1
|
Nakamura ZM, Ali NT, Crouch A, Dhillon H, Federico A, Gates P, Grech L, Kesler SR, Ledbetter L, Mantovani E, Mayo S, Ng DQ, Pembroke L, Pike KE, Tamburin S, Tan CJ, Toh YL, Yang Y, Von Ah D, Allen DH. Impact of Cognitive Rehabilitation on Cognitive and Functional Outcomes in Adult Cancer Survivors: A Systematic Review. Semin Oncol Nurs 2024:151696. [PMID: 39048409 DOI: 10.1016/j.soncn.2024.151696] [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: 05/10/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES This systematic review (PROSPERO CRD42021275421) synthesized evidence on the efficacy of cognitive rehabilitation on cognitive and functional outcomes in adult cancer survivors. METHODS Articles were identified though PubMed/MEDLINE, EMBASE, PsycINFO, and Web of Science from inception through June 30, 2023. Studies included participants ≥18 years old, diagnosed with cancer. Primary outcomes were validated measures of subjective and objective cognition. Articles were dual reviewed for eligibility and data extraction. Risk of bias was assessed with the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. RESULTS The search yielded 3,811 articles; 65 full-text articles were reviewed; 53 articles (15 cognitive training, 14 strategy-based, 21 combinations, three inpatient rehabilitation), representing 52 unique studies, were included. Positive effects were observed in at least one objective cognitive measure in 93% of strategy training, 81% of cognitive training, 79% of combination rehabilitation interventions. Positive effects were observed in subjective cognition in 100% of strategy training, 55% of cognitive training, and 92% of combination interventions. Among studies with comparator groups, processing speed improved in 60% of cognitive training studies, while strategy training did not improve processing speed; otherwise, cognitive domain effects were similar between intervention types. Impact on functional outcomes was inconclusive. CONCLUSIONS Cognitive rehabilitation appear beneficial for cancer-related cognitive impairment (CRCI). Differential effects on specific cognitive domains (eg, processing speed) and subjective cognition may exist between intervention types. IMPLICATIONS FOR NURSING PRACTICE Nurses should increase patient and provider awareness of the benefits of cognitive rehabilitation for CRCI.
Collapse
Affiliation(s)
- Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | | | - Adele Crouch
- Indiana University School of Nursing, Indianapolis, Indiana
| | - Haryana Dhillon
- Psycho-Oncology Cooperative Research Group, Faculty of Science, The University of Sydney, New South Wales, Australia
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, GB Rossi Hospital, University of Verona, Verona, Italy
| | - Priscilla Gates
- Peter Mac Callum Cancer Center, Deakin University, Burwood, Victoria, Australia
| | - Lisa Grech
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | | | - Leila Ledbetter
- Duke University Medical Center Library, DUMC 3702, Durham, North Carolina
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, GB Rossi Hospital, University of Verona, Verona, Italy
| | | | - Ding Quan Ng
- University of California Irvine, School of Pharmacy & Pharmaceutical Sciences, Irvine, CA, USA
| | - Lorna Pembroke
- School of Psychological Sciences Level 3, Australian Hearing Hub, Health and Human Sciences, Macquarie University, New South Wales, Australia
| | - Kerryn E Pike
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, GB Rossi Hospital, University of Verona, Verona, Italy
| | - Chia Jie Tan
- College of Pharmacy, University of Utah, Salt Lake City, Utah
| | - Yi Long Toh
- Department of Pharmacy, National University of Singapore, Singapore
| | - Yesol Yang
- The Ohio State University Comprehensive Cancer Center, Colombus, Ohio
| | - Diane Von Ah
- The Ohio State University, College of Nursing, Colombus, Ohio
| | | |
Collapse
|
2
|
Vergallito A, Gesi C, Torriero S. Intermittent Theta Burst Stimulation Combined with Cognitive Training to Improve Negative Symptoms and Cognitive Impairment in Schizophrenia: A Pilot Study. Brain Sci 2024; 14:683. [PMID: 39061423 PMCID: PMC11274516 DOI: 10.3390/brainsci14070683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
Schizophrenia is a chronic psychiatric disorder severely affecting patients' functioning and quality of life. Unlike positive symptoms, cognitive impairment and negative symptoms cannot be treated pharmacologically and represent consistent predictors of the illness's prognosis. Cognitive remediation (CR) interventions have been applied to target these symptoms. Brain stimulation also provides promising yet preliminary results in reducing negative symptoms, whereas its effect on cognitive impairment remains heterogeneous. Here, we combined intermittent theta burst stimulation (iTBS) with CR to improve negative symptoms and cognitive impairment in schizophrenia spectrum patients. One hundred eligible patients were invited, and twenty-one participated. We randomized them into four groups, manipulating the stimulation condition (real vs. sham) and CR (no training vs. training). We delivered fifteen iTBS sessions over the left dorsolateral prefrontal cortex for three weeks, followed (or not) by 50 min of training. Consensus-based clinical and cognitive assessment was administered at baseline and after the treatment, plus at three follow-ups occurring one, three, and six months after the intervention. Mixed-model analyses were run on cognitive and negative symptom scores. The preliminary findings highlighted a marginal modulation of iTBS on negative symptoms, whereas CR improved isolated cognitive functions. We herein discuss the limitations and strengths of the methodological approach.
Collapse
Affiliation(s)
- Alessandra Vergallito
- Department of Psychology & Neuromi, University of Milano-Bicocca, 20126 Milan, Italy
| | - Camilla Gesi
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy (S.T.)
| | - Sara Torriero
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy (S.T.)
| |
Collapse
|
3
|
Perra A, Galetti A, Zaccheddu R, Locci A, Piludu F, Preti A, Primavera D, Di Natale L, Nardi AE, Kurotshka PK, Cossu G, Sancassiani F, Stella G, De Lorenzo V, Zreik T, Carta MG. A Recovery-Oriented Program for People with Bipolar Disorder through Virtual Reality-Based Cognitive Remediation: Results of a Feasibility Randomized Clinical Trial. J Clin Med 2023; 12:jcm12062142. [PMID: 36983145 PMCID: PMC10056011 DOI: 10.3390/jcm12062142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Cognitive impairment is a frequent consequence of bipolar disorder (BD) that is difficult to prevent and treat. In addition, the quality of the preliminary evidence on the treatment of BD through Cognitive Remediation (CR) with traditional methods is poor. This study aims to evaluate the feasibility of a CR intervention with fully immersive Virtual Reality (VR) as an additional treatment for BD and offers preliminary data on its efficacy. Methods: Feasibility randomized controlled cross-over clinical study, with experimental condition lasting three months, crossed between two groups. Experimental condition: CR fully immersive VR recovery-oriented program plus conventional care; Control condition: conventional care. The control group began the experimental condition after a three months period of conventional care (waiting list). After the randomization of 50 people with BD diagnosis, the final sample consists of 39 participants in the experimental condition and 25 in the control condition because of dropouts. Results: Acceptability and tolerability of the intervention were good. Compared to the waitlist group, the experimental group reported a significant improvement regarding cognitive functions (memory: p = 0.003; attention: p = 0.002, verbal fluency: p = 0.010, executive function: p = 0.003), depressive symptoms (p = 0.030), emotional awareness (p = 0.007) and biological rhythms (p = 0.029). Conclusions: The results are preliminary and cannot be considered exhaustive due to the small sample size. However, the evidence of efficacy, together with the good acceptability of the intervention, is of interest. These results suggest the need to conduct studies with larger samples that can confirm this data. Trial registration: ClinicalTrialsgov NCT05070065, registered in September 2021
Collapse
Affiliation(s)
- Alessandra Perra
- International PhD in Innovation Sciences and Technologies, University of Cagliari, 09124 Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
- Correspondence:
| | - Alessia Galetti
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Rosanna Zaccheddu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Aurora Locci
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Federica Piludu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, 10125 Turin, Italy
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | | | - Antonio Egidio Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | | | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Giusy Stella
- Department of Mental Health and Pathological Addiction, ASL 5, 00034 Rome, Italy
| | | | - Thurayya Zreik
- Mental Health Service User Association, 11072070 Beirut, Lebanon
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| |
Collapse
|
4
|
Orloff NC, McGinley K, Lenz K, Mack AS, Timko CA. Adaptations of cognitive remediation therapy for adolescents with anorexia nervosa for delivery via telehealth. Int J Eat Disord 2023; 56:72-79. [PMID: 36401578 PMCID: PMC10207383 DOI: 10.1002/eat.23850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The COVID-19 pandemic hastened a transition to treatment delivery via telehealth. While barriers still exist, the increased uptake of telehealth has the potential to increase access to mental health treatment for all diagnoses, including eating disorders. Delivery of evidence-based treatment as well as adjunctive treatments, including those that are hard to find in-person, have been modified to virtual format to increase accessibility and allow for continuity of care for adolescents with anorexia nervosa. METHOD We describe how to modify and deliver Cognitive Remediation Therapy for youth with anorexia nervosa (CRT-AN) via a telehealth platform. Preliminary and practical guidance for best practice for both group and individual delivery is established. RESULTS With minimal modifications, CRT-AN can be delivered via telehealth for both individual and group delivery. More disengagement in group delivery was noted; however, overall application of the treatment via a remote platform was observed. DISCUSSION As more treatment moves to a telehealth format, highlighting how an adjunctive treatment like CRT-AN can combined with other treatments in a telehealth format has the potential to increase research in its implementation and furthermore increase its dissemination. PUBLIC SIGNIFICANCE Cognitive Remediation Therapy for Anorexia Nervosa (CRT-AN) requires significant manipulation of materials and supplementary human guidance. Suggestions for how to modify CRT-AN for remote delivery via telehealth are provided. Modifications grew out of immediate changes made during the beginning of the COVID-19 pandemic and can be used to inform changes therapists and programs can make to continue to or begin to use CRT-AN in a remote fashion.
