Abstract Objective Decreased processing speed (PS) is a key feature of schizophrenia with respect to cognition, functional outcome and clinical symptoms. Our objective was to test whether PS slowing ...mediates other neuropsychological deficits among patients with chronic schizophrenia. Method One hundred patients with schizophrenia and 53 healthy adults completed a series of neuropsychological measures that assess six cognitive domains. In addition to PS these included attention, verbal memory, visual memory, working memory, and executive functioning. Confirmatory factor analysis (CFA) was used to evaluate the fit of the 6-factor model. The cognitive performances of both groups were compared before and after controlling for the effect of PS, but also after controlling for the effect of each cognitive factor at a time. Finally, the PS-related variance was removed and the effect of the other cognitive factors was tested again. Results CFA supported the hypothesized 6-factor cognitive structure. As expected, the patients and controls differed on all cognitive measures. However, after controlling for the effects of PS, group differences on the other five cognitive factors decreased substantially. Controlling for other factors produced smaller attenuation of group differences, and these effects were also partially accounted for by decreased PS. Conclusions PS deficits account for most of the differences in cognition between patients with schizophrenia and healthy controls. PS slowing appears to be a core feature of schizophrenia, one that underlies impairments of working memory, executive functioning, and other abilities.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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Suicide attempts in bipolar patients López, P; Mosquera, F; de León, J ...
The journal of clinical psychiatry,
12/2001, Volume:
62, Issue:
12
Journal Article
Peer reviewed
Between 25% to 50% of patients with bipolar disorder make suicide attempts during their lives, but there are some controversies about factors related to suicide attempts in this group of patients. ...The aim of this study is to investigate the association between suicide attempts and the predictive factors previously described in the literature.
The sample included all 169 patients with DSM-III-R bipolar I disorder identified in a delimited area (northern Spain). Sociodemographic, clinical, and family history variables measured by Research Diagnostic Criteria-Family History were analyzed. Significant variables were introduced in a logistic regression analysis to control for the effects of other variables.
There were 56 patients (33%) who had one or more suicide attempts. Early age at onset, history of hospital admission during depressive episodes, drug abuse, and family history were significantly associated with suicide in the univariate analyses (p < .05). A much higher proportion of patients with onset at or before 25 years of age than patients with onset after 25 years of age attempted suicide (23% vs. 10%). The age at onset was no longer significant after controlling for the other 3 variables included in the logistic regression analysis.
Suicide attempts are highly prevalent in bipolar patients and are related to drug abuse, family history of affective disorders, and severe depressive episodes. This study suggests that the risk of suicide in patients with an early age at onset could reflect other variables such as drug abuse, a history of hospital admissions for depression, or family history.
Cognitive rehabilitation in schizophrenia has been proved to benefit cognition depending on the severity of the illness and the cognitive deficits. Nevertheless studies of efficiency with chronic ...patients, refractory to additional treatment interventions, have not yet been published.
Ninety three patients with schizophrenia were recruited from the Treatment Resistant Schizophrenia Unit in Alava (Spain). All subjects underwent a baseline and a 3 months assessment including cognition, clinical symptoms and functional capacity. Patients were randomly assigned to receive either neuropsychological rehabilitation or occupational therapy for 3 months in addition to treatment as usual (TAU).
Patients at the Rehacop group showed significantly greater improvements at 3 months in most areas of cognition evaluated including speed of processing, language, memory and executive functioning, compared to the occupational therapy group (group x time interactions p< 0.001). The Rehacop group also showed significant improvement in positive symptoms, functional and insight measures. Although data was not statistically significant, the Rehacop group showed a tendency to also improve negative symptoms compared to controls.
Despite to their limited respond to TAU, our data suggest that chronic refractory patients can improve their cognitive performance after neuropsychological rehabilitation with the Rehacop. These findings support the feasibility of integrating neuropsychological rehabilitation into TAU programs for patients with lower responses to other treatment plans.
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DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Abstract Introduction One of the criticisms of rehabilitation techniques is their limited application to the patient’s daily life. In the past, cinema has been used as a psychiatric rehabilitation ...tool, with the primary objective of facilitating training in social abilities and communication. In this study, we consider the use of film not only as a clinical recovery tool but also as a novel cognitive recovery tool for additional rehabilitation not only for communication and social abilities but also for all of the basic cognitive and social cognition processes. Methods In this randomized clinical trial, 48 patients with schizophrenia were assigned to an experimental or control group. Both of the groups received treatment sessions that included viewing episodes of the television series The Sopranos . Next, the experimental group participated in a structured cognitive training session that featured questions and exercises based on the episodes. The control group participated in an idea-sharing session (of the same duration and frequency) about what the group members saw in the episode. Results At the end of the treatment, both the positive and negative clinical symptoms of the experimental group improved significantly compared with the control group. However, this improvement was not observed in basic or social cognitive functions. Discussion A brief intervention based on transforming the activities of daily life can be an effective tool for psychiatric rehabilitation. However, the study’s current characteristics and sample did not produce benefits in cognitive parameters.