be assessed. Baseline predictors of treatment response will be examined. Discussion The present study is the first we are aware of to implement an Internet-based cognitive remediation program in patients with bipolar disorder with psychosis and to develop a comparable web-based control paradigm. The mixed online and study-site format allows accessible treatment while providing weekly staff contact and bridging. Based on user-provided feedback, participant blinding is feasible. Trial registration ClinicalTrials.gov NCT01470781; 11 July 2011.
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Affiliation(s)
| | - Sarah H Sperry
- McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA, 02478, USA
| | - Dost Ongur
- McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA, 02478, USA
| | - Bruce M Cohen
- McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA, 02478, USA
| | - Lesley A Norris
- McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA, 02478, USA
| | - Matcheri S Keshavan
- Beth Israel Deaconess Medical Center/Harvard Medical School, 75 Fenwood Rd., Boston, MA, 02115, USA
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Baandrup L, Østrup Rasmussen J, Klokker L, Austin S, Bjørnshave T, Fuglsang Bliksted V, Fink-Jensen A, Hedegaard Fohlmann A, Peter Hansen J, Kristine Nielsen M, Sandsten KE, Schultz V, Voss-Knude S, Nordentoft M. Treatment of adult patients with schizophrenia and complex mental health needs - A national clinical guideline. Nord J Psychiatry 2016; 70:231-40. [PMID: 26328910 DOI: 10.3109/08039488.2015.1074285] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM The Danish Health and Medicines Authority assembled a group of experts to develop a national clinical guideline for patients with schizophrenia and complex mental health needs. Within this context, ten explicit review questions were formulated, covering several identified key issues. METHODS Systematic literature searches were performed stepwise for each review question to identify relevant guidelines, systematic reviews/meta-analyses, and randomized controlled trials. The quality of the body of evidence for each review question was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Clinical recommendations were developed on the basis of the evidence, assessment of the risk-benefit ratio, and perceived patient preferences. RESULTS Based on the identified evidence, a guideline development group (GDG) recommended that the following interventions should be offered routinely: antipsychotic maintenance therapy, family intervention and assertive community treatment. The following interventions should be considered: long-acting injectable antipsychotics, neurocognitive training, social cognitive training, cognitive behavioural therapy for persistent positive and/or negative symptoms, and the combination of cognitive behavioural therapy and motivational interviewing for cannabis and/or central stimulant abuse. SSRI or SNRI add-on treatment for persistent negative symptoms should be used only cautiously. Where no evidence was available, the GDG agreed on a good practice recommendation. CONCLUSIONS The implementation of this guideline in daily clinical practice can facilitate good treatment outcomes within the population of patients with schizophrenia and complex mental health needs. The guideline does not cover all available interventions and should be used in conjunction with other relevant guidelines.
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Affiliation(s)
- Lone Baandrup
- a Danish Health and Medicines Authority and Mental Health Centre Glostrup , Denmark
| | | | - Louise Klokker
- c Danish Health and Medicines Authority and the Parker Institute, Bispebjerg and Frederiksberg Hospital , Denmark
| | | | | | | | | | | | - Jens Peter Hansen
- i Mental Health Services, Region of Southern Denmark and Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark
| | | | | | | | | | - Merete Nordentoft
- l Danish Health and Medicines Authority, Mental Health Centre Copenhagen and Institute of Clinical Medicine, Faculty of Health Science, University of Copenhagen , Denmark
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Clinical (but not cognitive) recovery in schizophrenia through the experience of fictional cinema. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:189-194. [PMID: 29114462 PMCID: PMC5609648 DOI: 10.1016/j.scog.2015.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction One of the criticisms of rehabilitation techniques is their limited application to the patient’s daily life. In the past, cinema has been used as a psychiatric rehabilitation tool, with the primary objective of facilitating training in social abilities and communication. In this study, we consider the use of film not only as a clinical recovery tool but also as a novel cognitive recovery tool for additional rehabilitation not only for communication and social abilities but also for all of the basic cognitive and social cognition processes. Methods In this randomized clinical trial, 48 patients with schizophrenia were assigned to an experimental or control group. Both of the groups received treatment sessions that included viewing episodes of the television series The Sopranos. Next, the experimental group participated in a structured cognitive training session that featured questions and exercises based on the episodes. The control group participated in an idea-sharing session (of the same duration and frequency) about what the group members saw in the episode. Results At the end of the treatment, both the positive and negative clinical symptoms of the experimental group improved significantly compared with the control group. However, this improvement was not observed in basic or social cognitive functions. Discussion A brief intervention based on transforming the activities of daily life can be an effective tool for psychiatric rehabilitation. However, the study’s current characteristics and sample did not produce benefits in cognitive parameters.