Collapse
Affiliation(s)
- Natalia C Orloff
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kate McGinley
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Private Practice, Cape May Court House, Cape May County, New Jersey, USA
| | - Katrina Lenz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amy S Mack
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Song M, Song YM. Randomized Controlled Trials of Digital Mental Health Interventions on Patients with Schizophrenia Spectrum Disorder: A Systematic Review. Telemed J E Health 2022. [PMID: 36264184 DOI: 10.1089/tmj.2022.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: This systematic review aimed to examine the study protocol of Digital Mental Health Interventions (DMHIs) and to review the effect of DMHIs among patients with Schizophrenia Spectrum Disorder (SSD). Methods: This review followed the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search was performed using PubMed, CINAHL, Embase, and PsycINFO electronic databases to identify randomized clinical trials without any limit on the publication year. Overall, 18 studies were selected and evaluated for the quality assessment utilizing the Risk of Bias 2 tool of Cochranes' Collaboration. In the quality assessment, four studies evaluated as overall high risk of bias were excluded from the selection, and the final 14 studies were chosen. Results: No DMHIs were provided for acute schizophrenia-related symptoms, and there were some studies related to schizophrenia-related symptoms (26.4%). Some studies for improving cognitive function (42.9%) were reported, and there was a significant effect when interventions that were proven to be effective when implemented in a face-to-face manner were delivered using various online devices and sensory stimuli. Nearly half of the studies reported intervention frequency and time (57.1%), and those with unclear reports relied either on a mobile app or telemedicine and were designed to self-pace the frequency and speed of the intervention. Conclusion: Based on our findings, it will be possible to understand the characteristics of DMHIs, without physical contact, for only SSD patients, providing a basis for digital mental health services.
Collapse
Affiliation(s)
- MoonJu Song
- Division of Admission Management and Policy Development, National Center for Mental health, Seoul, Republic of Korea
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Yul-Mai Song
- Department of Nursing, Honam University, Gwangju, Republic of Korea
| |
Collapse
|
6
|
Bae HJ, Kim J, Bae HJ, Park K, Yang X, Cho YJ, Jung SY, Park SJ, Ryu JH. Effects of repetitive training on learning and memory performance of TLR2 KO mice. Behav Brain Res 2022; 426:113836. [DOI: 10.1016/j.bbr.2022.113836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/22/2022] [Accepted: 03/05/2022] [Indexed: 11/30/2022]
|
7
|
Bernabei L, Bersani FS, Pompili E, Delle Chiaie R, Valente D, Corrado A, Vergnani L, Ferracuti S, Biondi M, Coccanari de'Fornari MA. Cognitive remediation for the treatment of neuropsychological disturbances in subjects with euthymic bipolar disorder: findings from a controlled study. J Affect Disord 2020; 273:576-585. [PMID: 32560956 DOI: 10.1016/j.jad.2020.05.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Individuals with euthymic Bipolar Disorder (BD) can experience deteriorated cognitive functioning, with such deterioration being associated with functional impairment. Cognitive remediation (CR) is considered an effective add-on intervention for neuropsychological impairments, but relatively few CR controlled studies have been performed on BD. In the present study the efficacy of a CR intervention designed for the improvement of cognition and functioning in patients with euthymic BD was tested. METHODS Patients (n = 54) with euthymic BD were assigned to receive active (n = 27) or control (n = 27) intervention. The active intervention (i.e. the Cognitive Remediation in Integrated Treatment - CRIIT - protocol) was made of 20 individual sessions focused on the treatment of attention, memory and executive functioning through the COGPACK software; each session was integrated with psychoeducation and rehabilitation interventions implemented through a metacognitive approach aimed at ameliorating personal agency. RESULTS A significant (p ≤ 0.015) time x group interaction at repeated measures MANOVA was observed on Rey Auditory Verbal Learning Test, Rey Complex Figure Test, Wisconsin Card Sorting Test, Trail Making Test, Visual Search, Life Skills Profile, and Barratt Impulsiveness Scale. LIMITATIONS A single-blind approach was used. DISCUSSION The results showed that patients undergoing active intervention improved in domains related to executive functions, attention, memory, functioning and impulsivity more significantly than patients undergoing control interventions. This study adds to the evidence that CR improves neurocognition in BD, and suggests that CRIIT protocol represents an add-on intervention of potential relevance to increase cognition and functioning in BD euthymic patients.
Collapse
Affiliation(s)
- Laura Bernabei
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy; Department of Mental Health, ASL Roma 5, Colleferro, Rome, Italy.
| | - Francesco Saverio Bersani
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy.
| | - Enrico Pompili
- Department of Mental Health, ASL Roma 5, Colleferro, Rome, Italy
| | - Roberto Delle Chiaie
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | - Alessandra Corrado
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | - Lucilla Vergnani
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | - Massimo Biondi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | | |
Collapse
|
8
|
Abstract
Current first-line treatments for mood disorders often improve mood symptoms but do little to reduce cognitive and functional impairment. This 10-week, uncontrolled, feasibility study evaluated a cognitive remediation (CR) intervention for individuals with recurrent mood disorders. Adults with recurrent major depressive disorder or bipolar disorder, who had recently been treated and discharged from specialized mental health services, were eligible for inclusion. Twenty patients completed the CR intervention, which involved weekly individual sessions with a therapist, as well as the practice of computerized CR exercises between sessions. The study assessed the acceptability of the assessment and treatment as well as outcomes in terms of mood symptoms, general functioning, and cognitive functioning. Patients reported that they were generally satisfied with the CR intervention and were close to reaching the recommended amount of practice between therapist-led sessions. The retention rate from baseline to posttreatment was 87%. When within-group effects were examined, large effect sizes over time (>0.9) were seen for 2 cognitive variables that measured executive function: Category Switching-Total Words and Total Switching Score. Findings from the current feasibility study will inform the development of a large randomized controlled trial of an adapted version of the CR intervention for mood disorders assessed in this preliminary study, with the goal of translating the intervention into clinical practice.
