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Gebreegziabhere Y, Habatmu K, Cella M, Alem A. Development and Evaluation of a Cognitive Battery for People With Schizophrenia in Ethiopia. Schizophr Bull 2024; 50:931-943. [PMID: 38159078 PMCID: PMC11283194 DOI: 10.1093/schbul/sbad178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND HYPOTHESIS Cognitive difficulties significantly burdened people with schizophrenia (PWS). However, cognitive assessment is often unavailable in low- and middle-income counties (LMICs) due to a lack of validated and culturally adapted cognitive assessment tools. In this study, we developed and evaluated a culturally sensitive cognitive battery for PWS in Ethiopia. STUDY DESIGN This study was conducted in three phases. First, we selected appropriate tests through an instrument selection procedure and created a new battery. Then, we rigorously adapted the tests using culturally competent procedures, including cognitive interviewing and expert meetings. Finally, we tested the new battery in 208 PWS and 208 controls. We evaluated its psychometric properties using advanced statistical techniques, including Item Response Theory (IRT). STUDY RESULTS The Ethiopian Cognitive Assessment battery for Schizophrenia (ECAS) was developed from three different batteries. Participants reported tests were easy to complete, and the raters found them easy to administer. All tests had good inter-rater reliability, and the composite score had very high test-retest reliability (ICC = 0.91). One-factor structure better represented the data with excellent internal consistency (α = .81). ECAS significantly differentiated PWS from controls with 77% sensitivity and 62% specificity at a Z-score ≤0.12 cut-off value. IRT analysis suggested that the battery functions best among moderately impaired participants (difficulty between -0.06 and 0.66). CONCLUSIONS ECAS is a practical, tolerable, reliable, and valid assessment of cognition. ECAS can supplement current assessment tools in LAMICs for PWS and can be used to measure cognitive intervention outcomes.
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Affiliation(s)
- Yohannes Gebreegziabhere
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kassahun Habatmu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England, UK
| | - Atalay Alem
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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2
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Jacobs KA. Changes of intuition in paranoid personality disorder. Front Psychiatry 2024; 14:1307629. [PMID: 38268566 PMCID: PMC10807694 DOI: 10.3389/fpsyt.2023.1307629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/24/2023] [Indexed: 01/26/2024] Open
Abstract
Wherever psychopathology operates with the concept of (disorders of) the self and personality, it can address the role of the intuitive access we have toward ourselves, others, and the world. This study discusses the concept of oikeiôsis. It examines its role in explaining paranoia as a change in intuitive self-and-world relatedness. In the first step, symptomatic features of paranoid personality disorder are sketched, with a focus on the explanatory role of attentional and interpretative biases, which correlate with significant changes in intuitive processing. In the second step, the prototypical phenomenality of feelings of unfamiliarity and mistrust are discussed against the backdrop of changes of oikeiôsis in paranoid personality disorder. In the third step, the main therapeutic challenge in treating paranoid personality disorder-building a trustful relationship-is explored. It is concluded that the notion of oikeiôsis resonates particularly with introspection-based therapeutic approaches.
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Affiliation(s)
- Kerrin Artemis Jacobs
- Department of Philosophy, Ethics, and Religious Studies, University of Hokkaido, Sapporo, Japan
- Center for Human Nature, Artificial Intelligence, and Neuroscience (CHAIN), University of Hokkaido, Sapporo, Japan
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3
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Deste G, Kakli M, Barlati S, Nibbio G, Dossou P, Degila SL, Ceraso A, Lisoni J, Calzavara-Pinton I, Villa S, Vita A. Application of cognitive remediation in the world: new experiences from two schizophrenia rehabilitation centers in Togo and Benin. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-023-02603-z. [PMID: 38184811 DOI: 10.1007/s00127-023-02603-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE People with schizophrenia in Sub-Saharan Africa often live in very difficult conditions, suffer important social isolation and usually do not receive any kind of treatment. In this context, some non-governmental initiatives have come to light, providing accommodation, food, primary healthcare, medications and, in some cases, education and rehabilitation. The aims of this study were to assess feasibility, effects, and acceptability of a Cognitive Remediation Therapy (CRT) intervention in the particular context of psychiatric rehabilitation in Togo and Benin. METHODS Patients diagnosed with schizophrenia accessing the "Saint Camille" association rehabilitation centers in Togo and Benin during the enrollment period were allocated consecutively with a 1:1 proportion to receive a manualized CRT intervention (46 one-hour sessions over 14 weeks) or continuing Treatment As Usual (TAU). The assessment included validated measures of cognitive performance and real-world functioning and was performed at baseline and at the conclusion of treatment. RESULTS All subjects that were invited into the study agreed to participate and completed the intervention, for a total of 36 participants. CRT produced greater improvements than TAU in processing speed, working memory, verbal memory, cognitive flexibility, and executive functions measures, with moderate to large effect sizes, in particular in processing speed and working memory domains. CONCLUSIONS CRT represents a feasible and effective psychosocial intervention that can be implemented even in contexts with very limited resources, and could represent an important instrument to promote the rehabilitation process of people living with schizophrenia in low-income countries.
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Affiliation(s)
- Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mawuko Kakli
- Association Saint Camille de Lellis, Lomé, Togo
- Diocese of Aného, Aného, Togo
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
| | | | | | - Anna Ceraso
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Irene Calzavara-Pinton
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - Simona Villa
- Congregation "Suore Misericordine" mission in Fatebenefratelli Hospital of Afagnan, Afanyagan, Togo
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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Petkari E, Martín-María N, Sánchez-Gutiérrez T, Fernández-Castilla B, Calvo A. A meta-analysis of cognitive interventions for patients with recent onset psychosis: are they effective for improving functioning? Psychol Med 2023; 53:3306-3321. [PMID: 37161705 DOI: 10.1017/s0033291723001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The increasing popularity of cognitive interventions for patients with psychosis calls for further exploration on how these interventions may benefit functional outcomes. We conducted a meta-analysis of randomized controlled trials (RCTs) to examine the effectiveness of cognitive interventions (i.e. Cognitive Remediation, Cognitive Training, Social Cognition, and their combination) on functioning of patients with recent onset psychosis, established as the period within the first five years from the first episode. The following databases were searched: Proquest, PUBMED/MEDLINE, PsycINFO, WOS, Scopus for research published until January 2022. In total, 12 studies were eligible. The total number of participants was 759, of which 32.2% in the intervention and 30.8% in the control group were female. We extracted data to calculate the standardized mean change from pre-test to post-test comparing the intervention with the control conditions. Overall, there was no effect of any of the cognitive intervention types on functioning. None of the examined factors (intervention type, length, and modality; control condition, follow-up time; cognitive functions; medication; symptoms) seemed to moderate these findings. Our results indicate that cognitive interventions as standalone interventions do not appear to improve functioning in patients with recent onset psychosis. Given the small number of eligible studies, further RCTs with larger and more refined samples are needed to test whether these interventions should be applied as single interventions with these patients.
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Affiliation(s)
- Eleni Petkari
- Faculty of Health Sciences, Universidad Internacional de La Rioja (UNIR), Logroño, Spain
| | - Natalia Martín-María
- Department of Biological and Health Psychology, School of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | - Belén Fernández-Castilla
- Department of Methodology of Behavioral and Health Sciences, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Ana Calvo
- Department of Personality, Assessment and Clinical Psychology. School of Psychology. Universidad Complutense de Madrid, Madrid, Spain
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van Duin D, Winter LD, Kroon H, Veling W, van Weeghel J. Associations between learning principles of cognitive remediation and cognitive and vocational outcomes in early psychosis-an exploratory analysis of RCT data. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 37178165 DOI: 10.1080/23279095.2023.2199935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Most cognitive remediation (CR) programs are based on multiple scientific learning principles. The role of those learning principles in the beneficial effects of CR is poorly understood. A better understanding of such underlying mechanisms is important to further tailor the intervention and to learn about optimal contexts.Method: An explorative secondary analysis was conducted of data from a randomized controlled trial (RCT) comparing the effects of Individual Placement and Support (IPS) with and without CR. The present study evaluated how CR learning principles of "massed practice," "errorless learning," "strategy use" and "therapist contribution" (therapist fidelity) were associated with cognitive and vocational outcomes within 26 participants in this RCT who were treatment exposed.Results: Cognitive gains after CR were positively associated with "massed practice" and "errorless learning." Negative associations were found with "strategy use" and "therapist fidelity." No direct relationship was found between CR principles and vocational outcomes.Conclusions: Results tentatively suggest that CR is most effective and efficient with a good balance between sufficient intensity, of more than 200 tasks, and a limited duration of the training up to 20 h, using tasks that remain both challenging and rewarding, being applied in a context that facilitates real-life practice.
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Affiliation(s)
- Daniëlle van Duin
- Phrenos Center of Expertise, Utrecht, the Netherlands
- Trimbos Institute, Utrecht, the Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
| | | | - Hans Kroon
- Trimbos Institute, Utrecht, the Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jaap van Weeghel
- Phrenos Center of Expertise, Utrecht, the Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
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Landreth K, Burgess M, Watson L, Lorusso JM, Grayson B, Harte MK, Neill JC. Handling prevents and reverses cognitive deficits induced by sub-chronic phencyclidine in a model for schizophrenia in rats. Physiol Behav 2023; 263:114117. [PMID: 36781093 DOI: 10.1016/j.physbeh.2023.114117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
Treatments for schizophrenia are not effective in ameliorating cognitive deficits. Therefore, novel therapies are needed to treat cognitive impairments associated with schizophrenia (CIAS), which are modelled in rats through administration of sub-chronic phencyclidine (scPCP). We have previously shown that enrichment via voluntary exercise prevents and reverses impairments in novel object recognition (NOR) in this model. The present study aimed to investigate if handling could prevent delay-induced NOR deficits and prevent and reverse scPCP-induced NOR deficits. Two cohorts of adult female Lister Hooded rats were used. In experiment one, handling (five minutes/day, five days/week for two weeks), took place before scPCP administration (2 mg/kg, i.p. twice-daily for seven days). NOR tests were conducted at two, four, and seven weeks post-handling with a one-minute inter-trial interval (ITI) and at five weeks post-dosing with a six-hour ITI. In experiment two, rats were handled after scPCP administration and tested immediately in the one-minute ITI NOR task and again at two weeks post-handling. In both handling regimens, the scPCP control groups failed to discriminate novelty, conversely the scPCP handled groups significantly discriminated in this task. In the 6 h ITI test, vehicle control and scPCP control failed to discriminate novelty; however, the vehicle handled and scPCP handled groups did significantly discriminate. Handling rats prevented and reversed scPCP-induced deficits and prevented delay-induced NOR deficits. These findings add to evidence that environmental enrichment is a viable treatment for cognitive deficits in rodent tests and models of relevance to schizophrenia, with potential to translate into effective treatments for CIAS.