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Hartmann-Riemer MN, Hager OM, Kirschner M, Bischof M, Kluge A, Seifritz E, Kaiser S. The association of neurocognitive impairment with diminished expression and apathy in schizophrenia. Schizophr Res 2015; 169:427-432. [PMID: 26526750 DOI: 10.1016/j.schres.2015.10.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/14/2015] [Accepted: 10/22/2015] [Indexed: 11/24/2022]
Abstract
Negative symptoms can be grouped into the two dimensions of diminished expression and apathy, which have been shown to be dissociable regarding external validators, such as functional outcome. Here, we investigated whether these two dimensions differentially relate to neurocognitive impairment in schizophrenia. 47 patients with schizophrenia or schizoaffective disorder and 33 healthy control participants were subjected to a neurocognitive test battery assessing multiple cognitive domains (processing speed, working memory, verbal fluency, verbal learning and memory, mental planning), which are integrated into a composite cognition score. Negative symptoms in patients were assessed using the Brief Negative Symptom Scale. We found that diminished expression significantly related to neurocognitive impairment, while severity of apathy symptoms was not directly associated with neurocognition. Other assessed clinical variables include chlorpromazine equivalents, positive symptoms, and depressive symptoms and did not influence the results. Our results are in line with a cognitive resource limitation model of diminished expression in schizophrenia and indicate that cognitive remediation therapy might be helpful to ameliorate expressive deficits.
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Affiliation(s)
- Matthias N Hartmann-Riemer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.
| | - Oliver M Hager
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Martin Bischof
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Agne Kluge
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Gomar JJ, Valls E, Radua J, Mareca C, Tristany J, del Olmo F, Rebolleda-Gil C, Jañez-Álvarez M, de Álvaro FJ, Ovejero MR, Llorente A, Teixidó C, Donaire AM, García-Laredo E, Lazcanoiturburu A, Granell L, Mozo CDP, Pérez-Hernández M, Moreno-Alcázar A, Pomarol-Clotet E, McKenna PJ. A Multisite, Randomized Controlled Clinical Trial of Computerized Cognitive Remediation Therapy for Schizophrenia. Schizophr Bull 2015; 41:1387-96. [PMID: 26006264 PMCID: PMC4601710 DOI: 10.1093/schbul/sbv059] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The effectiveness of cognitive remediation therapy (CRT) for the neuropsychological deficits seen in schizophrenia is supported by meta-analysis. However, a recent methodologically rigorous trial had negative findings. In this study, 130 chronic schizophrenic patients were randomly assigned to computerized CRT, an active computerized control condition (CC) or treatment as usual (TAU). Primary outcome measures were 2 ecologically valid batteries of executive function and memory, rated under blind conditions; other executive and memory tests and a measure of overall cognitive function were also employed. Carer ratings of executive and memory failures in daily life were obtained before and after treatment. Computerized CRT was found to produce improvement on the training tasks, but this did not transfer to gains on the primary outcome measures and most other neuropsychological tests in comparison to either CC or TAU conditions. Nor did the intervention result in benefits on carer ratings of daily life cognitive failures. According to this study, computerized CRT is not effective in schizophrenia. The use of both active and passive CCs suggests that nature of the control group is not an important factor influencing results.