Collapse
|
9
|
Sun Q, Fang Y, Peng X, Shi Y, Chen J, Wang L, Tan L. Hyper-Activated Brain Resting-State Network and Mismatch Negativity Deficit in Schizophrenia With Auditory Verbal Hallucination Revealed by an Event-Related Potential Evidence. Front Psychiatry 2020; 11:765. [PMID: 32903707 PMCID: PMC7438905 DOI: 10.3389/fpsyt.2020.00765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
Schizophrenia is a holergasia with unclear mechanism and high heterogeneity. Auditory verbal hallucination (AVH) study might help in understanding schizophrenia from the perspective of individual symptoms. This study aimed to investigate the activities of the resting-state networks (RSN) in the electroencephalogram (EEG) and mismatch negativity (MMN) in task-related state of schizophrenia patients with AVH. We recruited 30 schizophrenia patients without any medication for more than 4 weeks (15 AVH patients and 15 Non-AVH patients) and 15 healthy controls. We recorded the EEG data of the participants in the resting-state for 7 min and the event-related potential (ERP) data under an auditory oddball paradigm. In the resting-state EEG network, AVH patients exhibited a higher clustering coefficient than Non-AVH patients and healthy controls on delta and beta bands and a shorter characteristic path length than Non-AVH patients and healthy controls on all frequency bands. For ERP data, AVH patients showed a lower MMN amplitude than healthy controls (p = 0.017) and Non-AVH patients (p = 0.033). What's more, MMN amplitude was positively correlated with clustering coefficient, and negatively correlated with characteristic path length on delta, theta, beta and gamma band in AVH patients. Our results indicate that AVH patients showed a hyper-activity in resting-state and may have impaired higher-order auditory expectations in the task-related state than healthy controls and Non-AVH patients. And it seems reasonable to conclude that the formation of AVH may occupy certain brain resources and compete for brain resources with external auditory stimuli.
Collapse
Affiliation(s)
- Qiaoling Sun
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yehua Fang
- Department of Clinical Psychology, Zhuzhou Central Hospital, Zhuzhou, China
| | - Xuemei Peng
- Department Psychology, Xiangtan Central Hospital, Xiangtan, China
| | - Yongyan Shi
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinhong Chen
- Department of Sleeping Disorders & Neurosis, Brain Hospital of Hunan Province, Changsha, China
| | - Lifeng Wang
- Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Liwen Tan
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
10
|
Uscinska M, Polla Mattiot A, Bellino S. Treatment-Induced Brain Plasticity in Psychiatric Disorders. Behav Neurosci 2019. [DOI: 10.5772/intechopen.85448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
11
|
Matsuoka K, Morimoto T, Matsuda Y, Yasuno F, Taoka T, Miyasaka T, Yoshikawa H, Takahashi M, Kitamura S, Kichikawa K, Kishimoto T. Computer-assisted cognitive remediation therapy for patients with schizophrenia induces microstructural changes in cerebellar regions involved in cognitive functions. Psychiatry Res Neuroimaging 2019; 292:41-46. [PMID: 31521942 DOI: 10.1016/j.pscychresns.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/03/2019] [Accepted: 09/05/2019] [Indexed: 02/07/2023]
Abstract
Previous studies have reported that cognitive remediation therapy (CRT) improves cognitive deficits in patents with schizophrenia. However, few studies have focused on the underlying structural alterations in the brain following Vocational Cognitive Ability Training by the Japanese Cognitive Rehabilitation Program for Schizophrenia (VCAT-J). In this study, we analyzed changes in diffusion tensor imaging parameters in 31 patients with schizophrenia after 12 weeks of intervention consisting of standard treatment alone or standard treatment plus VCAT-J, in order to determine the effect of the latter on white matter microstructural plasticity. Cognitive function was evaluated using the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J) scale. The CRT group exhibited significant improvements in verbal fluency and composite BACS-J scores, relative to the treatment-as-usual (TAU) group. In addition, the CRT group exhibited significantly increased fractional anisotropy (FA) values, along with significantly decreased radial (RD) and mean diffusivity (MD) values, in the posterior lobe of the left cerebellum. Changes in RD and MD values were negatively correlated with changes in BACS-J composite scores. These suggest that VCAT-J might mediate improvements in myelin sheath composition in the posterior lobe of the left cerebellum, which may have been associated with improvements in cognitive function.
Collapse
Affiliation(s)
- Kiwamu Matsuoka
- Department of Psychiatry, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan.
| | - Tsubasa Morimoto
- Department of Psychiatry, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Yasuhiro Matsuda
- Department of Psychiatry, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Fumihiko Yasuno
- Department of Psychiatry, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan; Department of Psychiatry, National Center for Geriatrics and Gerontology, 7-430 Morioka-Cho, Obu, Aichi, Japan
| | - Toshiaki Taoka
- Department of Radiology, Nagoya University, Graduate School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi, Japan
| | - Toshiteru Miyasaka
- Department of Radiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Hiroaki Yoshikawa
- Department of Psychiatry, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Masato Takahashi
- Department of Psychiatry, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Soichiro Kitamura
- Department of Psychiatry, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| |
Collapse
|
12
|
Popov MM, Pluzhnikov IV, Kaleda VG. [Procognitive effects of transcranial magnetic stimulation in the light of neurocognitive deficit in schizophrenia]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:120-126. [PMID: 31089106 DOI: 10.17116/jnevro2019119031120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a relatively new method of non-invasive therapy of mental and neurological diseases that has great potential of therapeutic and diagnostic application. In schizophrenia, TMS may exert a positive effect on cognitive deficit. However this issue remains open. The authors analyze recent studies focused on the dynamics of neurocognitive deficit in TMS therapy and consider clinical effects of TMS in schizophrenia. The analysis has shown that TMS is successfully implemented in treatment of auditory positive symptoms and studies on its effect on negative symptoms of schizophrenia are perspective. Procognitive effect was found in working memory domain, and partially in perception domain within the perception of faces and facial expressions. The data on regulative functions, attention, speech, and nondeclarative memory remains controversial. It has been concluded that further research is needed to clarify the place of TMS in schizophrenia therapy.
Collapse
Affiliation(s)
- M M Popov
- Mental Health Research Center, Moscow, Russia
| | | | - V G Kaleda
- Mental Health Research Center, Moscow, Russia
| |
Collapse
|
13
|
Zhilyaeva TV, Sergeeva AV, Blagonravova AS, Mazo GE, Kibitov AO. One-Carbon Metabolism Disorders in Schizophrenia: Genetic and Therapeutic Aspects. NEUROCHEM J+ 2019. [DOI: 10.1134/s1819712419020156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
14
|
Rao N, Northoff G, Tagore A, Rusjan P, Kenk M, Wilson A, Houle S, Strafella A, Remington G, Mizrahi R. Impaired Prefrontal Cortical Dopamine Release in Schizophrenia During a Cognitive Task: A [11C]FLB 457 Positron Emission Tomography Study. Schizophr Bull 2019; 45:670-679. [PMID: 29878197 PMCID: PMC6483585 DOI: 10.1093/schbul/sby076] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Evidence from several lines of research suggests decreased dopamine release in the prefrontal cortex as the neurochemical correlates of cognitive deficits in schizophrenia (SCZ). However, in vivo examination of cortical hypodopaminergia using positron emission tomography (PET) during cognitive task performance in SCZ remains to be investigated. We examined dopamine release in anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (DLPFC), using PET while participants were performing a cognitive task. Thirteen drug-free patients with SCZ and 13 healthy volunteers (HV) matched for age and sex participated in the study. Data were acquired between 2011 and 2015. Two PET scans with [11C]FLB 457 were acquired while the participants were performing the Wisconsin Card Sorting Test (WCST) and a sensorimotor control task (SMCT). A magnetic resonance image was acquired for anatomical delineation. Differences in cortical dopamine release between SCZ and HV, indexed as percentage change in binding potential between WCST and SMCT (ΔBPND), were calculated in ACC and DLPFC. We observed significant differences in the ΔBPND in ACC (HV = 4.40 ± 6.00; SCZ = -11.48 ± 15.08; t = 3.52; P = .003) and a trend-level difference in ΔBPND in DLPFC (HV = -0.58 ± 8.45; SCZ = -7.79 ± 11.28; t = 1.84; P = .079), suggesting dopamine depletion in cortical brain regions in patients with SCZ while performing a cognitive task. These results provide the first in vivo evidence for reduced dopamine release or even dopamine depletion while performing cognitive task in ACC and DLPFC in patients with SCZ. The present results provide support for the frontal hypodopaminergia hypothesis of cognitive symptoms in SCZ.