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Affiliation(s)
- K Landreth
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - M Burgess
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - L Watson
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - J M Lorusso
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - B Grayson
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom.
| | - M K Harte
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - J C Neill
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom; Medical Psychedelics Working Group, Drug Science, United Kingdom
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Goldberg Z, Kuslak B, Kurtz MM. A meta-analytic investigation of cognitive remediation for mood disorders: Efficacy and the role of study quality, sample and treatment factors. J Affect Disord 2023; 330:74-82. [PMID: 36868388 DOI: 10.1016/j.jad.2023.02.137] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND The number of randomized, controlled studies of cognitive remediation (CR) for mood disorders (major depressive disorder [MDD] and bipolar illness [BD]), has grown substantially over the past 10 years. The role of study quality, participant characteristics, and intervention features in CR treatment effects remains largely unknown. METHODS Electronic databases were searched up to February 2022 using variants of the key words: "cognitive remediation", "clinical trials", "major depressive disorder" and "bipolar disorder". This search produced 22 unique randomized, controlled trials that met all inclusion criteria for the study. Data were extracted by 3 authors with strong reliability (>90 %). Primary cognitive, and secondary symptom and functional outcomes were assessed with random effects models. RESULTS The meta-analysis (993 participants) revealed that CR produced significant small-to-moderate size effects in attention, verbal learning and memory, working memory and executive function (Hedge's g = 0.29-0.45). CR produced a small-moderate effect on one secondary outcome: depressive symptoms (g = 0.33). CR programs that used an individualized approach produced larger effects on executive function. Samples with lower baseline IQ were more likely to benefit from CR on measures of working memory. Sample age, education, gender, or baseline depressive symptomatology did not serve as barriers to treatment gains, and observed effects were not epiphenomena of poorer design quality. LIMITATIONS The number of RCTs remains low. CONCLUSIONS CR produces small to moderate improvements in cognition and depressive symptoms in mood disorders. Future research should study how CR might be optimized to help generalize CR-related cognitive and symptom improvements to function.
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Affiliation(s)
- Zoey Goldberg
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Judd Hall, 207 High Street, Middletown, CT 06459, United States
| | - Brina Kuslak
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Judd Hall, 207 High Street, Middletown, CT 06459, United States
| | - Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Judd Hall, 207 High Street, Middletown, CT 06459, United States.
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Lohaus T, Rogalla S, Thoma P. Use of Technologies in the Therapy of Social Cognition Deficits in Neurological and Mental Diseases: A Systematic Review. Telemed J E Health 2023; 29:331-351. [PMID: 35532968 DOI: 10.1089/tmj.2022.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: This article systematically reviews the effects of technology-based (TB) treatments on impaired social cognition (SC) in neurological and mental disorders. Methods: Strictly adhering to the PRISMA guidelines, a systematic search was carried out in PsycINFO, PubMed, and Web of Science (last search: April 22, 2021) to identify studies that, implementing a control group design, evaluated TB treatments targeting deficits in emotion recognition, Theory of Mind (ToM) and social behavior in adult patients with nondevelopmental and nonprogressive neurological or mental disorders. Risk of bias was assessed using the PEDro Scale, certainty assessment followed the GRADE approach. Results: Sixteen studies involving 857 patients, all focusing on psychotic disorders, were retrieved. The most pronounced effects were observed concerning emotion recognition with all studies revealing overall improvements. Regarding ToM and social behavior, results were mixed. However, the number of studies including outcome measures for these domains, is significantly lower compared to the domain of emotion recognition, limiting the validity of the results. Risk of bias and certainty assessment revealed further limitations of evidence. Conclusion: TB treatment achieves positive effects especially with regard to emotion recognition impairments, at least for patients with schizophrenia. Future research should expand the evaluation of TB training of other SC domains, ought to be carried out in more diverse patient populations, rely on different devices, and include follow-up measurements.
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Affiliation(s)
- Tobias Lohaus
- Neuropsychological Therapy Centre (NTC), Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Sally Rogalla
- Neuropsychological Therapy Centre (NTC), Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Patrizia Thoma
- Neuropsychological Therapy Centre (NTC), Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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Kumari S, Dahuja S, Singh U. Association of clinical factors with socio-occupational functioning among individuals with schizophrenia. Ind Psychiatry J 2023; 32:65-70. [PMID: 37274589 PMCID: PMC10236679 DOI: 10.4103/ipj.ipj_141_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/31/2021] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Background Schizophrenia is assumed to be developing into a marked disability affecting performances in educational and vocational fields for both males and females. It is a psychiatric disorder that has been proven to be associated with poor occupational skills and functioning. This research aimed at studying the clinical correlates of socio-occupational functioning skills of persons with schizophrenia as per the ICD-10, DCR criteria. Materials and Methods The is a cross-sectional descriptive study that included 200 participants diagnosed with schizophrenia, in which sociode mographic and clinical data sheet and Socio-occupational Functioning Scale (SOFS) by Saraswat et al. were used. Results Mean age of the participants was 34 years, with onset of illness being 24 years of age. The results indicated significant correlation at 0.05 level between the total score of SOFS and age of onset and duration of illness. Conclusion It can be concluded that for a better treatment outcome in a disorder like schizophrenia, bio-psychosocial model of treatment is necessary.
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Affiliation(s)
- Sunita Kumari
- Department of Psychiatric Social Work, CEIMH, ABVIMS-Dr. RMLH, New Delhi, India
| | - Shrishti Dahuja
- Department of Psychiatry, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Upendra Singh
- Department of Psychiatric Social Work, CEIMH, ABVIMS-Dr. RMLH, New Delhi, India
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Datta R, Vishwanath R, Shenoy S. Are remote psychotherapy/remediation efforts accessible and feasible in patients with schizophrenia? A narrative review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:136. [PMID: 36415756 PMCID: PMC9673189 DOI: 10.1186/s41983-022-00574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cognitive remediation (CR) therapy provides an effective way to improve cognitive impairments in schizophrenia. With the advent of telehealth services, especially during COVID 19 pandemic, a suitable alternative can be found in computer and cell phone-based mental health interventions. Previous studies have proven that remote mental health interventions have by and large been successful. Remote psychotherapy/CR services can now be accessed through smartphone apps, iPads, laptops and wearable devices. This has the advantage of reaching a wider population in resource-limited settings. The lack of access to technology, difficulty in using these online interventions and lack of privacy provide impediments to the delivery of care through these online platforms. Further, as some previous studies have shown, there may be a high rate of dropout in people using remote mental health resources. We aim to look at the factors, which influence the accessibility of remote mental health interventions in schizophrenia. Additionally, we test the feasibility of these interventions and look at how they compare and the potential they hold for implementation in future clinical settings. Results We found remote cognitive remediation to be both accessible and feasible. Concerning features, however, are the high attrition rates and the concentration of the studies in Western populations. Conclusions Remote interventions are a viable alternative to in-person psychotherapy when in-person resources may not always be present. They are efficacious in improving health outcomes among patients with schizophrenia. Further research into the widespread implementation of remote CR will be beneficial in informing clinical decision-making.
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Buonocore M, Spangaro M, Bechi M, Trezzani S, Terragni R, Martini F, Agostoni G, Cocchi F, Cuoco F, Guglielmino C, Bosia M, Cavallaro R. Cognitive remediation in schizophrenia: What happens after 10 years? Schizophr Res Cogn 2022; 29:100251. [PMID: 35402166 PMCID: PMC8983434 DOI: 10.1016/j.scog.2022.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 10/26/2022]
Abstract
Cognitive Remediation Therapy (CRT) represents the gold standard treatment for cognitive impairment in schizophrenia, but the permanence of its effects over time have been poorly investigated. Our study aims to evaluate long lasting cognitive and functional effects of CRT together with standard rehabilitation interventions (SRT) in a group of patients diagnosed with schizophrenia, 10 years after the end of the treatment. Forty patients, previously included in a 5-year follow-up study evaluating the effects of CRT combined with SRT, were revalued 10 years after the complete of the intervention. Results revealed that cognitive and functional improvements of combined CRT/SRT interventions are still preserved 10 years after the end of the treatments, with the only exception of psychomotor speed and coordination cognitive subdomain. Moreover, investigating persistence of the influence of SRT, patients that underwent a shorter SRT following CRT (six months vs one year) showed worsened processing speed abilities. This is the first study confirming that cognitive and functional improvements of joint CRT/SRT interventions are still conserved 10 years after the end of the treatments. Preliminary datas suggest that a longer SRT following CRT may lead to significant benefits, in terms of cognitive gains, in patients affected by schizophrenia.
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Affiliation(s)
- Mariachiara Buonocore
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Spangaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Margherita Bechi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Francesca Martini
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Federica Cocchi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Cuoco
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmelo Guglielmino
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Bosia
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Seccomandi B, Agbedjro D, Keefe RS, Galderisi S, Fiszdon J, Mucci A, Wykes T, Cella M. Evaluating how treatment adherence influences cognitive remediation outcomes. Behav Res Ther 2022; 158:104186. [DOI: 10.1016/j.brat.2022.104186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/02/2022]
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The network structure of cognitive deficits in first episode psychosis patients. Schizophr Res 2022; 244:46-54. [PMID: 35594732 DOI: 10.1016/j.schres.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 08/26/2021] [Accepted: 05/09/2022] [Indexed: 11/20/2022]
Abstract
Network analysis is an important conceptual and analytical approach in mental health research. However, few studies have used network analysis to examine the structure of cognitive performance in psychotic disorders. We examined the network structure of the cognitive scores of a sample of 207 first-episode psychosis (FEP) patients and 188 healthy controls. Participants were assessed using a battery of 10 neuropsychological tests. Fourteen cognitive scores encompassing six cognitive domains and premorbid IQ were selected to perform the network analysis. Many similarities were found in the network structure of FEP patients and healthy controls. Verbal memory, attention, working memory and executive function nodes were the most central nodes in the network. Nodes in both groups corresponding to the same tests tended to be strongly connected. Verbal memory, attention, working memory and executive function were central dimensions in the cognitive network of FEP patients and controls. These results suggest that the interplay between these core dimensions is essential for demands to solve complex tasks, and these interactions may guide the aims of cognitive rehabilitation. Network analysis of cognitive dimensions might have therapeutic implications that deserve further research.