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Affiliation(s)
- Jesús J. Gomar
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain;,CIBERSAM, Spain;,Litwin-Zucker Research Center, the Feinstein Institute for Medical Research, Manhasset, New York
| | - Elia Valls
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain
| | - Joaquim Radua
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain;,CIBERSAM, Spain;,Department of Psychosis Studies, Institute of Psychiatry, King’s College London, UK
| | - Celia Mareca
- Psicoclínica Mare de Déu de la Mercè, Barcelona, Spain
| | | | | | | | | | | | | | - Ana Llorente
- Benito Menni CASM, Sant Boi de Llobregat, Barcelona, Spain
| | | | | | | | | | - Luis Granell
- Complejo Asistencial Benito Menni, Ciempozuelos, Madrid, Spain
| | | | | | - Ana Moreno-Alcázar
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain;,CIBERSAM, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain; CIBERSAM, Spain;
| | - Peter J. McKenna
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain;,CIBERSAM, Spain
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Bhagyavathi HD, Mehta UM, Thirthalli J, Kumar CN, Kumar JK, Subbakrishna DK, Gangadhar BN. Cascading and combined effects of cognitive deficits and residual symptoms on functional outcome in schizophrenia - A path-analytical approach. Psychiatry Res 2015. [PMID: 26208988 DOI: 10.1016/j.psychres.2015.07.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Understanding the complex relationship among determinants of real-world functioning in schizophrenia patients in remission is important in planning recovery-oriented interventions. We explored two path-analytical models of functioning in schizophrenia. 170 Schizophrenia patients remitted from positive symptoms underwent fairly comprehensive assessments of cognition - neurocognition (NC) and social cognition (SC), residual symptoms - insight, motivation and other negative symptoms, and socio-occupational functioning. We explored (a) a cascading model, where NC predicted functional outcome through its effects on other determinants and (b) a combined model, incorporating additional direct paths from each of the determinants. The combined model, and not the cascading model demonstrated a good fit. Post-hoc trimming of the combined model by elimination of non-significant paths maintained the goodness-of-fit and was retained as the final model. In addition to the direct paths, this final model demonstrated that (a) NC influenced functioning through SC and insight and (b) SC influenced functioning through motivation and negative symptoms. This suggests that NC and SC may influence functional outcome directly, as well as indirectly, via specific impact on insight, and motivation and negative symptoms respectively.
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Affiliation(s)
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
| | - C Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
| | - J Keshav Kumar
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
| | - D K Subbakrishna
- Department of Biostatistics, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
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Yu M, Tang X, Wang X, Zhang X, Zhang X, Sha W, Yao S, Shu N, Zhang X, Zhang Z. Neurocognitive Impairments in Deficit and Non-Deficit Schizophrenia and Their Relationships with Symptom Dimensions and Other Clinical Variables. PLoS One 2015; 10:e0138357. [PMID: 26381645 PMCID: PMC4575183 DOI: 10.1371/journal.pone.0138357] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/28/2015] [Indexed: 11/18/2022] Open
Abstract
Background Deficit schizophrenia (DS) has been proposed as a pathophysiologically distinct subgroup within schizophrenia. Earlier studies focusing on neurocognitive function of DS patients have yielded inconsistent findings ranging from substantial deficits to no significant difference relative to non-deficit schizophrenia patients (NDS). The present study investigated the severity and characteristic patterns of neurocognitive impairments in DS and NDS patients and their relationships with clinical variables. Methods Attention, ideation fluency, cognitive flexibility and visuospatial memory function were assessed in 40 DS patients, 57 NDS patients, and 52 healthy controls by a comprehensive neuropsychological battery. Results Both schizophrenia subgroups had overall more severe cognitive impairments than controls while DS performed worse on every neuropsychological measure except the Stroop interference than the NDS patients with age and education as the covariates. Profile analysis found significantly different patterns of cognitive profiles between two patients group mainly due to their differences in attention and cognitive flexibility functions. Age, education, illness duration and negative symptoms were found to have the correlations with cognitive impairments in the NDS group, while only age and the negative symptoms were correlated with the cognitive impairments in the DS group. Multiple regression analyses revealed that sustained attention and cognitive flexibility were the core impaired cognitive domains mediating other cognitive functions in DS and NDS patients respectively. Conclusions DS patients exemplified worse in almost all cognitive domains than NDS patients. Sustained attention and cognitive flexibility might be the key impaired cognitive domains for DS and NDS patients respectively. The present study suggested the DS as a specific subgroup of schizophrenia.