Collapse
Affiliation(s)
- Naren Rao
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Georg Northoff
- Institute of Mental Health Research: Mind, Brain Imaging and Neuroethics, University of Ottawa, Ottawa, ON, Canada
| | - Abanti Tagore
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Pablo Rusjan
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Miran Kenk
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alan Wilson
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sylvain Houle
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Antonio Strafella
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gary Remington
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Romina Mizrahi
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada,To whom correspondence should be addressed; University of Toronto, Focus on Youth Psychosis Prevention (FYPP), Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8 Canada; tel: 416-535-8501 ext. 34508, fax: 416-979-4656, e-mail:
| |
Collapse
|
15
|
Dondé C, Mondino M, Brunelin J, Haesebaert F. Sensory-targeted cognitive training for schizophrenia. Expert Rev Neurother 2019; 19:211-225. [PMID: 30741038 DOI: 10.1080/14737175.2019.1581609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Auditory and visual dysfunctions are key pathophysiological features of schizophrenia (Sz). Therefore, remedial interventions that directly target such impairments could potentially drive gains in higher-order cognition (e.g., memory, executive functions, emotion processing), symptoms and functional outcome, in addition to improving sensory abilities in this population. Here, we reviewed available sensory-targeted cognitive training (S-TCT) programs that were investigated so far in Sz patients. Area covered: A systematic review of the literature was conducted following PRISMA guidelines. Twenty-seven relevant records were included. The superiority of S-TCT over control conditions on higher-order cognition measures was repeatedly demonstrated, but mostly lost significance at later endpoints of evaluation. Clinical symptoms and functional outcome were improved in a minority of studies. S-TCT interventions were associated with the relative normalization of several neurobiological biomarkers of neuroplasticity and sensory mechanisms. Expert commentary: S-TCT, although time-intensive, is a cost-efficient, safe and promising technique for Sz treatment. Its efficacy on higher-order cognition opens a critical window for clinical and functional improvement. The biological impact of S-TCT may allow for the identification of therapeutic biomarkers to further precision-medicine. Additional research is required to investigate the long-term effects of S-TCT, optimal training parameters and potential confounding factors associated with the illness.
Collapse
Affiliation(s)
- Clément Dondé
- a INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team , Lyon, F-69678 , France.,b University Lyon 1 , Villeurbanne, F-69000 , France.,c Centre Hospitalier Le Vinatier, Department of Psychiatry , Bron, F-69000 , France
| | - Marine Mondino
- a INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team , Lyon, F-69678 , France.,b University Lyon 1 , Villeurbanne, F-69000 , France.,c Centre Hospitalier Le Vinatier, Department of Psychiatry , Bron, F-69000 , France
| | - Jérôme Brunelin
- a INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team , Lyon, F-69678 , France.,b University Lyon 1 , Villeurbanne, F-69000 , France.,c Centre Hospitalier Le Vinatier, Department of Psychiatry , Bron, F-69000 , France
| | - Frédéric Haesebaert
- a INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team , Lyon, F-69678 , France.,b University Lyon 1 , Villeurbanne, F-69000 , France.,c Centre Hospitalier Le Vinatier, Department of Psychiatry , Bron, F-69000 , France
| |
Collapse
|
16
|
Kaneko K. Negative Symptoms and Cognitive Impairments in Schizophrenia: Two Key Symptoms Negatively Influencing Social Functioning. Yonago Acta Med 2018. [PMID: 29946215 DOI: 10.33160/yam.2018.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Schizophrenia is a chronic, disabling disorder, which commonly emerges in adolescence and young adulthood. While pharmacological treatment with currently available second-generation antipsychotics exerts beneficial effects on the positive symptoms of schizophrenia, they have little effect on negative symptoms or cognitive deficits. Because these two types of symptoms are enduring, and negatively impact social functioning throughout the course of the illness, there is an urgent requirement to develop new effective therapeutic approaches to manage them. Negative symptoms have proven difficult to assess accurately because of their complexity, even with commonly used clinical rating scales such as the Scales for Assessment of Negative Symptoms (SANS). In this context, new "next-generation" assessment tools have recently been developed, which include items representing the five domains encompassed by the two established clusters of negative symptoms (diminished expression and avolition), and enable the detection of changes in severity. Despite various therapeutic approaches to alleviating negative symptoms, there are currently no established methods available for clinical practice. Cognitive deficits are also a core feature in the majority of people with schizophrenia, with impaired performance observed across many cognitive domains, including verbal memory, working memory, attention, and executive functions. Such cognitive deficits are likely associated with either reduced or inefficient function of related distributed neural networks. Psychosocial treatments for cognitive impairments in schizophrenia seem promising given the beneficial effects of cognitive remediation therapy on such impairments, as well as on social functioning, as substantiated in several meta-analytic studies with modest effect sizes. Furthermore, using functional neuroimaging techniques, the size of these therapy-induced beneficial changes in neurocognitive performance has been demonstrated to be correlated with the degree of the changes in brain activation during performing some cognitive tasks in the prefrontal and temporal cortices. This suggests neurobiological effects are exerted by psychosocial cognitive remediation treatments.
Collapse
Affiliation(s)
- Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neurosciences, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| |
Collapse
|
17
|
Kaneko K. Negative Symptoms and Cognitive Impairments in Schizophrenia: Two Key Symptoms Negatively Influencing Social Functioning. Yonago Acta Med 2018; 61:91-102. [PMID: 29946215 PMCID: PMC6015796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/23/2018] [Indexed: 09/27/2023]
Abstract
Schizophrenia is a chronic, disabling disorder, which commonly emerges in adolescence and young adulthood. While pharmacological treatment with currently available second-generation antipsychotics exerts beneficial effects on the positive symptoms of schizophrenia, they have little effect on negative symptoms or cognitive deficits. Because these two types of symptoms are enduring, and negatively impact social functioning throughout the course of the illness, there is an urgent requirement to develop new effective therapeutic approaches to manage them. Negative symptoms have proven difficult to assess accurately because of their complexity, even with commonly used clinical rating scales such as the Scales for Assessment of Negative Symptoms (SANS). In this context, new "next-generation" assessment tools have recently been developed, which include items representing the five domains encompassed by the two established clusters of negative symptoms (diminished expression and avolition), and enable the detection of changes in severity. Despite various therapeutic approaches to alleviating negative symptoms, there are currently no established methods available for clinical practice. Cognitive deficits are also a core feature in the majority of people with schizophrenia, with impaired performance observed across many cognitive domains, including verbal memory, working memory, attention, and executive functions. Such cognitive deficits are likely associated with either reduced or inefficient function of related distributed neural networks. Psychosocial treatments for cognitive impairments in schizophrenia seem promising given the beneficial effects of cognitive remediation therapy on such impairments, as well as on social functioning, as substantiated in several meta-analytic studies with modest effect sizes. Furthermore, using functional neuroimaging techniques, the size of these therapy-induced beneficial changes in neurocognitive performance has been demonstrated to be correlated with the degree of the changes in brain activation during performing some cognitive tasks in the prefrontal and temporal cortices. This suggests neurobiological effects are exerted by psychosocial cognitive remediation treatments.