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Introducción Una de las críticas que se hace a las técnicas de la rehabilitación es la limitada generalización a la vida cotidiana del paciente. El cine se ha empleado como herramienta de ...rehabilitación psiquiátrica en el pasado con el objetivo principal de facilitar el entrenamiento en habilidades sociales y de comunicación. En este estudio nos planteamos emplear el cine como herramienta de recuperación clínica, pero también como herramienta novedosa de recuperación cognitiva para trabajar adicionalmente comunicación y habilidades sociales y todos los procesos cognitivos básicos y de cognición social. Método En este ensayo clínico aleatorizado, 48 pacientes con esquizofrenia fueron asignados a un grupo experimental o control. Ambos grupos recibieron sesiones de tratamiento que incluían la visualización de capítulos de cine de la serie Los Soprano. Tras ello, el grupo experimental realizaba una sesión estructurada de entrenamiento cognitivo con preguntas y ejercicios basados en el capítulo de cine. Con la misma duración y frecuencia el grupo control realizaba una puesta común en voz alta sobre lo visto en el capítulo. Resultados Al final del tratamiento, el grupo experimental mejoró significativamente en síntomas clínicos tanto positivos como negativos en comparación con el grupo control. Sin embargo, esta mejoría no se observó en las funciones cognitivas ni básicas ni en cognición social. Discusión Una intervención breve basada en actividades de la vida diaria puede ser transformada en herramienta eficaz de rehabilitación psiquiátrica. Sin embargo, con las características actuales y en la muestra de este estudio, la misma intervención no aportó beneficios en parámetros de cognición.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective The goal of this study is to test the efficacy of the Memory Module of the REHACOP (Cognitive Training Program for Psychosis, Ojeda, Peña, 2006), in the improvement of cognition in patients ...with chronic schizophrenia (CS). Chronic patients present a moderate to severe cognitive performance on verbal memory and the severity of the illness and variables associated to the course of the diagnosis prevent them from improving cognition with traditional treatments. Methods 57 patients with CS (illness duration, 10.17±7.22) were allocated randomly into either REHACOP (N=27) or control group (N=30). The REHACOP group received memory training with structured sessions 3 times per week for 8 weeks. Control group attended occupational therapy with the same frequency and timetables. Verbal Learning and Memory (Hopkins Verbal Learning Test; HVLT) and Working Memory (Digits Backwards from WAIS-III) were assessed at baseline and after the intervention. Results Repeated measures of MANOVA showed that the interaction term groupXtime was significant for all the memory measures, suggesting REHACOP group improved significantly when compared to controls. Specifically, the interaction term F value was significant for HVLT learning ( F =6.78, p < 0.01), HVLT Long-term memory ( F =7.02, p < 0.01) and working memory (Digits Backward ( F =10.04, p < 0.01), and Sum ( F =11.39, p < 0.01). Conclusions Patients with CS improved significantly in all memory impairments when compared to those receiving other treatment. This study supports the efficacy of the REHACOP in the intervention of memory impairments in patients with schizophrenia, in spite of the severity.
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GEOZS, IMTLJ, KILJ, NUK, OILJ, PNG, SBCE, SBJE, UL, UM, UPUK
Objectives Processing speed and executive functioning are among the more impaired cognitive domains in schizophrenia, do not improve despite antipsychotic medication, and are associated with poor ...long-term functioning and quality of life. Cognitive remediation therapy for psychosis (REHACOP) try to improve cognitive deficits by teaching information processing strategies through guided mental exercises. The objective of this study is to evaluate the effectiveness of cognitive remediation therapy (REHACOP), compared to other treatments, on processing speed and executive functioning difficulties. Material and methods Fifty-seven patients with DSM-IV schizophrenia and 29 with first-episode psychosis were randomly allocated into one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy group. The REHACOP group received 3 months structured group rehabilitation sessions (3 per week) focused on tasks requiring attention, language, memory, speed, executive functioning and activities of daily living. All subjects underwent a neuropsychological assessment pre- and post treatment, which included tests for processing speed (Trail-Making Test-A, Digit Symbol, and Stroop-Color) and executive functioning (Stroop Word-Color part and interference) Results Repeated measures of MANOVA showed that the interaction term groupXtime was significant for the executive functioning ( F = 9.88, p < 0.01) and processing speed ( F = 5.92, p < 0.05) measures, suggesting that the REHACOP experimental group improved significantly when compared to the control group's performance on both domains. Conclusions Results suggest that REHACOP is effective to improve executive dysfunction and processing speed deficits in first-episode psychosis and schizophrenia compared to occupational therapy.
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GEOZS, IMTLJ, KILJ, NUK, OILJ, PNG, SBCE, SBJE, UL, UM, UPUK
Aims To examine the relative contributions of psychiatric symptoms, functional disability, neuropsychological functioning and sociodemographic variables to quality of life (QOL) in patients with ...chronic schizophrenia. Method We examined 165 hospitalised patients with long term schizophrenia (DSM-IV). Measures of psychiatric symptoms included depression (Calgary depression Scale), insight (David Insight Scale), symptom severity (BPRS) and PANSS (Positive and Negative Symptom Scale). Neuropsychological battery included tests for verbal memory, executive functioning, verbal fluency, working memory, motor speed and processing speed. Functional disability was assessed with the Disability Assessment Schedule (DAS-WHO) and Quality of life was assessed with the Quality of Life Scale. Results Age, years of evolution, negative symptoms, insight and neuropsychological variables (except motor speed) all were significantly related to level of quality of life. In a multiple regression analysis, entering the neuropsychological functioning, functional disability and negative symptoms generated a model which accounted for a 74.9% of the variance in QOL. Functional disability, as expected, accounted for 56% of the variance, whereas Processing Speed explained an additional 6.2%. Symptom Severity and Verbal Fluency predicted 3.7% and 3.5% of the variance, respectively. Negative symptoms, Verbal Memory and Vocabulary, were also significant predictors in the model, but had less predictive value. However, Positive Symptoms and Sociodemographic Variables did not significantly contribute to predict quality of life. Conclusion Our findings support the predictive value of neuropsychological functioning, functional disability and severity of negative symptoms in long term quality of life in schizophrenia.
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GEOZS, IMTLJ, KILJ, NUK, OILJ, PNG, SBCE, SBJE, UL, UM, UPUK
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