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Affiliation(s)
- Miao Yu
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - XiaoWei Tang
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - Xiang Wang
- Medical Psychological Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - XiangRong Zhang
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
- * E-mail: (XRZ); (ZJZ)
| | - XiaoBin Zhang
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - WeiWei Sha
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - ShuQiao Yao
- Medical Psychological Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - XiangYang Zhang
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States of America
| | - ZhiJun Zhang
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
- * E-mail: (XRZ); (ZJZ)
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Hesse K, Kriston L, Wittorf A, Herrlich J, Wölwer W, Klingberg S. Longitudinal relations between symptoms, neurocognition, and self-concept in schizophrenia. Front Psychol 2015; 6:917. [PMID: 26191025 PMCID: PMC4490211 DOI: 10.3389/fpsyg.2015.00917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/19/2015] [Indexed: 12/18/2022] Open
Abstract
Objective: Cognitive models suggest that the self-concept of persons with psychosis can be fundamentally affected. Self-concepts were found to be related to different symptom domains when measured concurrently. Longitudinal investigations to disentangle the possible causal associations are rare. Method: We examined a sample of 160 people with a diagnosis of schizophrenia who took part in a psychotherapy study. All participants had the DSM-IV diagnosis of a schizophrenia and pronounced negative symptoms. Neurocognition, symptoms, and self-concepts were assessed at two time points 12 months apart. Structural equation modeling was used to test whether symptoms influence self-concepts (scar-model) or self-concepts affect symptoms (vulnerability model). Results: Negative symptoms correlated concurrently with self-concepts. Neurocognitive deficits are associated with more negative self-concepts 12 months later. Interpersonal self-concepts were found to be relevant for paranoia. Conclusion: The findings implicate that if deficits in neurocognition are present, fostering a positive self-concept should be an issue in therapy. Negative interpersonal self-concept indicates an increased risk for paranoid delusions in the course of 1 year. New aspects for cognitive models in schizophrenia and clinical implications are discussed.
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Affiliation(s)
- Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
| | - Jutta Herrlich
- Department of Psychiatry and Psychotherapy, University of Frankfurt Frankfurt, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duesseldorf Duesseldorf, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
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Abstract
Schizophrenia ranks among the leading causes of disability worldwide. The presence of neurological signs co-occurring with the psychiatric symptoms is indicative of an organic brain pathology. In the present article, we review the current literature on neurology issues in schizophrenia. Firstly, common neurological signs found in patients with schizophrenia (neurological soft signs and smell abnormalities) and their association with imaging findings are reviewed. Secondly, the significant association of schizophrenia with epilepsy and stroke is described as well as the absent association with other organic brain diseases such as multiple sclerosis. Thirdly, we discuss the potential role of NMDA receptor antibodies in schizophrenia. Fourthly, neurological side effects of antipsychotic drugs and their treatment are reviewed; and lastly, we discuss neurocognitive deficits in patients with schizophrenia and their treatment. The focus of the review remains on articles with relevance to the clinician.
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Affiliation(s)
- Katharina Hüfner
- Department of Psychiatry & Psychotherapy, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria,
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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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Bralet MC, Farhat SL, Gautier C, Hochard C, Lambert T. Intérêt d’une prise en charge intégrative en réhabilitation psycho-sociale chez les patients souffrant de schizophrénie : COMBIMOD. Eur Psychiatry 2014. [DOI: 10.1016/j.eurpsy.2014.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Plusieurs études montrent l’intérêt des programmes de remédiation cognitive et de psychoéducation dans la prise en charge des patients souffrant de schizophrénie dans le cadre de soins de réhabilitation psycho-sociale [1]. Ces programmes dispensés de façon isolée sont moins efficaces que ceux effectués dans une démarche de soins intégrative [2,3] et en impliquant l’ensemble des acteurs de soins et de réhabilitation (sanitaire, MDPH, médico-social, milieu professionnel). Depuis 2009, le centre intersectoriel Crisalid (pôle FJ5, CHI de Clermont de l’Oise, Picardie) propose un programme intégratif et personnalisé, appelé COMBIMOD (combinaison de modules de remédiation cognitive et d’éducation thérapeutique) destiné aux personnes souffrant de schizophrénie et à leurs proches habitant dans l’Oise, suivi par le sanitaire, le privé et le médico-social. Ce programme combine des modules de remédiation cognitive francophones validés à des modules d’éducation thérapeutique spécifiques construits autour des déficits cognitifs. L’objectif de ce poster est :– de décrire au travers du parcours de soins de 3 personnes souffrant de schizophrénie la mise en place du programme COMBIMOD (de l’importance de : l’entretien motivationnel, l’évaluation globale [clinique, thérapeutique, neurocognitive, cognition sociale, fonctionnelle], la restitution du bilan, la mise en place d’un programme personnalisé et intégratif) jusqu’à la réalisation des objectifs professionnels ;– montrer l’importance de l’articulation entre le sanitaire, le privé, le médico-social et le milieu professionnel.Au terme du programme et grâce à un travail d’articulation entre le sanitaire (secteur : CMP, hôpital de jour, CATTP), la MDPH, le médico-social (centre de réadaptation professionnelle et de formation, ESAT de transition) les 3 patients se sont réinsérer professionnellement en milieu ordinaire.