Collapse
Affiliation(s)
- Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neurosciences, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| |
Collapse
|
18
|
Associations of suicidality with cognitive ability and cognitive insight in outpatients with Schizophrenia. Schizophr Res 2018; 192:340-344. [PMID: 28655480 PMCID: PMC5742308 DOI: 10.1016/j.schres.2017.06.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/09/2017] [Accepted: 06/10/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous literature suggests that better cognitive ability and insight are associated with greater lifetime risk of suicide attempts in schizophrenia, counter to the direction of association in the general population. However, the conjoint association between distinct cognitive domains, insight, and suicidality has not been assessed. METHOD In a cross-sectional study, 162 adults with schizophrenia or schizoaffective disorder completed cognitive testing via the MATRICS battery, symptom and cognitive insight assessments, along with the Columbia Suicide Severity Rating Scale. We then contrasted participants based on history of suicidality by cognitive domains and insight measures and conducted multivariate analyses. RESULTS Although a history of any passive ideation was not associated with cognitive ability or insight, verbal learning was positively associated with a greater history of suicidal attempt and prior ideation with a plan and intent. Higher cognitive insight, and the self-reflectiveness subscale insight, was also associated with history of passive or active suicidal ideation. Cognitive insight and cognitive ability were independent from each other, and there were no moderating influences of insight on the effect of cognitive ability on suicide related history. Exploratory analyses revealed that history of planned attempts were associated with greater verbal learning, whereas histories of aborted attempts were associated with poorer reasoning and problem-solving. IMPLICATIONS Although cross-sectional and retrospective, this study provides support that greater cognitive ability, specifically verbal learning, along with self-reflectiveness, may confer elevated risk for more severe suicidal ideation and behavior in an independent fashion. Interestingly, poorer problem-solving was associated with aborted suicide attempts.
Collapse
|
19
|
Leppanen J, Adamson J, Tchanturia K. Impact of Cognitive Remediation Therapy on Neurocognitive Processing in Anorexia Nervosa. Front Psychiatry 2018; 9:96. [PMID: 29615940 PMCID: PMC5869183 DOI: 10.3389/fpsyt.2018.00096] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is characterized by severe malnutrition as well as inefficiencies in neurocognitive functioning, which are believed to contribute to the maintenance of disordered eating. The aim of this study was to examine the impact of individual cognitive remediation therapy (CRT) on neurocognition in AN. METHODS A total of 145 adult women from an eating disorders inpatient program took part in the present study. All participants were given individual CRT in addition to treatment as usual. Neurocognitive processes were assessed at baseline and at the end of treatment using task-based and self-report measures. The task-based measures included the Rey-Osterrieth Complex Figure test and the Brixton test, which were used to assess central coherence and set-shifting. The Detail and Flexibility Questionnaire was used to examine patients self-reported detail focus and cognitive flexibility. RESULTS Participants showed significant improvement in task-based measures of neurocognition following CRT. There were no significant changes in self-report measures. CONCLUSION These findings suggest that CRT may be an effective intervention targeting inefficiencies in neurocognition in AN. Future studies may benefit from assessing neural changes associated with these improvements and conducting randomized controlled trials to replicate these findings.
Collapse
Affiliation(s)
- Jenni Leppanen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - James Adamson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychology, Illia State University, Tbilisi, Georgia
| |
Collapse
|
20
|
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.
Collapse
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.
| |
Collapse
|
21
|
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.
Collapse
|
22
|
Takeda K, Matsumoto M, Ogata Y, Maida K, Murakami H, Murayama K, Shimoji K, Hanakawa T, Matsumoto K, Nakagome K. Impaired prefrontal activity to regulate the intrinsic motivation-action link in schizophrenia. NEUROIMAGE-CLINICAL 2017; 16:32-42. [PMID: 29071207 PMCID: PMC5650579 DOI: 10.1016/j.nicl.2017.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 12/04/2022]
Abstract
A core feature of schizophrenia (SCZ) is impairment in intrinsic motivation. Although intrinsic motivation plays an important role in enhancing improvement of the social functioning, its neural mechanisms of impairment have yet to be clarified. We hypothesized that abnormal function of the frontostriatal loop consisting of the striatum and lateral prefrontal cortex (LPFC) may be related to impaired intrinsic motivation in SCZ. We tested this by comparing the brain activity measured by functional magnetic resonance imaging and behavioral parameters associated with movement, motivation, and cognitive control between 18 stable SCZ patients and 17 healthy control (HC) participants during a task that elicits intrinsic motivation. We also compared the functional connectivity during resting-state and the fractional anisotropy using diffusion tensor imaging analysis between the two groups. We adopted an enjoyable timing task to stop a stopwatch at an exact time, which in our previous study has demonstrated to elicit intrinsic motivation. Although the performance level in general was not different between groups, the SCZ group performed worse than the HC group in trials following “overshoot” errors (i.e., the response was too late). SCZ participants showed lower intrinsic motivation to the task than the HC group in an inventory report. The striatal activity during the prediction at the task cue period was consistently lower in SCZ participants than in HC. The LPFC activity at the task cue period positively correlated with intrinsic motivation and also with the rate of success following overshoot errors in the HC group, but not in the SCZ group. The LPFC activity at the task cue period was also positively correlated with the striatal activity in both groups. The striatal activity during the feedback period was not significantly different between groups. These results suggest that, unlike HC, the neural activity in the LPFC fails to mediate between prediction of hedonic events and cognitive control of action plans in SCZ, whereas the hedonic response is retained. The neural basis of impaired motivation in schizophrenia is examined using fMRI. The hedonic response to a feedback in the striatum is retained in schizophrenia. Translating hedonic events to action plans is impeded by poor cognitive control. The cognitive control impairment is associated with altered prefrontal function.
Collapse
Affiliation(s)
- Kazuyoshi Takeda
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Madoka Matsumoto
- Department of Neuropsychiatry, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yousuke Ogata
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan.,Institute of Innovative Research, Tokyo Institute of Technology, Nagatsuta-cho, Yokohama 226-8503, Japan
| | - Keiko Maida
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Hiroki Murakami
- Department of Psychology, Oita University, Oita City 870-1192, Japan.,Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Kou Murayama
- Faculty of Life Sciences, University of Reading, Reading, Berkshire RG6 6AH, UK.,Research Unit of Psychology, Education & Technology, Kochi University of Technology, Tosayamada-machi, Kochi 782-8502, Japan
| | - Keigo Shimoji
- Department of Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo 173-0015, Japan
| | - Takashi Hanakawa
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| | - Kenji Matsumoto
- Brain Science Institute, Tamagawa University, Machida, Tokyo 194-8610, Japan
| | - Kazuyuki Nakagome
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan
| |
Collapse
|
23
|
Fraguas D, Díaz-Caneja CM, Rodríguez-Quiroga A, Arango C. Oxidative Stress and Inflammation in Early Onset First Episode Psychosis: A Systematic Review and Meta-Analysis. Int J Neuropsychopharmacol 2017; 20:435-444. [PMID: 28575316 PMCID: PMC5452799 DOI: 10.1093/ijnp/pyx015] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/08/2017] [Accepted: 03/01/2017] [Indexed: 01/17/2023] Open
Abstract
Background People with schizophrenia and other psychosis show increased proinflammatory and prooxidative status. However, the few studies that have specifically assessed oxidative and inflammatory markers in early onset psychosis (onset before age 18) have shown contradictory results. Methods Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for systematic reviews and meta-analyses were used to conduct a systematic literature search to detect studies comparing inflammatory and oxidative markers in early onset psychosis patients and healthy controls. Results Seven studies met criteria for the qualitative analysis. Four studies met criteria for meta-analysis, comprising an overall sample of 261 early onset psychosis patients and 246 healthy controls. Six independent meta-analyses were performed for catalase, glutathione, glutathione peroxidase, superoxide dismutase, total antioxidant status, and cell/DNA oxidative damage. No significant differences were found between early onset psychosis patients and controls in any of the parameters assessed. Heterogeneity among studies was high. Qualitative analysis of individual studies showed an association of inflammatory and oxidative markers with clinical, cognitive, and neurobiological outcomes, especially in longitudinal assessments. Conclusions Despite the lack of significant differences between early onset psychosis patients and controls in the oxidative markers assessed in the meta-analyses, results based on individual studies suggest that greater inflammation and oxidative stress might lead to poorer outcomes in patients with first episodes of early onset psychosis.