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Clinicians’ Approach to Cognitive Impairment After Electroconvulsive Therapy: Current Situations and Challenges. ARCHIVES OF NEUROSCIENCE 2022. [DOI: 10.5812/ans.120762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Electroconvulsive therapy (ECT) is one of the most effective treatments for severe refractory mental diseases. Widespread cognitive complications have affected the acceptance of this treatment. Despite current evidence of short-term cognitive impairment, long-term cognition consequences are less determined. Objectives: This study aimed to evaluate the clinical approach of psychiatrists, psychiatry residents, and nurses in psychiatric hospitals to the necessity, method, and frequency of cognitive assessment in candidate patients for ECT. Methods: In this descriptive study, 89 professional members of Roozbeh and Razi hospitals, Tehran, Iran, including nurses, residents, and faculty members of psychiatry, were selected using the purposive sampling method. The research questionnaires were sent, and 58 fulfilled questionnaires were sent back. The data were analyzed using central indicators and statistical dispersion. The designed questionnaire included the items related to the specialists’ views on the necessity of post-ECT cognitive evaluations, best batteries, frequency of performing the tests, and other related domains. Results: After close follow-up, 58 out of 89 participants completed the questionnaires, including 17 psychiatrists (29.3%), 20 nurses (34.5%), and 21 psychiatry residents (36.2%). The results were analyzed and interpreted in detail. The average work experience of respondents in the psychiatry field was 6.89 years (range: 1 - 25 years). Additionally, 97% of the specialists did not have any project in the ECT field and cognitive disorders. More than 80% of the participants believed that cognition evaluation is necessary for ECT-candidate patients; however, only 15% of the specialists referred patients for the assessment. Moreover, 43% of the experts recommended the Wechsler Memory Scale-Revised; nevertheless, nearly 26% of the experts recommended the Delis-Kaplan Executive Function System for the cognitive assessment of these patients. The Rey Auditory Verbal Learning Test was recommended by 20% of the experts. Nearly two-thirds of the respondents believed that a proper assessment should be carried out in about 30 minutes. More than 60% of the experts believed that patients should be evaluated before receiving the first session of ECT, and nearly one-third of the experts recommended only a post-ECT evaluation. More than half of the experts believed that ECT should be discontinued in case of severe cognitive impairment after ECT. Alternatively, less than 30% of the experts believed that it is necessary to make changes in the treatment dose and the interval between sessions. Furthermore, 80% of the experts recommended cognitive rehabilitation for patients with significant cognitive impairment after ECT; nonetheless, less than 20% of the experts recommended treatment with a cholinesterase inhibitor. Conclusions: A large percentage of patients do not undergo a comprehensive cognitive assessment after ECT, which is an important challenge in the estimation of post-ECT cognitive decline. There is a need to design inexpensive and sensitive tests for cognitive assessment. The test could measure different cognitive domains and be acceptable in terms of time. Due to the limited number of specialists working in this field, the frequency of assessment and treatment methods after the identification of cognitive disorders are heterogeneous. Therefore, it is required to design a native and practical guideline. These results could help the researchers design future studies to determine the best method of cognitive evaluation after ECT, appropriate batteries, recommended intervals, and treatment decisions after cognitive decline detection.
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Bourke E, Barker C, Fornells-Ambrojo M. Systematic review and meta-analysis of therapeutic alliance, engagement, and outcome in psychological therapies for psychosis. Psychol Psychother 2021; 94:822-853. [PMID: 33569885 DOI: 10.1111/papt.12330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/16/2021] [Indexed: 01/07/2023]
Abstract
AIM The moderate association between therapeutic alliance (TA) and psychological therapy outcome is well established. Historically, the field has not focused on people with a severe mental illness. This is the first review to conduct a meta-analysis of associations between TA and therapeutic engagement as well as outcome in psychological therapy for psychosis. ELIGIBILITY CRITERIA Eligible studies conducted a quantitative investigation of the relationship between TA during a psychological therapy and outcome at a subsequent time-point. METHOD A systematic review examined the relationship between TA and engagement as well as outcome measures within psychological therapy for psychosis. Correlational meta-analyses using an aggregate random effects model were conducted. RESULTS Twenty-four studies were eligible for inclusion (n = 1,656) of which 13 were included in the meta-analyses. Client- and therapist-rated TA were associated with engagement in therapy (rclient (c) = 0.36, p = .003; rtherapist (t) = 0.40, p = .0053). TA was also associated with reduction in global (rc = 0.29, p = .0005; rt = 0.24, p = .0015) and psychotic symptoms (rc = 0.17, p = .0115; rt = 0.30, p = .0003). The systematic review identified no evidence or limited evidence for a relationship between TA during therapy and depression, substance use, physical health behaviours, global as well as social functioning, overall mental health recovery, and self-esteem at follow-up. Although number of studies was small, TA was related to a reduced risk of subsequent hospitalization in 40% of analyses (across two studies) and improved cognitive outcome in 50% of analyses (across three studies). CONCLUSIONS The observed TA-therapy engagement and TA-outcome associations were broadly consistent with those identified across non-psychotic diagnostic groups. Well-powered studies are needed to investigate the relationship between TA and process as well as outcome in psychological therapy for psychosis specifically. PRACTITIONER POINTS This is the first review to conduct a meta-analytic synthesis of the association between therapeutic alliance (TA) and both engagement and change in outcome in psychological therapies for psychosis. TA (as rated by therapist and client) was associated with the extent of therapeutic engagement as well as reduction in global mental health symptoms and psychotic symptoms. The significant associations between TA and engagement as well as change in outcome identified in the current review are broadly consistent with those observed across non-psychotic diagnostic groups. We consider factors that could impact upon the dynamic and potentially interdependent relationships between TA and therapeutic techniques, including attachment security and severity of paranoid ideation.
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Affiliation(s)
- Emilie Bourke
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chris Barker
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Miriam Fornells-Ambrojo
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Singhal V, Heuer AJ, York J, Gill KJ. The Effects of Oral Health Instruction, and the Use of a Battery-Operated Toothbrush on Oral Health of Persons with Serious Mental Illness: A Quasi-Experimental Study. Community Ment Health J 2021; 57:357-364. [PMID: 32519153 DOI: 10.1007/s10597-020-00657-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 06/05/2020] [Indexed: 11/26/2022]
Abstract
People with a diagnosis of serious mental illness (SMI) have a greater incidence of poorer oral health as compared to the general population. The aim of this quasi-experimental study was to determine the effect that a combination of the use of a battery-operated toothbrush and a related educational intervention may have on the oral health of individuals with serious mental illness. Key findings include that the battery-operated toothbrush resulted in a significant improvement in the mean change in gingival index, a common indicator of oral health. The study also found that oral home care instructions, smoking and level of negative symptoms did not have an effect on the mean change in plaque or gingival indices. This project suggests that the implementation of a relatively simple, cost effective measures such as a battery-operated toothbrush may have a positive impact on the oral health in this population.
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Affiliation(s)
- Vaishali Singhal
- Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07107, USA.
| | - Albert J Heuer
- Rutgers School of Health Professions, 65 Bergen Street, Newark, NJ, 07107, USA
| | - Jill York
- Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ, 07103, USA
| | - Kenneth J Gill
- Rutgers School of Health Professions, 675 Hoes Lane West, Piscataway, NJ, 08854, USA
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Seccomandi B, Agbedjro D, Bell M, Keefe RSE, Keshavan M, Galderisi S, Fiszdon J, Mucci A, Cavallaro R, Ojeda N, Peña J, Müller D, Roder V, Wykes T, Cella M. Exploring the role of age as a moderator of cognitive remediation for people with schizophrenia. Schizophr Res 2021; 228:29-35. [PMID: 33429151 DOI: 10.1016/j.schres.2020.11.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/05/2020] [Accepted: 11/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND While Cognitive Remediation (CR) is effective in reducing cognitive and functioning difficulties in people with schizophrenia, there is variability in treatment response. Previous research suggested that participants' age may be a significant moderator of CR response. AIM To examine the impact of participants' age on CR outcomes. METHOD Individual participant data were accessed from fourteen CR randomised controlled trials. We tested the moderating effect of participants' age on cognitive and functioning outcomes using multivariate linear models. RESULTS Data from 1084 people with a diagnosis of schizophrenia were considered. Participants had a mean age of 36.6 years (SD 11), with 11.6 years of education (SD 2.8), and an average duration of illness of 13.5 years (SD 10.7). Multivariate models showed that participants' age, when considered as a continuous variable, was not a significant moderator of treatment effect for cognitive and functioning outcomes. However, when participants were split by median age, younger participants showed higher gains in executive functions following CR compared to older participants (p=0.02). CONCLUSION These results suggest that participants' age does not moderate most CR outcomes. However, larger age differences may influence the effect of CR on executive function. This may suggest some adaptation of CR practice according to participants' age. These findings inform the CR personalisation agenda.
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Affiliation(s)
- Benedetta Seccomandi
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Deborah Agbedjro
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Morris Bell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Richard S E Keefe
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Silvana Galderisi
- Department of Psychiatry, Seconda Universita degli Studi di Napoli, Naples, Italy
| | - Joanna Fiszdon
- Department of Psychology, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Armida Mucci
- Department of Psychiatry, Seconda Universita degli Studi di Napoli, Naples, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, Scientific Institute San Raffaele, Milan, Italy
| | - Natalia Ojeda
- Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Daniel Müller
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Volker Roder
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - 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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18
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Välimäki M, Yang M, Lam YTJ, Lantta T, Palva M, Palva S, Yee B, Yip SH, Yu KSD, Chang HCC, Cheng PYI, Bressington D. The impact of video gaming on cognitive functioning of people with schizophrenia (GAME-S): study protocol of a randomised controlled trial. BMC Psychiatry 2021; 21:46. [PMID: 33461506 PMCID: PMC7814579 DOI: 10.1186/s12888-020-03031-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/22/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Video gaming is a promising intervention for cognitive and social impairment in patients with schizophrenia. A number of gaming interventions have been evaluated in small-scale studies with various patient groups, but studies on patients with schizophrenia remain scarce and rarely include the evaluation of both clinical and neurocognitive outcomes. In this study, we will test the effectiveness of two interventions with gaming elements to improve cognitive and clinical outcomes among persons with schizophrenia. METHODS The participants will be recruited from different outpatient units (e.g., outpatient psychiatric units, day hospitals, residential care homes). The controlled clinical trial will follow a three-arm parallel-group design: 1) cognitive training (experimental group, CogniFit), 2) entertainment gaming (active control group, SIMS 4), and 3) treatment as usual. The primary outcomes are working memory function at 3-month and 6-month follow-ups. The secondary outcomes are patients' other cognitive and social functioning, the ability to experience pleasure, self-efficacy, and negative symptoms at 3-month and 6-month follow-ups. We will also test the effectiveness of gaming interventions on neurocognitive outcomes (EEG and 3 T MRI plus rs-fMRI) at a 3-month follow-up as an additional secondary outcome. Data will be collected in outpatient psychiatric services in Hong Kong. Participants will have a formal diagnosis of schizophrenia and be between 18 and 60 years old. We aim to have a total of 234 participants, randomly allocated to the three arms. A sub-sample of patients (N = 150) will be recruited to undergo an EEG. For neuroimaging assessment, patients will be randomly allocated to a subset of patients (N=126). We will estimate the efficacy of the interventions on the primary and secondary outcomes based on the intention-to-treat principle. Behavioural and EEG data will be analysed separately. DISCUSSION The study will characterise benefits of gaming on patients' health and well-being, and contribute towards the development of new treatment approaches for patients with schizophrenia. TRIAL REGISTRATION ClinicalTrials.gov NCT03133143 . Registered on April 28, 2017.