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Peña J, Ibarretxe-Bilbao N, García-Gorostiaga I, Gomez-Beldarrain MA, Díez-Cirarda M, Ojeda N. Improving functional disability and cognition in Parkinson disease: randomized controlled trial. Neurology 2014; 83:2167-74. [PMID: 25361785 PMCID: PMC4276404 DOI: 10.1212/wnl.0000000000001043] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: To examine the efficacy of an integrative cognitive training program (REHACOP) to improve cognition, clinical symptoms, and functional disability of patients with Parkinson disease (PD). Methods: Forty-two patients diagnosed with PD in Hoehn & Yahr stages 1 to 3 were randomly assigned to either the cognitive training group (REHACOP) or the control group (occupational activities) for 3 months (3 sessions, 60 min/wk). Primary outcomes were change on processing speed, verbal memory, visual memory, executive functioning, and theory of mind. Secondary outcomes included changes on neuropsychiatric symptoms, depression, apathy, and functional disability. The trial was registered with clinicaltrials.gov (NCT02118480). Results: No baseline group differences were found. Bootstrapped analysis of variance results showed significant differences in the mean change scores between the REHACOP group and control group in processing speed (0.13 [SE = 0.07] vs −0.15 [SE = 0.09], p = 0.025), visual memory (0.10 [SE = 0.10] vs −0.24 [SE = 0.09], p = 0.011), theory of mind (1.00 [SE = 0.37] vs −0.27 [SE = 0.29], p = 0.013), and functional disability (−5.15 [SE = 1.35] vs 0.53 [SE = 1.49], p = 0.012). Conclusions: Patients with PD receiving cognitive training with REHACOP demonstrated statistically significant and clinically meaningful changes in processing speed, visual memory, theory of mind, and functional disability. Future studies should consider the long-term effect of this type of intervention. These findings support the integration of cognitive training into the standard of care for patients with PD. Classification of evidence: This study provides Class II evidence that for patients with PD, an integrative cognitive training program improves processing speed, visual memory, theory of mind, and functional disability.
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Affiliation(s)
- Javier Peña
- From the Department of Methods and Experimental Psychology (J.P., N.I.-B., M.D.-C., N.O.), Faculty of Psychology and Education, University of Deusto, Bilbao, Basque Country; and Department of Neurology (I.G.-G., M.A.G.-B.), Galdakao Hospital, Basque Country, Spain
| | - Naroa Ibarretxe-Bilbao
- From the Department of Methods and Experimental Psychology (J.P., N.I.-B., M.D.-C., N.O.), Faculty of Psychology and Education, University of Deusto, Bilbao, Basque Country; and Department of Neurology (I.G.-G., M.A.G.-B.), Galdakao Hospital, Basque Country, Spain.
| | - Inés García-Gorostiaga
- From the Department of Methods and Experimental Psychology (J.P., N.I.-B., M.D.-C., N.O.), Faculty of Psychology and Education, University of Deusto, Bilbao, Basque Country; and Department of Neurology (I.G.-G., M.A.G.-B.), Galdakao Hospital, Basque Country, Spain
| | - Maria Angeles Gomez-Beldarrain
- From the Department of Methods and Experimental Psychology (J.P., N.I.-B., M.D.-C., N.O.), Faculty of Psychology and Education, University of Deusto, Bilbao, Basque Country; and Department of Neurology (I.G.-G., M.A.G.-B.), Galdakao Hospital, Basque Country, Spain
| | - María Díez-Cirarda
- From the Department of Methods and Experimental Psychology (J.P., N.I.-B., M.D.-C., N.O.), Faculty of Psychology and Education, University of Deusto, Bilbao, Basque Country; and Department of Neurology (I.G.-G., M.A.G.-B.), Galdakao Hospital, Basque Country, Spain
| | - Natalia Ojeda
- From the Department of Methods and Experimental Psychology (J.P., N.I.-B., M.D.-C., N.O.), Faculty of Psychology and Education, University of Deusto, Bilbao, Basque Country; and Department of Neurology (I.G.-G., M.A.G.-B.), Galdakao Hospital, Basque Country, Spain