Collapse
Affiliation(s)
- David Fraguas
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Alberto Rodríguez-Quiroga
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| |
Collapse
|
24
|
Giombini L, Turton R, Turco M, Nesbitt S, Lask B. The use of cognitive remediation therapy on a child adolescent eating disorder unit: Patients and therapist perspectives. Clin Child Psychol Psychiatry 2017; 22:288-300. [PMID: 27432543 DOI: 10.1177/1359104516657859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cognitive remediation therapy (CRT) is an intervention for anorexia nervosa (AN) that focuses on ameliorating the neuropsychological inefficiencies that underlie the illness. The current literature has reported promising results regarding its efficacy as an intervention for AN. However, there is a scarcity of studies considering the implementation of CRT in a child and adolescent population. This article describes an individual CRT therapy programme for children and adolescents with AN delivered on an inpatient unit for eating disorders. It considers the therapeutic process including the differing viewpoints of the patients and the therapists. The article concludes that CRT can be viewed as an engaging therapeutic intervention that could be useful as an additional treatment for AN.
Collapse
Affiliation(s)
| | - Robert Turton
- 2 Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Matteo Turco
- 1 Rhodes Wood Hospital, Partnerships in Care, UK
| | | | - Bryan Lask
- 1 Rhodes Wood Hospital, Partnerships in Care, UK
| |
Collapse
|
25
|
Penadés R, González-Rodríguez A, Catalán R, Segura B, Bernardo M, Junqué C. Neuroimaging studies of cognitive remediation in schizophrenia: A systematic and critical review. World J Psychiatry 2017; 7:34-43. [PMID: 28401047 PMCID: PMC5371171 DOI: 10.5498/wjp.v7.i1.34] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/14/2016] [Accepted: 12/14/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To examine the effects of cognitive remediation therapies on brain functioning through neuroimaging procedures in patients with schizophrenia.
METHODS A systematic, computerised literature search was conducted in the PubMed/Medline and PsychInfo databases. The search was performed through February 2016 without any restrictions on language or publication date. The search was performed using the following search terms: [(“cogniti*” and “remediation” or “training” or “enhancement”) and (“fMRI” or “MRI” or “PET” or “SPECT”) and (schizophrenia or schiz*)]. The search was accompanied by a manual online search and a review of the references from each of the papers selected, and those papers fulfilling our inclusion criteria were also included.
RESULTS A total of 101 studies were found, but only 18 of them fulfilled the inclusion criteria. These studies indicated that cognitive remediation improves brain activation in neuroimaging studies. The most commonly reported changes were those that involved the prefrontal and thalamic regions. Those findings are in agreement with the hypofrontality hypothesis, which proposes that frontal hypoactivation is the underlying mechanism of cognitive impairments in schizophrenia. Nonetheless, great heterogeneity among the studies was found. They presented different hypotheses, different results and different findings. The results of more recent studies interpreted cognitive recovery within broader frameworks, namely, as amelioration of the efficiency of different networks. Furthermore, advances in neuroimaging methodologies, such as the use of whole-brain analysis, tractography, graph analysis, and other sophisticated methodologies of data processing, might be conditioning the interpretation of results and generating new theoretical frameworks. Additionally, structural changes were described in both the grey and white matter, suggesting a neuroprotective effect of cognitive remediation. Cognitive, functional and structural improvements tended to be positively correlated.
CONCLUSION Neuroimaging studies of cognitive remediation in patients with schizophrenia suggest a positive effect on brain functioning in terms of the functional reorganisation of neural networks.
Collapse
|
26
|
Hegde S. A review of Indian research on cognitive remediation for schizophrenia. Asian J Psychiatr 2017; 25:54-59. [PMID: 28262174 DOI: 10.1016/j.ajp.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 07/25/2016] [Accepted: 10/07/2016] [Indexed: 12/22/2022]
Abstract
Cognitive deficits play a central role in recovery from Schizophrenia (SZ). Cognitive remediation (CR) is increasingly being examined to improve cognitive functions in SZ. It is becoming an inevitable component of treatment for this debilitating illness. This review article presents the current status of research on CR for SZ in India. In contrast to the numerous studies reported from across the globe, there are only five studies on CR for SZ published from India. Of the five, only two are randomized controlled trials, two are non-randomized studies and one is a series of case reports. With different strategies used for CR and a variety of tools and measurements as outcome measures, combined analysis of the data was not feasible. Improvement in cognitive functions and sustenance of the improvement observed at follow-up period ranging from 2 to 6 months duration was underscored by all the four studies. Indigenous methods such as home-based CR techniques and Yoga therapy as an adjunct CR technique have been researched upon. Established method of CR such as the Integrated Psychological Therapy (IPT) has been used with modifications made to suit the cultural scenario. Other treatment methods such as family therapy have been added along with CR for chronic patients. The limited number of research studies has tried to encompass various dimensions. However, there is a dire need for studies with larger sample size with stringent research methods. Culturally feasible CR technique and multi-centric studies with larger sample size can be the next way forward.
Collapse
Affiliation(s)
- Shantala Hegde
- Neuropsychology Unit, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru-560029, Karnataka, India.