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Affiliation(s)
- Maritta Välimäki
- Xiangya Nursing School, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China. .,School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, Hong Kong SAR. .,Department of Nursing Science, Faculty of Medicine, University of Turku, 20014, Turku, Finland.
| | - Min Yang
- grid.13291.380000 0001 0807 1581West China School of Public Health, Sichuan University, Chengdu, China ,grid.1027.40000 0004 0409 2862Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Victoria 3122 Australia
| | - Yuen Ting Joyce Lam
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, Hong Kong SAR
| | - Tella Lantta
- grid.1374.10000 0001 2097 1371Department of Nursing Science, Faculty of Medicine, University of Turku, 20014 Turku, Finland
| | - Matias Palva
- grid.7737.40000 0004 0410 2071Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Satu Palva
- grid.7737.40000 0004 0410 2071Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Benjamin Yee
- grid.16890.360000 0004 1764 6123Department of Rehabilitation Sciences, Hung Hom, Kowloon, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR
| | - Siu Hung Yip
- grid.415504.10000 0004 1794 2766Department of Psychiatry, Kowloon Hospital, Hong Kong, Hong Kong SAR
| | - Kin-sun Dan Yu
- The Mental Health Association of Hong Kong, 2 Kung Lok Road, Hong Kong, Hong Kong SAR
| | - Hing Chiu Charles Chang
- grid.194645.b0000000121742757Department of Diagnostic Radiology, The Hong Kong Jockey Club for Interdisciplinary Research, The University of Hong Kong, 5 Sassoon Road, Hong Kong, Hong Kong SAR
| | - Po Yee Ivy Cheng
- grid.417134.40000 0004 1771 4093Department of Psychiatry, Community Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong SAR
| | - Daniel Bressington
- grid.1043.60000 0001 2157 559XCollege of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
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Seccomandi B, Agbedjro D, Bell M, Keefe RSE, Keshavan M, Galderisi S, Fiszdon J, Mucci A, Cavallaro R, Bechi M, Ojeda N, Peña J, Wykes T, Cella M. Can IQ moderate the response to cognitive remediation in people with schizophrenia? J Psychiatr Res 2021; 133:38-45. [PMID: 33307353 DOI: 10.1016/j.jpsychires.2020.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND IQ and IQ decline are considered risk factors for poor prognosis in people with a diagnosis of schizophrenia. However, it is still not clear if, at least in part, IQ and IQ decline influence long-term outcomes via a negative effect on interventions. AIM To identify whether current IQ, estimated premorbid IQ, or IQ decline moderate the response to cognitive remediation (CR). METHOD Individual participant data from twelve randomised controlled trials of CR were considered. Hierarchical and k-means analyses were carried out to identify different IQ clusters. The moderating effect of estimated premorbid IQ, current IQ, and different IQ clusters (preserved, deteriorated and compromised trajectories) on cognitive outcomes at post-therapy and follow-up were evaluated using multiple linear regression. RESULTS Data from 984 participants (CR = 544, control = 440) with schizophrenia and schizoaffective disorders were considered. The sample had a mean current IQ of 84.16 (SD 15.61) and estimated premorbid IQ of 95.82 (SD 10.63). Current IQ moderated working memory outcomes: people with higher IQ had larger working memory gains after therapy compared to those with a lower IQ. Those with a preserved IQ had better cognitive outcomes compared to either the deteriorated or compromised IQ groups, and those with a deteriorated IQ had better outcomes compared to those in the compromised IQ group. CONCLUSION Current IQ is a significant moderator of cognitive gains after CR. These findings highlight the need to evaluate whether therapy adaptations (e.g. offering more sessions) can attenuate this effect so that those with lower IQ may derive benefit similar to those with higher IQ.
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Affiliation(s)
- Benedetta Seccomandi
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Deborah Agbedjro
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Morris Bell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Richard S E Keefe
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Joanna Fiszdon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, Vita Salute San Raffaele University and Scientific Institute San Raffaele Hospital, Milan, Italy
| | - Margherita Bechi
- Department of Clinical Neurosciences, Vita Salute San Raffaele University and Scientific Institute San Raffaele Hospital, Milan, Italy
| | - Natalia Ojeda
- Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - 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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20
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Transcranial direct current stimulation and working memory: Comparison of effect on learning shapes and English letters. PLoS One 2020; 15:e0222688. [PMID: 32706780 PMCID: PMC7380606 DOI: 10.1371/journal.pone.0222688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 06/25/2020] [Indexed: 11/25/2022] Open
Abstract
We present the results of a study investigating whether there is an effect of Anodal-Transcranial Direct Current Stimulation (A-tDCS) on working memory (WM) performance. The relative effectiveness of A-tDCS on WM is investigated using a 2-back test protocol using two commonly used memory visual stimuli (shapes and letters). In a double-blinded, randomised, crossover, sham-controlled experiment, real A-tDCS and sham A-tDCS were applied separately to the left dorsolateral prefrontal cortex (L-DLPFC) of twenty healthy subjects. There was a minimal interval of one week between sham and real A-tDCS sessions. For the letters based stimulus experiment, 2-back test recall accuracy was measured for a set of English letters (A-L) which were presented individually in a randomised order where each was separated by a blank interval. A similar 2-back protocol was used for the shapes based stimuli experiment where instead of letters, a set of 12 geometric shapes were used. The working memory accuracy scores measured appeared to be significantly affected by memory stimulus type used and by the application of A-tDCS (repeated measures ANOVA p<0.05). A large effect size (d = 0.98) and statistical significance between sham and real A-tDCS WM scores (p = 0.01) was found when shapes were used as a visual testing stimulus, while low (d = 0.38) effect size and insignificant difference (p = 0.15) was found when letters were used. This results are important as they show that recollection different stimuli used in working memory can be affected differently by A-tDCS application. This highlights the importance of considering using multiple methods of WM testing when assessing the effectiveness of A-tDCS.
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Tan S, Zhu X, Fan H, Tan Y, Yang F, Wang Z, Zhao Y, Fan F, Guo J, Li Z, Quan W, Wang X, Reeder C, Zhou D, Zou Y, Wykes T. Who will benefit from computerized cognitive remediation therapy? Evidence from a multisite randomized controlled study in schizophrenia. Psychol Med 2020; 50:1633-1643. [PMID: 31298171 PMCID: PMC7408576 DOI: 10.1017/s0033291719001594] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 06/05/2019] [Accepted: 06/14/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Computerized cognitive remediation therapy (CCRT) is generally effective for the cognitive deficits of schizophrenia. However, there is much uncertainty about what factors mediate or moderate effectiveness and are therefore important to personalize treatment and boost its effects. METHOD In total, 311 Chinese inpatients with Diagnostic and Statistical Manual of Mental Disorders-IV schizophrenia were randomized to receive CCRT or Active control for 12 weeks with four to five sessions per week. All participants were assessed at baseline, post-treatment and 3-month follow-up. The outcomes were cognition, clinical symptoms and functional outcomes. RESULTS There was a significant benefit in the MATRICS Consensus Cognitive Battery (MCCB) total score for CCRT (F1,258 = 5.62; p = 0.02; effect size was 0.27, 95% confidence interval 0.04-0.49). There were no specific moderators of CCRT improvements. However, across both groups, Wisconsin Card Sort Test improvement mediated a positive effect on functional capacity and Digit Span benefit mediated decreases in positive symptoms. In exploratory analyses younger and older participants showed cognitive improvements but on different tests (younger on Symbol Coding Test, while older on the Spatial Span Test). Only the older age group showed MSCEIT benefits at post-treatment. In addition, cognition at baseline negatively correlated with cognitive improvement and those whose MCCB baseline total score was around 31 seem to derive the most benefit. CONCLUSIONS CCRT can improve the cognitive function of patients with schizophrenia. Changes in cognitive outcomes also contributed to improvements in functional outcomes either directly or solely in the context of CCRT. Age and the basic cognitive level of the participants seem to affect the cognitive benefits from CCRT.