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Fervaha G, Foussias G, Agid O, Remington G. Motivational and neurocognitive deficits are central to the prediction of longitudinal functional outcome in schizophrenia. Acta Psychiatr Scand 2014; 130:290-9. [PMID: 24850369 DOI: 10.1111/acps.12289] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Functional impairment is characteristic of most individuals with schizophrenia; however, the key variables that undermine community functioning are not well understood. This study evaluated the association between selected clinical variables and one-year longitudinal functional outcomes in patients with schizophrenia. METHOD The sample included 754 patients with schizophrenia who completed both baseline and one-year follow-up visits in the CATIE study. Patients were evaluated with a comprehensive battery of assessments capturing symptom severity and cognitive performance among other variables. The primary outcome variable was functional status one-year postbaseline measured using the Heinrichs-Carpenter Quality of Life Scale. RESULTS Factor analysis of negative symptom items revealed two factors reflecting diminished expression and amotivation. Multivariate regression modeling revealed several significant independent predictors of longitudinal functioning scores. The strongest predictors were baseline amotivation and neurocognition. Both amotivation and neurocognition also had independent predictive value for each of the domains of functioning assessed (e.g., vocational). CONCLUSION Both motivational and neurocognitive deficits independently contribute to longitudinal functional outcomes assessed 1 year later among patients with schizophrenia. Both of these domains of psychopathology impede functional recovery; hence, it follows that treatments ameliorating each of these symptoms should promote community functioning among individuals with schizophrenia.
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Affiliation(s)
- G Fervaha
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
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Millan MJ, Fone K, Steckler T, Horan WP. Negative symptoms of schizophrenia: clinical characteristics, pathophysiological substrates, experimental models and prospects for improved treatment. Eur Neuropsychopharmacol 2014; 24:645-92. [PMID: 24820238 DOI: 10.1016/j.euroneuro.2014.03.008] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/19/2014] [Indexed: 12/11/2022]
Abstract
Schizophrenia is a complex and multifactorial disorder generally diagnosed in young adults at the time of the first psychotic episode of delusions and hallucinations. These positive symptoms can be controlled in most patients by currently-available antipsychotics. Conversely, they are poorly effective against concomitant neurocognitive dysfunction, deficits in social cognition and negative symptoms (NS), which strongly contribute to poor functional outcome. The precise notion of NS has evolved over the past century, with recent studies - underpinned by novel rating methods - suggesting two major sub-domains: "decreased emotional expression", incorporating blunted affect and poverty of speech, and "avolition", which embraces amotivation, asociality and "anhedonia" (inability to anticipate pleasure). Recent studies implicate a dysfunction of frontocortico-temporal networks in the aetiology of NS, together with a disruption of cortico-striatal circuits, though other structures are also involved, like the insular and parietal cortices, amygdala and thalamus. At the cellular level, a disruption of GABAergic-glutamatergic balance, dopaminergic signalling and, possibly, oxytocinergic and cannibinoidergic transmission may be involved. Several agents are currently under clinical investigation for the potentially improved control of NS, including oxytocin itself, N-Methyl-d-Aspartate receptor modulators and minocycline. Further, magnetic-electrical "stimulation" strategies to recruit cortical circuits and "cognitive-behavioural-psychosocial" therapies likewise hold promise. To acquire novel insights into the causes and treatment of NS, experimental study is crucial, and opportunities are emerging for improved genetic, pharmacological and developmental modelling, together with more refined readouts related to deficits in reward, sociality and "expression". The present article comprises an integrative overview of the above issues as a platform for this Special Issue of European Neuropsychopharmacology in which five clinical and five preclinical articles treat individual themes in greater detail. This Volume provides, then, a framework for progress in the understanding - and ultimately control - of the debilitating NS of schizophrenia.
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Affiliation(s)
- Mark J Millan
- Pole of Innovation in Neuropsychiatry, Institut de Recherche Servier, 125 Chemin de Ronde, 78290 Croissy-sur-Seine, Paris, France.
| | - Kevin Fone
- School of Biomedical Sciences, Medical School, Queen׳s Medical Centre, Nottingham University, Nottingham NG72UH, UK
| | - Thomas Steckler
- Janssen Research and Development, Turnhoutseweg 30, 2340 Beerse, Belgium
| | - William P Horan
- VA Greater Los Angeles Healthcare System, University of California, Los Angeles, MIRECC 210A, Bldg. 210, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA
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