| |
Collapse
|
27
|
Wei YY, Wang JJ, Yan C, Li ZQ, Pan X, Cui Y, Su T, Liu TS, Tang YX. Correlation Between Brain Activation Changes and Cognitive Improvement Following Cognitive Remediation Therapy in Schizophrenia: An Activation Likelihood Estimation Meta-analysis. Chin Med J (Engl) 2017; 129:578-85. [PMID: 26904993 PMCID: PMC4804440 DOI: 10.4103/0366-6999.176983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Several studies using functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have indicated that cognitive remediation therapy (CRT) might improve cognitive function by changing brain activations in patients with schizophrenia. However, the results were not consistent in these changed brain areas in different studies. The present activation likelihood estimation (ALE) meta-analysis was conducted to investigate whether cognitive function change was accompanied by the brain activation changes, and where the main areas most related to these changes were in schizophrenia patients after CRT. Analyses of whole-brain studies and whole-brain + region of interest (ROI) studies were compared to explore the effect of the different methodologies on the results. Methods: A computerized systematic search was conducted to collect fMRI and PET studies on brain activation changes in schizophrenia patients from pre- to post-CRT. Nine studies using fMRI techniques were included in the meta-analysis. Ginger ALE 2.3.1 was used to perform meta-analysis across these imaging studies. Results: The main areas with increased brain activation were in frontal and parietal lobe, including left medial frontal gyrus, left inferior frontal gyrus, right middle frontal gyrus, right postcentral gyrus, and inferior parietal lobule in patients after CRT, yet no decreased brain activation was found. Although similar increased activation brain areas were identified in ALE with or without ROI studies, analysis including ROI studies had a higher ALE value. Conclusions: The current findings suggest that CRT might improve the cognition of schizophrenia patients by increasing activations of the frontal and parietal lobe. In addition, it might provide more evidence to confirm results by including ROI studies in ALE meta-analysis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Yun-Xiang Tang
- Department of Medical Psychology, Faculty of Mental Health, Second Military Medical University, Shanghai 200433, China
| |
Collapse
|
28
|
Chang M, Womer FY, Bai C, Zhou Q, Wei S, Jiang X, Geng H, Zhou Y, Tang Y, Wang F. Voxel-Based Morphometry in Individuals at Genetic High Risk for Schizophrenia and Patients with Schizophrenia during Their First Episode of Psychosis. PLoS One 2016; 11:e0163749. [PMID: 27723806 PMCID: PMC5056757 DOI: 10.1371/journal.pone.0163749] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/13/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Understanding morphologic changes in vulnerable and early disease state of schizophrenia (SZ) may provide further insight into the development of psychosis. METHOD Whole brain voxel-based morphometry was performed to identify gray matter (GM) regional differences in 60 individuals with SZ during their first psychotic episode (FE-SZ), 31 individuals at genetic high risk for SZ (GHR-SZ) individuals, and 71 healthy controls. RESULTS Significant differences were found in several regions including the prefrontal cortex, parietal lobe, temporal lobe, hippocampus, occipital lobe, and cerebellum among the three groups (p<0.05, corrected). Compared to the HC group, the FE-SZ group had significantly decreased GM volumes in several regions including the cerebellum, hippocampus, fusiform gyrus, lingual gyrus, supramarginal gyrus, and superior, middle, and inferior temporal gyri and significantly increased GM volumes in the middle frontal gyrus and inferior operculum frontal gyrus (p<0.05). The GHR-SZ group had significant decreases in GM volumes in the supramaginal gyrus, precentral gyrus, and rolandic operculum and significant increases in GM volumes in the cerebellum, fusiform gyrus, middle frontal gyrus, inferior operculum frontal gyrus, and superior, middle, and inferior temporal gyri when compared to the HC group (p<0.05). Compared to the GHR-SZ group, the FE-SZ group had significant decreases in GM volumes in several regions including the cerebellum, fusiform gyrus, supramarginal gyrus, and superior, middle, and inferior temporal gyri (p<0.05). CONCLUSIONS The findings herein implicate the involvement of multisensory integration in SZ development and pathophysiology. Additionally, the patterns of observed differences suggest possible indicators of disease, vulnerability, and resiliency in SZ.
Collapse
Affiliation(s)
- Miao Chang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Fay Y. Womer
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Chuan Bai
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Qian Zhou
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Shengnan Wei
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Xiaowei Jiang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Haiyang Geng
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Yifang Zhou
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Yanqing Tang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Fei Wang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| |
Collapse
|
29
|
Campos C, Santos S, Gagen E, Machado S, Rocha S, Kurtz MM, Rocha NB. Neuroplastic Changes Following Social Cognition Training in Schizophrenia: A Systematic Review. Neuropsychol Rev 2016; 26:310-328. [PMID: 27541742 DOI: 10.1007/s11065-016-9326-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/27/2016] [Indexed: 01/24/2023]
Abstract
Social cognitive impairment is a key feature of schizophrenia and social cognition training (SCT) is a promising tool to address these deficits. Neurobiological dysfunction in schizophrenia has been widely researched, but neuronal changes induced by SCT have been scarcely explored. This review aims to assess the neuroplastic effects of SCT in patients with schizophrenia spectrum disorders. PubMed and Web of Science databases were searched for clinical trials testing the effects of SCT in functional and structural brain measurements of adult patients with schizophrenia or schizoaffective disorders. A total of 11 studies were included: five used fMRI, two used EEG and ERP, one used ERP only, two used MEG and one study used MRI. Data extracting and processing regarding sociodemographic and clinical variables, intervention characteristics, neuroimaging procedures, neuroplastic findings, effect sizes and study quality criteria was completed by two raters. Results indicate a wide range of structural and functional changes in numerous regions and circuits of the social brain, including early perceptual areas, the limbic system and prefrontal regions. Despite the small number of trials currently available, evidence suggests that SCT is associated with neuroplastic changes in the social brain and concomitant improvements in social cognitive performance. There is a lack of extensive knowledge about the neural mechanisms that underlie social cognitive enhancement after treatment, but the reported findings may shed light on the neural substrates of social cognitive impairment in schizophrenia and how improved treatment procedures can be developed and applied.
Collapse
Affiliation(s)
- Carlos Campos
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal. .,Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Av. Venceslau Brás, 71, Campus da Praia Vermelha, Rio de Janeiro, Brazil.
| | - Susana Santos
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal
| | - Emily Gagen
- Department of Psychology, University of North Carolina-Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599-3720, USA
| | - Sérgio Machado
- Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Av. Venceslau Brás, 71, Campus da Praia Vermelha, Rio de Janeiro, Brazil.,Physical Activity Neuroscience, Physical Activity Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Rua Marechal Deodoro, 263 - Centro, Niterói, Brazil
| | - Susana Rocha
- School of Accounting and Administration of Porto, Polytechnic Institute of Porto, Rua Jaime Lopes Amorim, s/n, 4465-004 S, Mamede de Infesta, Portugal
| | - Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, 45 Wyllys Ave, Middletown, CT, 06459, USA.,Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
| | - Nuno Barbosa Rocha
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal.
| |
Collapse
|
30
|
Deshpande SN, Bhatia T, Mohandas E, Nimgaonkar VL. Cognitive remediation in schizophrenia-The view from India. Asian J Psychiatr 2016; 22:124-8. [PMID: 27520912 PMCID: PMC5445020 DOI: 10.1016/j.ajp.2016.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/15/2016] [Accepted: 06/23/2016] [Indexed: 12/27/2022]
Abstract
The prevalence and disability due to Schizophrenia (SZ) in India is similar to other parts of the world. Cognitive impairments are also present in a large group of Indian persons with SZ. Interventions to address these impairments - termed cognitive remediation or cognitive retraining - are being tested all over the world. Indian research on remediation in schizophrenia has been eclectic and is reviewed here. Some investigators have focused mainly on symptom control and quality of life, as yoga could be a cost effective and culturally acceptable intervention for remediation and rehabilitation. Although participants were not exhaustively tested for improvement in cognitive function in the majority of such trials, published results are encouraging.
Collapse
Affiliation(s)
- Smita N Deshpande
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, Park Street, New Delhi, 110001, India.
| | - Triptish Bhatia
- Indo-US Projects, Department of Psychiatry, Post Graduate Institute of Medical Education and Research, PGIMER-Dr. Ram Manohar Lohia Hospital, New Delhi, India.
| | - E Mohandas
- Sun Medical & Research Centre, Trichur, Kerala, India.
| | - Vishwajit L Nimgaonkar
- Dept. of Psychiatry and Dept. of Human Genetics, University of Pittsburgh, Pittsburgh, USA.
| |
Collapse
|
31
|
Bryce S, Sloan E, Lee S, Ponsford J, Rossell S. Cognitive remediation in schizophrenia: A methodological appraisal of systematic reviews and meta-analyses. J Psychiatr Res 2016; 75:91-106. [PMID: 26828372 DOI: 10.1016/j.jpsychires.2016.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/01/2015] [Accepted: 01/04/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Systematic reviews and meta-analyses are a primary source of evidence when evaluating the benefit(s) of cognitive remediation (CR) in schizophrenia. These studies are designed to rigorously synthesize scientific literature; however, cannot be assumed to be of high methodological quality. The aims of this report were to: 1) review the use of systematic reviews and meta-analyses regarding CR in schizophrenia; 2) conduct a systematic methodological appraisal of published reports examining the benefits of this intervention on core outcome domains; and 3) compare the correspondence between methodological and reporting quality. METHOD Electronic databases were searched for relevant articles. Twenty-one reviews met inclusion criteria and were scored according to the AMSTAR checklist-a validated scale of methodological quality. Five meta-analyses were also scored according to PRISMA statement to compare 'quality of conduct' with 'quality of reporting'. RESULTS Most systematic reviews and meta-analyses shared strengths and fell within a 'medium' level of methodological quality. Nevertheless, there were consistent areas of potential weakness that were not addressed by most reviews. These included the lack of protocol registration, uncertainty regarding independent data extraction and consensus procedures, and the minimal assessment of publication bias. Moreover, quality of conduct may not necessarily parallel quality of reporting, suggesting that consideration of these methods independently may be important. CONCLUSIONS Reviews concerning CR for schizophrenia are a valuable source of evidence. However, the methodological quality of these reports may require additional consideration. Enhancing quality of conduct is essential for enabling research literature to be interpreted with confidence.