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Affiliation(s)
- Shuping Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Xiaolin Zhu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Hongzhen Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Yunlong Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Yanli Zhao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Fengmei Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Junhua Guo
- Beijing Anding Hospital of Capital Medical University, Beijing100088, P.R. China
| | - Zhanjiang Li
- Beijing Anding Hospital of Capital Medical University, Beijing100088, P.R. China
| | - Wenxiang Quan
- Institute of Mental Health, Peking University, Beijing100191, P.R. China
| | - Xiangqun Wang
- Institute of Mental Health, Peking University, Beijing100191, P.R. China
| | - Clare Reeder
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, LondonSE5 8AF, UK
| | - Dongfeng Zhou
- Institute of Mental Health, Peking University, Beijing100191, P.R. China
| | - Yizhuang Zou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing100096, P.R. China
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, LondonSE5 8AF, UK
- South London and Maudsley NHS Foundation Trust
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Otto LKM, Hofstra J, Mullen MG, Malenczak D, Boonstra N, van der Meer L, Veling W, Boerhout C, van Rijsbergen GD, de Vries J, van der Pol B, Pijnenborg GHM, Korevaar L. A cognitive remediation training for young adults with psychotic disorders to support their participation in education - study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2020; 6:54. [PMID: 32355565 PMCID: PMC7187485 DOI: 10.1186/s40814-020-00579-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background Most severe mental disorders have their onset between the age of 17 and 27, a time when many young adults begin participating in secondary or post-secondary education. The cognitive deficits typically associated with psychiatric disorders, especially psychotic disorders, increase the risk of leaving school early, which can lead to a reduction in employment opportunities later on in life and, in turn, a poorer long-term prognosis. Therefore, specific interventions aiming to improve these cognitive functions are needed. Cognitive remediation (CR) aims to improve cognitive functioning and may increase real-world functioning in educational performance. This study aims to examine the feasibility and applicability of a CR training named Mindset for students with psychotic disorders in the Netherlands. Methods/design Sixty students diagnosed with a psychotic disorder and currently reporting cognitive deficits will be included from four Dutch Mental Health Care institutes. Half of the participants (N = 30) will be randomly assigned to the CR training consisting of twelve, individual, weekly 1-h meetings. The other half will be assigned to an active control condition consisting of twelve weekly assignments that will be sent by email aiming to improve school performance. Students will be evaluated at baseline (T0), directly after finishing the CR training or control intervention (T1), and 6 months later (T2). Treatment feasibility will be the primary outcome, using evaluation forms, interviews with trainers and participants, number of study drop outs, and patient eligibility and recruitment rates. School functioning, cognitive functioning, and strategy use will also be assessed to get a preliminary idea of the potential effectiveness of the intervention. Discussion The CR training in this study will provide real-world examples and exercises aimed to teach useful strategies to cope with the cognitive deficits experienced by students with psychotic disorders. Furthermore, since students with other psychiatric disorders might also experience cognitive deficits, the results of this study may also provide some further implications for future studies on the effect of this CR training for students with these disorders. Trial registration The study was registered with Trialregister.nl, no. NL6590 (NTR6764), date registered: September 7, 2017. Register name: Mindset. A cognitive rehabilitation training for young adults with psychotic spectrum disorder in an educational setting: A pilot study. Protocol version: 3, date December 23, 2019
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Affiliation(s)
- Lana K M Otto
- 1Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Zernikeplein 23, 9747 AS Groningen, The Netherlands.,2Faculty of Behavioural and Social Sciences, Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Jacomijn Hofstra
- 1Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Zernikeplein 23, 9747 AS Groningen, The Netherlands
| | - Michelle G Mullen
- 3Transitions to Adulthood Center for Research, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA 01545 USA
| | - Derek Malenczak
- 4Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers University, 675 Hoes Lane West, Piscataway, NJ 08854 USA
| | - Nynke Boonstra
- Department of Research and Education, Friesland Mental Health Services, PO Box 932, 8901 BS Leeuwarden, The Netherlands.,NHL Stenden University of Applied Science, Research group Care & Welfare, Rengerslaan 8, 8917 DD Leeuwarden, The Netherlands
| | - Lisette van der Meer
- 7Department of Rehabilitation, Lentis Psychiatric Institute, E 035, 9471 KA, Zuidlaren, The Netherlands.,8Rob Giel Research Center, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands.,9Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Wim Veling
- 10University Center for Psychiatry, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Cees Boerhout
- 10University Center for Psychiatry, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | | | - Jos de Vries
- 10University Center for Psychiatry, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Boudien van der Pol
- Department of Research and Education, Friesland Mental Health Services, PO Box 932, 8901 BS Leeuwarden, The Netherlands
| | - Gerdina H M Pijnenborg
- 2Faculty of Behavioural and Social Sciences, Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.,11GGz Drenthe Mental Health Institution, Dennenweg 9, 9404 LA Assen, The Netherlands
| | - Lies Korevaar
- 1Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Zernikeplein 23, 9747 AS Groningen, The Netherlands
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Hodgins S, Cree A, Khalid F, Patel K, Sainz-Fuentes R, Shortt M, Mak T, Riaz M. Do community mental health teams caring for severely mentally ill patients adjust treatments and services based on patients’ antisocial or criminal behaviours? Eur Psychiatry 2020; 24:373-9. [DOI: 10.1016/j.eurpsy.2009.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 07/20/2009] [Accepted: 07/20/2009] [Indexed: 11/25/2022] Open
Abstract
AbstractBackgroundAntisocial behaviour is common among patients with severe mental illness (SMI) requiring hospitalisation.AimTo determine whether differential treatments and services are provided to patients with SMI who engage in antisocial behaviour.MethodA random sample of 161 inpatients with SMI were recruited from general adult wards and assessed at baseline and two years later. Information on symptoms, aggressive behaviour, substance misuse, and service use was obtained from patients and clinical files.ResultsPast antisocial behaviours were not associated with type or intensity of treatments and services. Severity of positive symptoms, aggressive behaviour, and illicit drug use were positively associated with the frequency of CMHT contact, but not with the type of CMHT, type of medication, or other treatments and benefits.ConclusionsWhile the frequency of meetings with CMHTs increased with the severity of antisocial behaviours, no specific treatments were provided to patients with SMI engaging in antisocial behaviours.
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Thuaire F, Rondepierre F, Bacon E, Vallet GT, Jalenques I, Izaute M. Executive functions in schizophrenia aging: Differential effects of age within specific executive functions. Cortex 2019; 125:109-121. [PMID: 31981891 DOI: 10.1016/j.cortex.2019.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/19/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022]
Abstract
There are common cognitive and brain abnormalities in schizophrenia and healthy aging which may cumulate in schizophrenia aging. However, the course of executive deficits in late-life schizophrenia is still controversial as it remains unclear whether schizophrenia patients show accelerated aging. The use of specific models of executive functions might help to shed new lights on this issue. The aim of this study was then to determine how each of the four specific executive functions (shifting, updating, inhibition and access to long-term memory) is affected by aging in schizophrenia compared to healthy aging. 20 younger (age 18-34), 17 middle-aged (age 35-49) and 25 older (age 59-76) schizophrenia patients and 62 healthy comparison participants matched for gender, age and education performed a neurocognitive battery evaluating the four specific executive functions. Schizophrenia patients performed worse than comparison participants on shifting, updating and access, whereas inhibition appeared preserved. Age affected the four functions with increased degradation of shifting and access in schizophrenia patients, whereas updating and inhibition showed a normal decline with age. These results suggest a vulnerability of prefrontal and cingulate cortexes in schizophrenia aging. Moreover, as age affected the specific executive functions differently, remediation programs should be adapted to older patients. Models of specific executive functions are useful for understanding the complexity of cognition in schizophrenia and its course during later life so that healthcare can be adapted accordingly.
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Affiliation(s)
- Flavien Thuaire
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401 - 63001 Clermont-Ferrand Cedex 1.
| | - Fabien Rondepierre
- Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - Elisabeth Bacon
- INSERM U-1114, Fédération de Médecine Translationnelle de Strasbourg (FMTS), CHU de Strasbourg, Université de Strasbourg, France.
| | - Guillaume T Vallet
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401 - 63001 Clermont-Ferrand Cedex 1.
| | - Isabelle Jalenques
- Service de Psychiatrie de l'Adulte A et Psychologie Médicale, Centre Mémoire de Ressources et de Recherche, CHU Clermont-Ferrand, Institut de Psychiatrie-GDR 3557, Université Clermont Auvergne, Clermont-Ferrand, France.
| | - Marie Izaute
- Université Clermont Auvergne, CNRS, LAPSCO, 34 avenue Carnot - TSA 60401 - 63001 Clermont-Ferrand Cedex 1.
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25
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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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26
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The efficacy of computer-based cognitive training for executive dysfunction in schizophrenia. Psychiatry Res 2019; 279:62-70. [PMID: 31302353 DOI: 10.1016/j.psychres.2019.06.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/30/2019] [Accepted: 06/30/2019] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to assess the effect of computer-based cognitive training on executive dysfunction in patients with schizophrenia. Sixty-five patients with schizophrenia were randomly assigned to a training group (n = 33) or a non-training group (n = 32), and compared in terms of executive performance to a healthy control group (n = 33). Executive function was assessed using the Trail Making Test, the Stroop Color and Word Test, and the Wisconsin Card Sorting Test (computer version). Cognitive training was performed using RehaCom software over a course of 16 individual sessions. Primary outcomes were training (performance at three different timepoints) and neuropsychological components (flexibility and cognitive inhibition, high executive processing, and processing speed). In both clinical groups, all aspects of executive function were found to be deficient. In the patient training group, the use of computer-based training alongside pharmacological treatment was more effective in terms of cognitive improvement than pharmacological treatment alone. However, there was no significant effect of cognitive training on processing speed. Cognitive training in schizophrenia patients was effective at improving several aspects of executive function, but did not improve processing speed.
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27
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Exploring Heterogeneity on the Wisconsin Card Sorting Test in Schizophrenia Spectrum Disorders: A Cluster Analytical Investigation. J Int Neuropsychol Soc 2019; 25:750-760. [PMID: 31104647 DOI: 10.1017/s1355617719000420] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The Wisconsin Card Sorting Test (WCST) is a complex measure of executive function that is frequently employed to investigate the schizophrenia spectrum. The successful completion of the task requires the interaction of multiple intact executive processes, including attention, inhibition, cognitive flexibility, and concept formation. Considerable cognitive heterogeneity exists among the schizophrenia spectrum population, with substantive evidence to support the existence of distinct cognitive phenotypes. The within-group performance heterogeneity of individuals with schizophrenia spectrum disorder (SSD) on the WCST has yet to be investigated. A data-driven cluster analysis was performed to characterise WCST performance heterogeneity. METHODS Hierarchical cluster analysis with k-means optimisation was employed to identify homogenous subgroups in a sample of 210 schizophrenia spectrum participants. Emergent clusters were then compared to each other and a group of 194 healthy controls (HC) on WCST performance and demographic/clinical variables. RESULTS Three clusters emerged and were validated via altered design iterations. Clusters were deemed to reflect a relatively intact patient subgroup, a moderately impaired patient subgroup, and a severely impaired patient subgroup. CONCLUSIONS Considerable within-group heterogeneity exists on the WCST. Identification of subgroups of patients who exhibit homogenous performance on measures of executive functioning may assist in optimising cognitive interventions. Previous associations found using the WCST among schizophrenia spectrum participants should be reappraised. (JINS, 2019, 25, 750-760).
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Reser MP, Slikboer R, Rossell SL. A systematic review of factors that influence the efficacy of cognitive remediation therapy in schizophrenia. Aust N Z J Psychiatry 2019; 53:624-641. [PMID: 31177813 DOI: 10.1177/0004867419853348] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cognitive remediation therapy is a moderately effective intervention for ameliorating cognitive deficits in individuals with schizophrenia-related disorders. With reports of considerable variability in individual response to cognitive remediation therapy, we need to better understand factors that influence cognitive remediation therapy efficacy to realise its potential. A systematic review was conducted to identify and evaluate predictors of cognitive outcome. METHODS An electronic database search was conducted identifying peer-reviewed articles examining predictors of cognitive response to cognitive remediation therapy. RESULTS A total of 40 articles accounting for 1681 cognitive remediation therapy participants were included; 81 distinct predictors of cognitive response were identified. Data synthesis and discussion focused on 20 predictors examined a minimum three times in different studies. Few of the examined predictors of cognitive outcome following cognitive remediation therapy were significant when examined through systematic review. A strong trend was found for baseline cognition, with reasoning and problem solving and working memory being strongly predictive of within-domain improvement. Training task progress was the most notable cross-domain predictor of cognitive outcome. CONCLUSION It remains unclear why a large proportion of participants fail to realise cognitive benefit from cognitive remediation therapy. However, when considering only those variables where a majority of articles reported a statistically significant association with cognitive response to cognitive remediation therapy, three stand out: premorbid IQ, baseline cognition and training task progress. Each of these relates in some way to an individual's capacity or potential for change. There is a need to consolidate investigation of potential predictors of response to cognitive remediation therapy, strengthening the evidence base through replication and collaboration.