Collapse
Affiliation(s)
- Shayden Bryce
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia.
| | - Elise Sloan
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Stuart Lee
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
| | - Susan Rossell
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia; Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
32
|
Isaac C, Januel D. Neural correlates of cognitive improvements following cognitive remediation in schizophrenia: a systematic review of randomized trials. SOCIOAFFECTIVE NEUROSCIENCE & PSYCHOLOGY 2016; 6:30054. [PMID: 26993787 PMCID: PMC4799394 DOI: 10.3402/snp.v6.30054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/31/2015] [Accepted: 02/04/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cognitive impairments are a core feature in schizophrenia and are linked to poor social functioning. Numerous studies have shown that cognitive remediation can enhance cognitive and functional abilities in patients with this pathology. The underlying mechanism of these behavioral improvements seems to be related to structural and functional changes in the brain. However, studies on neural correlates of such enhancement remain scarce. OBJECTIVES We explored the neural correlates of cognitive enhancement following cognitive remediation interventions in schizophrenia and the differential effect between cognitive training and other therapeutic interventions or patients' usual care. METHOD We searched MEDLINE, PsycInfo, and ScienceDirect databases for studies on cognitive remediation therapy in schizophrenia that used neuroimaging techniques and a randomized design. Search terms included randomized controlled trial, cognitive remediation, cognitive training, rehabilitation, magnetic resonance imaging, positron emission tomography, electroencephalography, magnetoencephalography, near infrared spectroscopy, and diffusion tensor imaging. We selected randomized controlled trials that proposed multiple sessions of cognitive training to adult patients with a schizophrenia spectrum disorder and assessed its efficacy with imaging techniques. RESULTS In total, 15 reports involving 19 studies were included in the systematic review. They involved a total of 455 adult patients, 271 of whom received cognitive remediation. Cognitive remediation therapy seems to provide a neurobiological enhancing effect in schizophrenia. After therapy, increased activations are observed in various brain regions mainly in frontal - especially prefrontal - and also in occipital and anterior cingulate regions during working memory and executive tasks. Several studies provide evidence of an improved functional connectivity after cognitive training, suggesting a neuroplastic effect of therapy through mechanisms of functional reorganization. Neurocognitive and social-cognitive training may have a cumulative effect on neural networks involved in social cognition. The variety of proposed programs, imaging tasks, and techniques may explain the heterogeneity of observed neural improvements. Future studies would need to specify the effect of cognitive training depending on those variables.
Collapse
Affiliation(s)
- Clémence Isaac
- Unité de Recherche Clinique, EPS Ville Evrard, Neuilly-Sur-Marne, France;
| | - Dominique Januel
- Unité de Recherche Clinique, EPS Ville Evrard, Neuilly-Sur-Marne, France
| |
Collapse
|
33
|
Rezapour T, DeVito EE, Sofuoglu M, Ekhtiari H. Perspectives on neurocognitive rehabilitation as an adjunct treatment for addictive disorders. PROGRESS IN BRAIN RESEARCH 2016; 224:345-69. [DOI: 10.1016/bs.pbr.2015.07.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
34
|
Abstract
Insufficient outcomes amongst adults with major depressive disorder (MDD) provide the impetus to identify and refine therapeutic targets that are most critical to outcome from patient, provider, and societal perspectives. Towards this aim, a pivotal shift towards the transnosological domain, cognition, is occurring in the study of MDD and other brain disorders. This paper aims to provide a framework for conceptualizing and prioritizing cognitive function amongst adults with MDD with a particular view to provide a conceptual framework for research and clinical priorities. We also summarize extant data pertaining to psychotropic effects, notably antidepressants, on the cognitive dimension/domain. This narrative review was based on articles identified through a PubMed/MEDLINE search of all English-language articles published between January 1966 and October 2014. The search words were major depressive disorder, depression, unipolar depression, cognition, cognitive dysfunction, cognitive deficit, and cognitive function. The search was supplemented with a manual review of relevant references. The selection of articles for inclusion in this review was based on overall methodological quality as well as on their pertinence to informing the framework described herein. Cognitive dysfunction in MDD is a discrete domain subserved by discrete yet overlapping substrates. There is a need to provide a glossary of terms commonly employed in the cognition literature for consensus as to the appropriate screening, measurement, and monitoring tools. The guiding principle of measurement-based care should include systematic assessment and measurement of cognition in subpopulations with MDD, as a tactic to improve outcome. Relatively few treatment strategies have demonstrated efficacy specifically for the cognitive domain in MDD. The antidepressant vortioxetine has replicated evidence of specific pro-cognitive effects in adults with MDD across multiple subdomains of cognitive function. Vortioxetine is a novel antidepressant that is hypothesized to act through a combination of direct effects on receptor activity and serotonin receptor inhibition, as well as other systems. Pro-cognitive effects for other US FDA-approved agents are suggested, but pseudospecificity has not been excluded as a possible explanation of their beneficial effects on cognitive function. A disparate assortment of other agents are currently under investigation for possible benefit in mitigating cognitive deficits and improving cognitive performance (e.g., intranasal insulin, erythropoietin, anti-inflammatory agents). Non-pharmacological approaches including, but not limited to, cognitive remediation (CR), aerobic exercise, and neuromodulation are promising.
Collapse
|
35
|
Targeted training modifies oscillatory brain activity in schizophrenia patients. NEUROIMAGE-CLINICAL 2015; 7:807-14. [PMID: 26082889 PMCID: PMC4459048 DOI: 10.1016/j.nicl.2015.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/03/2015] [Accepted: 03/15/2015] [Indexed: 01/01/2023]
Abstract
Effects of both domain-specific and broader cognitive remediation protocols have been reported for neural activity and overt performance in schizophrenia (SZ). Progress is limited by insufficient knowledge of relevant neural mechanisms. Addressing neuronal signal resolution in the auditory system as a mechanism contributing to cognitive function and dysfunction in schizophrenia, the present study compared effects of two neuroplasticity-based training protocols targeting auditory–verbal or facial affect discrimination accuracy and a standard rehabilitation protocol on magnetoencephalographic (MEG) oscillatory brain activity in an auditory paired-click task. SZ were randomly assigned to either 20 daily 1-hour sessions over 4 weeks of auditory–verbal training (N = 19), similarly intense facial affect discrimination training (N = 19), or 4 weeks of treatment as usual (TAU, N = 19). Pre-training, the 57 SZ showed smaller click-induced posterior alpha power modulation than did 28 healthy comparison participants, replicating Popov et al. (2011b). Abnormally small alpha decrease 300–800 ms around S2 improved more after targeted auditory–verbal training than after facial affect training or TAU. The improvement in oscillatory brain dynamics with training correlated with improvement on a measure of verbal learning. Results replicate previously reported effects of neuroplasticity-based psychological training on oscillatory correlates of auditory stimulus differentiation, encoding, and updating and indicate specificity of cortical training effects. Induced posterior alpha power modulation in auditory paired-click design is abnormally small in schizophrenia patients. Abnormal alpha power modulation improved after neuroplasticity-based auditory training. Results confirm targeted training effects on oscillatory correlates of auditory stimulus discrimination, encoding, updating. No similar effects of visual affect discrimination training on alpha power indicate specificity of cortical training effects.
Collapse
|