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Affiliation(s)
- Maree P Reser
- 1 Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Reneta Slikboer
- 1 Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Susan L Rossell
- 1 Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,2 Psychiatry, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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Kumar D, Ashwini K, Hegde S, Prasanna L, Joseph B, Bose A, Nawani H, Bharath RD, Varambally S, Venkatasubramanian G, Gangadhar BN. Caregiver assisted home-based cognitive remediation for individuals diagnosed with schizophrenia: A pilot study. Asian J Psychiatr 2019; 42:87-93. [PMID: 30981943 PMCID: PMC7613146 DOI: 10.1016/j.ajp.2019.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/16/2019] [Accepted: 03/20/2019] [Indexed: 01/04/2023]
Abstract
Cognitive deficits in individuals diagnosed with schizophrenia are ubiquitous and, therefore, cognitive remediation is considered one of the prime targets of a comprehensive intervention program for schizophrenia. However, cognitive remediation is a resource consuming intervention and in lower and middle-income countries (LAMIC) such interventions are often neglected due to the resource constraints of the mental health services set-ups. Therefore, it is imperative to develop cognitive remediation programs that are less resource consuming for the mental health service delivery system. Keeping this in view, in the present pilot study, we tested the feasibility of a caregiver assisted home-based cognitive remediation program and compared its efficacy with a clinic-based cognitive remediation program. Findings show that it is feasible to conduct cognitive remediation program with the help of caregivers in patients' home settings and that the home-based cognitive remediation is as effective as the clinic-based cognitive remediation. The results of the study have been further discussed in the light of the practical implications, limitations and future research.
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Affiliation(s)
- Devvarta Kumar
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India.
| | - K Ashwini
- National Institute of Advanced Studies (NIAS), IISC, Bengaluru, India
| | - Shantala Hegde
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Lavanya Prasanna
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Boban Joseph
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Anushree Bose
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Hema Nawani
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Rose Dawn Bharath
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Krężołek M, Pionke R, Banaszak B, Kokoszka A, Gawęda Ł. The relationship between jumping to conclusions and neuropsychological functioning in schizophrenia. Psychiatry Res 2019; 273:443-449. [PMID: 30684790 DOI: 10.1016/j.psychres.2019.01.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 12/20/2022]
Abstract
Jumping to conclusions (JTC) is defined as a tendency to make decisions based on insufficient information. JTC has been reported in patients with psychosis, but the mechanisms of this cognitive bias remain unknown. The main aim of our study was to investigate the relationship between JTC and neuropsychological functioning in schizophrenia. A total of 85 schizophrenia patients were assessed with neuropsychological tests, including executive functions, verbal memory, working memory, processing speed and attention. JTC was assessed with the Fish Task (probability 80:20 and 60:40) and a self-report scale (The Davos Assessment of Cognitive Biases Scale, DACOBS). Symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS). The relationship between JTC and neuropsychological functioning was investigated with correlation and regression analyses. The regression analyses model, when controlling for duration of illness, age and symptoms, showed that verbal memory and working memory were specifically related to JTC measured by Fish Task 60:40. JTC measured using Fish Task 60:40 was correlated only with severity of symptoms of disorganization (PANSS). The results from the present study suggest that the relationship between decision making during the reasoning task and neuropsychological functioning is modulated by task demands.
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Affiliation(s)
- Martyna Krężołek
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, Medical University of Warsaw, Poland.
| | - Renata Pionke
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, Medical University of Warsaw, Poland
| | | | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Poland
| | - Łukasz Gawęda
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, Medical University of Warsaw, Poland.
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31
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Compensatory cognitive training for people with severe mental illnesses in supported employment: A randomized controlled trial. Schizophr Res 2019; 203:41-48. [PMID: 28823720 PMCID: PMC5816728 DOI: 10.1016/j.schres.2017.08.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/02/2017] [Accepted: 08/05/2017] [Indexed: 01/07/2023]
Abstract
Treatments for cognitive and functional impairments associated with severe mental illnesses are urgently needed. We tested a 12-week, manualized, Compensatory Cognitive Training (CCT) intervention targeting prospective memory, attention, learning/memory, and executive functioning in the context of supported employment for people with severe mental illnesses who were seeking work. 153 unemployed, work-seeking outpatients with schizophrenia/schizoaffective disorder (n=58), bipolar disorder (n=37), or major depression (n=58) were randomized to receive supported employment plus CCT or enhanced supported employment, a robust control group. Assessments of neuropsychological performance, functional capacity, psychiatric symptom severity, and self-reported functioning and quality of life were administered at baseline and multiple follow-up assessments over two years; work outcomes were collected for two years. Forty-seven percent of the participants obtained competitive work, but there were no differences in work attainment, weeks worked, or wages earned between the CCT and the enhanced supported employment group. ANCOVAs assessing immediate post-treatment effects demonstrated significant, medium to large, CCT-associated improvements on measures of working memory (p=0.038), depressive symptom severity (p=0.023), and quality of life (p=0.003). Longer-term results revealed no statistically significant CCT-associated improvements, but a trend (p=0.058) toward a small to medium CCT-associated improvement in learning. Diagnostic group (schizophrenia-spectrum vs. mood disorder) did not affect outcomes. We conclude that CCT has the potential to improve cognitive performance, psychiatric symptom severity, and quality of life in people with severe mental illnesses. Receiving CCT did not result in better work outcomes, suggesting that supported employment can result in competitive work regardless of cognitive status.
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32
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Thomas ML, Treichler EBH, Bismark A, Shiluk AL, Tarasenko M, Zhang W, Joshi YB, Sprock J, Cardoso L, Tiernan K, Light GA. Computerized cognitive training is associated with improved psychosocial treatment engagement in schizophrenia. Schizophr Res 2018; 202:341-346. [PMID: 29929773 PMCID: PMC7409521 DOI: 10.1016/j.schres.2018.06.024] [Citation(s) in RCA: 12] [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: 09/26/2017] [Revised: 02/14/2018] [Accepted: 06/10/2018] [Indexed: 11/28/2022]
Abstract
Poor treatment engagement is an enduring problem in the care of patients with schizophrenia. Evidence suggests that targeted cognitive training (TCT) improves cognition and functional outcomes, but this time-consuming intervention might reduce patients' engagement in other treatment activities when implemented in real-world settings. This is especially true of residential care programs which encourage patients to engage in group therapies, self-care, and a wide variety of structured social, work, and other rehabilitation activities. This study aimed to determine whether TCT negatively impacts engagement in other psychosocial treatments. Patients with schizophrenia were recruited from a community-based residential care program and randomized to one of two intervention arms: treatment as usual (TAU; n = 22) or TAU augmented with TCT (n = 24). Psychosocial treatment engagement was tracked over 20 weeks. Treatment groups did not significantly differ on baseline variables or psychosocial treatment engagement in the 5 weeks prior to randomization. TCT had a positive effect on engagement (β = 0.112, p = 0.003), but there was no treatment-by-time interaction (β = -0.029, p = 0.672). Participants in TCT engaged in an average of 1.34 additional group therapies, 0.58 additional activities of daily living, and 0.84 additional rehabilitation activities per week in comparison to TAU participants. Baseline cognition was also a significant predictor of psychosocial treatment engagement. Overall, results suggest that TCT can be implemented in real-world settings without negatively impacting engagement in other psychosocial treatments. Additional studies are needed to determine what role nonspecific factors play in the positive impact of TCT.
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Affiliation(s)
- Michael L Thomas
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States.
| | - Emily B H Treichler
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Andrew Bismark
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Alexandra L Shiluk
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States
| | - Melissa Tarasenko
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Wen Zhang
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Yash B Joshi
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Joyce Sprock
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Lauren Cardoso
- Alpine Special Treatment Center Inc., Alpine, CA, United States
| | | | - Gregory A Light
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
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Kim EJ, Bahk YC, Oh H, Lee WH, Lee JS, Choi KH. Current Status of Cognitive Remediation for Psychiatric Disorders: A Review. Front Psychiatry 2018; 9:461. [PMID: 30337888 PMCID: PMC6178894 DOI: 10.3389/fpsyt.2018.00461] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/05/2018] [Indexed: 12/22/2022] Open
Abstract
Cognition is an important factor that affects daily functioning and quality of life. Impairment in cognitive function is a common symptom present in various psychological disorders, which hinders patients from functioning normally. Given that cognitive impairment has devastating effects, enhancing this in patients should lead to improvements in compromised quality of life and functioning, including vocational functioning. Over the past 50 years, several attempts have been made to improve impaired cognition, and empirical evidence for cognitive remediation (CR) has accumulated that supports its efficacy for treating schizophrenia. More recently, CR has been successfully applied in the treatment of depressive disorders, bipolar disorders, attention deficit/hyperactivity disorder, and anorexia nervosa. This study critically reviews recent CR studies and suggests their future direction. This study aimed to provide a modern definition of CR, and examine the current status of empirical evidence and representative CR programs that are widely used around the world.
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Affiliation(s)
- Eun Jin Kim
- Department of Psychology, Korea University, Seoul, South Korea
| | - Yong-Chun Bahk
- Department of Psychology, Korea University, Seoul, South Korea
| | - Hyeonju Oh
- Department of Psychology, Korea University, Seoul, South Korea
| | - Won-Hye Lee
- Department of Clinical Psychology, National Center for Mental Health, Seoul, South Korea
| | - Jong-Sun Lee
- Department of Psychology, Kangwon National University, Chuncheon, South Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University, Seoul, South Korea
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Penadés R, López-Vílchez I, Catalán R, Arias B, González-Rodríguez A, García-Rizo C, Masana G, Ruíz V, Mezquida G, Bernardo M. BDNF as a marker of response to cognitive remediation in patients with schizophrenia: A randomized and controlled trial. Schizophr Res 2018; 197:458-464. [PMID: 29274733 DOI: 10.1016/j.schres.2017.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 12/01/2017] [Accepted: 12/10/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is considered to be a putative biomarker for cognitive recovery in schizophrenia. However, current evidence is still scarce for pharmacological treatments, and the use of BDNF as a biomarker has only been tested once with cognitive remediation treatment (CRT). METHODS A randomized and controlled trial (NCT02341131) with 70 schizophrenia outpatients and 15 healthy volunteers was conducted. The participants with schizophrenia were randomly assigned to either CRT or the control group. All the participants were assessed in terms of cognition, quality of life, and their serum BDNF levels at both baseline and after the intervention. Additionally, comparisons of the effects of the different genotypes of the Val66Met polymorphism at the BDNF gene on the outcome variables were also performed. RESULTS The patients in the CRT group presented with improvements in both cognition and quality of life. However, no significant changes were detected in the serum levels of BDNF. Interestingly, we found a significant positive interaction effect between the serum BDNF levels and the different BDNF genotypes. The Val/Val group showed significantly higher serum levels after the CRT treatment. However, the interaction among the serum BDNF levels, the BDNF genotypes and the treatment condition was not statistically significant. CONCLUSIONS The replication of the previous finding of increased serum BDNF levels after cognitive remediation in clinically stable individuals with schizophrenia was not achieved. However, our data indicated that genetic variability may be mediating serum BDNF activity in the context of CRT.
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Affiliation(s)
- Rafael Penadés
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain.
| | - Irene López-Vílchez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Hemotherapy and Hemostasis, Centre for Biomedical Diagnosis (CDB), Hospital Clínic, Barcelona, Spain
| | - Rosa Catalán
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
| | - Bárbara Arias
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Anthropology, Faculty of Biology and Biomedicine Institute, University of Barcelona, Spain
| | - Alexandre González-Rodríguez
- Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
| | - Clemente García-Rizo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
| | - Guillem Masana
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
| | - Victoria Ruíz
- Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
| | - Miquel Bernardo
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clinic, Barcelona, Spain
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Neurocognitive and Self-efficacy Benefits of Cognitive Remediation in Schizophrenia: A Randomized Controlled Trial. J Int Neuropsychol Soc 2018; 24:549-562. [PMID: 29352823 DOI: 10.1017/s1355617717001369] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of computer-assisted "drill-and-strategy" cognitive remediation (CR) for community-dwelling individuals with schizophrenia on cognition, everyday self-efficacy, and independent living skills. METHODS Fifty-six people with schizophrenia or schizoaffective disorder were randomized into CR or computer game (CG) playing (control), and offered twenty 1-hr individual sessions in a group setting over 10 weeks. Measures of cognition, psychopathology, self-efficacy, quality of life, and independent living skills were conducted at baseline, end-group and 3 months following intervention completion. RESULTS Forty-three participants completed at least 10 sessions and the end-group assessment. Linear mixed-effect analyses among completers demonstrated a significant interaction effect for global cognition favoring CR (p=.028). CR-related cognitive improvement was sustained at 3-months follow-up. At end-group, 17 (77%) CR completers showed a reliable improvement in at least one cognitive domain. A significant time effect was evident for self-efficacy (p=.028) with both groups improving over time, but no significant interaction effect was observed. No significant effects were found for other study outcomes, including the functional measure. CONCLUSIONS Computer-assisted drill-and-strategy CR in schizophrenia improved cognitive test performance, while participation in both CR and CG playing promoted enhancements in everyday self-efficacy. Changes in independent living skills did not appear to result from CR, however. Adjunctive psychosocial rehabilitation is likely necessary for improvements in real-world community functioning to be achieved. (JINS, 2018, 24, 549-562).
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Butler G, Howard L, Choi S, Thornicroft G. Characteristics of people with severe mental illness who obtain employment. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.108.021683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodWe explored sociodemographic and clinical factors associated with obtaining employment for people with severe mental illness. Standardised validated interviews and questionnaires were administered to participants who had been recruited into a randomised controlled trial of supported employment.ResultsOlder age and diagnosis of schizophrenia were found to be independent predictors of unemployment in the previous year. Other factors of unemployment such as ethnicity and educational level were not associated with obtaining employment.Clinical implicationsOlder people and those with a diagnosis of schizophrenia may need additional targeted help in obtaining employment if they are to be helped to meet their vocational aims. Further research is needed to determine how this can be done most effectively.
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Kerby J, Calton T, Dimambro B, Flood C, Glazebrook C. Anti-stigma films and medical students' attitudes towards mental illness and psychiatry: randomised controlled trial. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.107.017152] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo explore the feasibility of a randomised controlled trial of the effects of two anti-stigma films on medical students' attitudes to serious mental illness and psychiatry. Attitudes to serious mental illness, perceived dangerousness, social distance and psychiatry, were measured before and after watching the films and at 8 weeks.ResultsIntervention films significantly improved general attitudes to serious mental illness and social distance, with a trend towards reducing perceived dangerousness. These effects appeared to attenuate during the students' clinical placements, suggesting a possible interaction with their clinical experiences.Clinical ImplicationsOur results suggest both that it may be possible to conduct a substantive trial of the effects of the intervention films on a larger cohort of medical students and that the films may be effective in reducing stigmatising attitudes in medical students.
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Ohi K, Sumiyoshi C, Fujino H, Yasuda Y, Yamamori H, Fujimoto M, Sumiyoshi T, Hashimoto R. A Brief Assessment of Intelligence Decline in Schizophrenia As Represented by the Difference between Current and Premorbid Intellectual Quotient. Front Psychiatry 2017; 8:293. [PMID: 29312019 PMCID: PMC5743746 DOI: 10.3389/fpsyt.2017.00293] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/11/2017] [Indexed: 01/25/2023] Open
Abstract
Patients with schizophrenia elicit several clinical features, such as psychotic symptoms, cognitive impairment, and subtle decline of intelligence. The latter two features become evident around the onset of the illness, although they may exist even before the disease onset in a substantial proportion of cases. Here, we review the literature concerning intelligence decline (ID) during the progression of schizophrenia. ID can be estimated by comparing premorbid and current intellectual quotient (IQ) by means of the Adult Reading Test and Wechsler Adult Intelligence Scale (WAIS), respectively. For the purpose of brief assessment, we have recently developed the WAIS-Short Form, which consists of Similarities and Symbol Search and well reflects functional outcomes. According to the degree of ID, patients were classified into three distinct subgroups; deteriorated, preserved, and compromised groups. Patients who show deteriorated IQ (deteriorated group) elicit ID from a premorbid level (≥10-point difference between current and premorbid IQ), while patients who show preserved or compromised IQ do not show such decline (<10-point difference). Furthermore, the latter patients were divided into patients with preserved and compromised IQ based on an estimated premorbid IQ score >90 or below 90, respectively. We have recently shown the distribution of ID in a large cohort of schizophrenia patients. Consistent with previous studies, approximately 30% of schizophrenia patients had a decline of less than 10 points, i.e., normal intellectual performance. In contrast, approximately 70% of patients showed deterioration of IQ. These results indicate that there is a subgroup of schizophrenia patients who have mild or minimal intellectual deficits, following the onset of the disorder. Therefore, a careful assessment of ID is important in identifying appropriate interventions, including medications, cognitive remediation, and social/community services.
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Affiliation(s)
- Kazutaka Ohi
- Department of Neuropsychiatry, Kanazawa Medical University, Uchinada, Japan
| | - Chika Sumiyoshi
- Faculty of Human Development and Culture, Fukushima University, Fukushima, Japan
| | - Haruo Fujino
- Graduate School of Education, Oita University, Oita, Japan
| | - Yuka Yasuda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidenaga Yamamori
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Michiko Fujimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomiki Sumiyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Ryota Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
- Molecular Research Center for Children’s Mental Development, United Graduate School of Child Development, Osaka University, Suita, Japan
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McBride RL, Horsfield S, Sandler CX, Cassar J, Casson S, Cvejic E, Vollmer-Conna U, Lloyd AR. Cognitive remediation training improves performance in patients with chronic fatigue syndrome. Psychiatry Res 2017; 257:400-405. [PMID: 28830024 DOI: 10.1016/j.psychres.2017.08.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/12/2017] [Accepted: 08/15/2017] [Indexed: 10/19/2022]
Abstract
Neurocognitive disturbance with subjectively-impaired concentration and memory is a common, disabling symptom reported by patients with chronic fatigue syndrome (CFS). We recently reported preliminary evidence for benefits of cognitive remediation as part of an integrated cognitive-behavioral therapy (CBT)/ graded exercise therapy (GET) program. Here, we describe a contemporaneous, case-control trial evaluating the effectiveness of an online cognitive remediation training program (cognitive exercise therapy; CET) in addition to CBT/GET (n=36), compared to CBT/GET alone (n=36). The study was conducted in an academic, tertiary referral outpatient setting over 12 weeks (11 visits) with structured, home-based activities between visits. Participants self-reported standardized measures of symptom severity and functional status before and after the intervention. Those in the CET arm also completed standardized neurocognitive assessment before, and following, treatment. The addition of formal CET led to significantly greater improvements in self-reported neurocognitive symptoms compared to CBT/GET alone. Subjective improvement was predicted by CET group and lower baseline mood disturbance. In the CET group, significant improvements in objectively-measured executive function, processing speed, and working memory were observed. These subjective and objective performance improvements suggest that a computerized, home-based cognitive training program may be an effective intervention for patients with CFS, warranting randomized controlled trials.
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Affiliation(s)
- Richard L McBride
- UNSW Fatigue Clinic, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sarah Horsfield
- UNSW Fatigue Clinic, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Carolina X Sandler
- UNSW Fatigue Clinic, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Joanne Cassar
- UNSW Fatigue Clinic, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sally Casson
- UNSW Fatigue Clinic, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Erin Cvejic
- School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia; University of Sydney, School of Public Health, Camperdown, NSW 2006, Australia.
| | - Uté Vollmer-Conna
- School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Andrew R Lloyd
- UNSW Fatigue Clinic, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia; Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
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Greer TL, Furman JL, Trivedi MH. Evaluation of the benefits of exercise on cognition in major depressive disorder. Gen Hosp Psychiatry 2017; 49:19-25. [PMID: 28690019 DOI: 10.1016/j.genhosppsych.2017.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cognitive impairment is increasingly recognized as a significant symptom in patients with major depressive disorder (MDD). While exercise is already recommended in many treatment guidelines for patients with MDD and has been shown to improve cognition in other disorders (e.g., Alzheimer's, Parkinson's, schizophrenia), limited research is available evaluating the effect of exercise on cognition in MDD. METHODS We provide a narrative review of existing literature regarding the effect(s) of exercise on cognition across several neurodegenerative and psychiatric diseases, and particularly in MDD, with specific emphasis on study design and methodology that may impair adequate synthesis of the results. We also describe mechanisms by which exercise may improve cognition in depression and other brain disorders. RESULTS Of existing studies with MDD, data are equivocal, as some are supportive of improved cognition, whereas others demonstrate no benefit. Several limitations were noted, including insufficiently-powered designs, variability in interventions examined (e.g., aerobic, anaerobic, mind-body) or control groups, lack of attention to the status of baseline cognitive impairment, and/or heterogeneity across outcome measures and clinical characteristics. CONCLUSIONS While preliminary results suggest the potential for exercise as a beneficial treatment or augmentation strategy for impaired cognition in MDD, the aforementioned limitations necessitate further investigation.
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Affiliation(s)
- Tracy L Greer
- University of Texas, Southwestern Medical Center, Dallas, TX, USA
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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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Reeder C, Huddy V, Cella M, Taylor R, Greenwood K, Landau S, Wykes T. A new generation computerised metacognitive cognitive remediation programme for schizophrenia (CIRCuiTS): a randomised controlled trial. Psychol Med 2017; 47:2720-2730. [PMID: 28866988 PMCID: PMC5647677 DOI: 10.1017/s0033291717001234] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cognitive remediation (CR) is a psychological therapy, which improves cognitive and social functioning in people with schizophrenia. It is now being implemented within routine clinical services and mechanisms of change are being explored. We designed a new generation computerised CR programme, CIRCuiTS (Computerised Interactive Remediation of Cognition - a Training for Schizophrenia), to enhance strategic and metacognitive processing, with an integrated focus on the transfer of cognitive skills to daily living. This large trial tested its feasibility to be delivered in therapist-led and independent sessions, and its efficacy for improved cognitive and social functioning. METHODS A two arm single blind randomised superiority trial comparing CIRCuiTS plus treatment-as-usual (TAU) with TAU alone in 93 people with a diagnosis of schizophrenia. Cognitive, social functioning and symptom outcomes were assessed at pre- and post-therapy and 3 months later. RESULTS 85% adhered to CIRCuiTS, completing a median of 28 sessions. There were significant improvements in visual memory at post-treatment (p = 0.009) and follow-up (p = 0.001), and a trend for improvements in executive function at post-treatment (p = 0.056) in favour of the CIRCuiTS group. Community function was also differentially and significantly improved in the CIRCuiTS group at post-treatment (p = 0.003) but not follow-up, and was specifically predicted by improved executive functions. CONCLUSIONS CIRCuiTS was beneficial for improving memory and social functioning. Improved executive functioning emerges as a consistent predictor of functional gains and should be considered an important CR target to achieve functional change. A larger-scale effectiveness trial of CIRCuiTS is now indicated.
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Affiliation(s)
- C. Reeder
- Institute of Psychiatry, Psychology and
Neuroscience (IoPPN), King's College London, UK
| | | | - M. Cella
- Institute of Psychiatry, Psychology and
Neuroscience (IoPPN), King's College London, UK
| | - R. Taylor
- Institute of Psychiatry, Psychology and
Neuroscience (IoPPN), King's College London, UK
| | - K. Greenwood
- Sussex Partnership NHS Foundation
Trust, Sussex, UK
- School of Psychology, University of
Sussex, Falmer, UK
| | - S. Landau
- Institute of Psychiatry, Psychology and
Neuroscience (IoPPN), King's College London, UK
| | - T. Wykes
- Institute of Psychiatry, Psychology and
Neuroscience (IoPPN), King's College London, UK
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Özaslan Z, Bilgin H. Şizofrenide Üstbiliş. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2017. [DOI: 10.30934/kusbed.317079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ohi K, Shimada T, Nemoto K, Kataoka Y, Yasuyama T, Kimura K, Okubo H, Uehara T, Kawasaki Y. Cognitive clustering in schizophrenia patients, their first-degree relatives and healthy subjects is associated with anterior cingulate cortex volume. Neuroimage Clin 2017; 16:248-256. [PMID: 28831376 PMCID: PMC5554933 DOI: 10.1016/j.nicl.2017.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/27/2017] [Accepted: 08/07/2017] [Indexed: 12/21/2022]
Abstract
Cognitive impairments are a core feature in schizophrenia patients (SCZ) and are also observed in first-degree relatives (FR) of SCZ. However, substantial variability in the impairments exists within and among SCZ, FR and healthy controls (HC). A cluster-analytic approach can group individuals based on profiles of traits and create more homogeneous groupings than predefined categories. Here, we investigated differences in the Brief Assessment of Cognition in Schizophrenia (BACS) neuropsychological battery (six subscales) among SCZ, unaffected FR and HC. To identify three homogeneous and meaningful cognitive groups regardless of categorical diagnoses (SCZ, FR and HC), cognitive clustering was performed, and differences in the BACS subscales among the cognitive cluster groups were investigated. Finally, the effects of diagnosis and cognition on brain volumes were examined. As expected, there were significant differences in the five BACS subscales among the diagnostic groups. The cluster-analytic approach generated three meaningful subgroups: (i) neuropsychologically normal, (ii) intermediate impaired and (iii) widespread impaired. The cognitive subgroups were mainly affected by the clinical diagnosis, and significant differences in all BACS subscales among clusters were found. The effects of the diagnosis and cognitive clusters on brain volumes overlapped in the frontal, temporal and limbic regions. Frontal and temporal volumes were mainly affected by the diagnosis, whereas the anterior cingulate cortex (ACC) volumes were affected by the additive effects of diagnosis and cognition. Our findings demonstrate a cognitive continuum among SCZ, FR and HC and support the concept of cognitive impairment and the related ACC volumes as intermediate phenotypes in SCZ.
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Affiliation(s)
- Kazutaka Ohi
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Takamitsu Shimada
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Kiyotaka Nemoto
- Department of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuzuru Kataoka
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Toshiki Yasuyama
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Kohei Kimura
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroaki Okubo
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Takashi Uehara
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
| | - Yasuhiro Kawasaki
- Department of Neuropsychiatry, Kanazawa Medical University, Ishikawa, Japan
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Computerized cognitive remediation therapy effects on resting state brain activity and cognition in schizophrenia. Sci Rep 2017; 7:4758. [PMID: 28684776 PMCID: PMC5500543 DOI: 10.1038/s41598-017-04829-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/22/2017] [Indexed: 01/09/2023] Open
Abstract
This study aimed to test how an 8-week training using computerized cognitive remediation therapy (CCRT) would modify resting brain functional activity and improve cognitive function in patients with schizophrenia. Twenty-seven patients with schizophrenia were recruited and randomized into two groups: CCRT or treatment-as-usual (TAU). The CCRT group received 40 sessions of computerized cognitive training over an eight-week period. There was a significant treatment group × time interaction on the processing speed (trail making test: F = 8.14, P = 0.01) and a trend in problem solving (mazes test: P = 0.06). Post-hoc tests showed that CCRT but not TAU significantly improved scores from baseline to end-of-treatment on these two cognitive assessments. For the resting brain functional activity, significant group × time interaction effect was found in the medial prefrontal cortex (mPFC)/anterior cingulate cortex (ACC) and brainstem pons region. Post-hoc tests showed that there was significant increased activity in the mPFC/ACC in CCRT but not TAU group. In this small sample study, computerized cognitive remediation therapy is shown to enhance mPFC/ACC activity even at resting state and improve cognitive function in patients with schizophrenia. If replicated, this community and clinic accessible therapy may assist cognitive remediation effort for people with schizophrenia.
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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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Roberts DL, Liu PYT, Busanet H, Maples N, Velligan D. A tablet-based intervention to manipulate social cognitive bias in schizophrenia. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2017. [DOI: 10.1080/15487768.2017.1302897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Broyd A, Balzan RP, Woodward TS, Allen P. Dopamine, cognitive biases and assessment of certainty: A neurocognitive model of delusions. Clin Psychol Rev 2017; 54:96-106. [PMID: 28448827 DOI: 10.1016/j.cpr.2017.04.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 01/24/2017] [Accepted: 04/15/2017] [Indexed: 12/17/2022]
Abstract
This paper examines the evidence that delusions can be explained within the framework of a neurocognitive model of how the brain assesses certainty. Here, 'certainty' refers to both low-level interpretations of one's environment and high-level (conscious) appraisals of one's beliefs and experiences. A model is proposed explaining how the brain systems responsible for assigning certainty might dysfunction, contributing to the cause and maintenance of delusional beliefs. It is suggested that delusions arise through a combination of perturbed striatal dopamine and aberrant salience as well as cognitive biases such as the tendency to jump to conclusions (JTC) and hypersalience of evidence-hypothesis matches. The role of emotion, stress, trauma and sociocultural factors in forming and modifying delusions is also considered. Understanding the mechanisms involved in forming and maintaining delusions has important clinical implications, as interventions that improve cognitive flexibility (e.g. cognitive remediation therapy and mindfulness training) could potentially attenuate neurocognitive processes.
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Affiliation(s)
- Annabel Broyd
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College, London, UK
| | - Ryan P Balzan
- School of Psychology, Flinders University, Adelaide, SA, Australia
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; BC Mental Health and Addictions Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College, London, UK; Department of Psychology, University of Roehampton, London, UK.
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Moriana JA, Gálvez-Lara M, Corpas J. Psychological treatments for mental disorders in adults: A review of the evidence of leading international organizations. Clin Psychol Rev 2017; 54:29-43. [PMID: 28384513 DOI: 10.1016/j.cpr.2017.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
Abstract
Most mental health services throughout the world currently regard evidence-based psychological treatments as best practice for the treatment of mental disorders. The aim of this study was to analyze evidence-based treatments drawn from RCTs, reviews, meta-analyses, guides, and lists provided by the National Institute for Health and Care Excellence (NICE), Division 12 (Clinical Psychology) of the American Psychological Association (APA), Cochrane and the Australian Psychological Society (APS) in relation to mental disorders in adults. A total of 135 treatments were analyzed for 23 mental disorders and compared to determine the level of agreement among the organizations. The results indicate that, in most cases, there is little agreement among organizations and that there are several discrepancies within certain disorders. These results require reflection on the meaning attributed to evidence-based practice with regard to psychological treatments. The possible reasons for these differences are discussed. Based on these findings, proposals to unify the criteria that reconcile the realities of clinical practice with a scientific perspective were analyzed.
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Affiliation(s)
- Juan Antonio Moriana
- Department of Psychology, University of Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain; Reina Sofia University Hospital, Spain.
| | - Mario Gálvez-Lara
- Department of Psychology, University of Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain; Reina Sofia University Hospital, Spain
| | - Jorge Corpas
- Department of Psychology, University of Cordoba, Spain
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50
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A Neurophysiological Perspective on a Preventive Treatment against Schizophrenia Using Transcranial Electric Stimulation of the Corticothalamic Pathway. Brain Sci 2017; 7:brainsci7040034. [PMID: 28350371 PMCID: PMC5406691 DOI: 10.3390/brainsci7040034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/11/2017] [Accepted: 03/24/2017] [Indexed: 12/16/2022] Open
Abstract
Schizophrenia patients are waiting for a treatment free of detrimental effects. Psychotic disorders are devastating mental illnesses associated with dysfunctional brain networks. Ongoing brain network gamma frequency (30–80 Hz) oscillations, naturally implicated in integrative function, are excessively amplified during hallucinations, in at-risk mental states for psychosis and first-episode psychosis. So, gamma oscillations represent a bioelectrical marker for cerebral network disorders with prognostic and therapeutic potential. They accompany sensorimotor and cognitive deficits already present in prodromal schizophrenia. Abnormally amplified gamma oscillations are reproduced in the corticothalamic systems of healthy humans and rodents after a single systemic administration, at a psychotomimetic dose, of the glutamate N-methyl-d-aspartate receptor antagonist ketamine. These translational ketamine models of prodromal schizophrenia are thus promising to work out a preventive noninvasive treatment against first-episode psychosis and chronic schizophrenia. In the present essay, transcranial electric stimulation (TES) is considered an appropriate preventive therapeutic modality because it can influence cognitive performance and neural oscillations. Here, I highlight clinical and experimental findings showing that, together, the corticothalamic pathway, the thalamus, and the glutamatergic synaptic transmission form an etiopathophysiological backbone for schizophrenia and represent a potential therapeutic target for preventive TES of dysfunctional brain networks in at-risk mental state patients against psychotic disorders.
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