Introduction
Treatment-resistant schizophrenia (TRS) represents a major clinical issue, characterized by worse psychopathological outcome, a more disrupted neurobiological substrate and higher ...healthcare costs. Cognitive impairment is a core feature of schizophrenia, strongly associated with patients’ functional outcome. Different studies showed that TRS patients exhibit poorer neurocognitive performance, particularly on verbal domains. To date Cognitive Remediation Therapy (CRT) represents the best available tool for treating cognitive deficits in schizophrenia. However, CRT outcomes are highly heterogeneous and significant treatment predictors are still lacking.
Objectives
To investigate possible differences of CRT outcome among patients with schizophrenia, stratified according to antipsychotic response (TRSs vs. first-line responders - FLRs).
Methods
150 patients with schizophrenia, (95 FLRs, 55 TRSs) were assessed for neurocognition with BACS and WCST at baseline and after CRT. General Linear Models (GLMs) were performed to investigate possible differences between groups on basal cognition and CRT outcome (Cohen’s d Effect Size).
Results
At baseline, GLMs showed significant differences in Verbal Memory (F=4,66; p=0,03) and WCST–executive functions (F=5,59; p=0,02), both worse in TRS group. Effecr Sizes of CRT outcome resulted significantly different in domains of Verbal Memory (F=4,68; p=0,03) and WCST–executive functions (F=4,62; p=0,03), with greater improvements among TRS patients.
Conclusions
This is the first study to indicate treatment-resistance as a possible predictor of CRT outcome in schizophrenia. Moreover, we observed that CRT resulted able to fill the cognitive gap between treatment groups. Thus, these results further highlight the importance of early cognitive interventions in order to reduce the neuropsychological and functional burden associated with the disease, especially for TRS patients.
Disclosure
No significant relationships.
Theory of Mind, the ability to understand the potential mental states and intentions of others, represents a relevant aspect of social cognition, with high impact on the capacity to interact within ...the social world. This very human ability has been one of the focuses of neuroscience research in the past decades and data from neuroimaging studies allowed to identify a Theory of Mind network and to formulate a neurobiological model. Concurrent neuropsychiatric studies showed that Theory of Mind is differently impaired in several conditions, among these, in schizophrenia, a disease characterized by functional and social disability. This paper addresses the issue of neurofunctional correlates of Theory of Mind deficits in schizophrenia, reviewing functional imaging studies of the past ten years comparing schizophrenia patients to healthy controls. Several differences in hemodynamic response between patients and controls were observed in the areas known to be critically involved in social cognition, such as the medial prefrontal cortex, temporal cortex surrounding superior temporal sulcus and temporo-parietal junction and cingulate cortex. Results are promising, however they are still heterogeneous. The reported variability could depend on factors related to the construct of Theory of Mind itself, technical aspects and psychopathological/physiopathological mechanisms and needs to be further addressed by future studies.
Neurocognitive and social cognitive impairments represent important treatment targets in schizophrenia, as they are significant predictors of functional outcome. Different rehabilitative ...interventions have recently been developed, addressing both cognitive and psychosocial domains. Although promising, results are still heterogeneous and predictors of treatment outcome are not yet identified. In this study we evaluated the efficacy of two newly developed social cognitive interventions, respectively based on the use of videotaped material and comic strips, combined with domain-specific Cognitive Remediation Therapy (CRT). We also analysed possible predictors of training outcome, including basal neurocognitive performance, the degree of cognitive improvement after CRT and psychopathological variables.
Seventy-five patients with schizophrenia treated with CRT, were randomly assigned to: social cognitive training (SCT) group, Theory of Mind Intervention (ToMI) group, and active control group (ACG).
ANOVAs showed that SCT and ToMI groups improved significantly in ToM measures, whereas the ACG did not. We reported no influences of neuropsychological measures and improvement after CRT on changes in ToM. Both paranoid and non-paranoid subjects improved significantly after ToMI and SCT, without differences between groups, despite the better performance in basal ToM found among paranoid patients. In the ACG only non-paranoid patients showed an improvement in non-verbal ToM.
Results showed that both ToMI and SCT are effective in improving ToM in schizophrenia with no influence of neuropsychological domains. Our data also suggest that paranoid symptoms may discriminate between different types of ToM difficulties in schizophrenia.
Cognitive Remediation represents the best available tool to treat cognitive deficits in schizophrenia and evidence suggests an effect also on global functioning. However, the relationship between ...cognitive and functional improvement is not yet fully elucidated: do cognitive changes need to be of a definite size and/or encompass a certain number of domains in order to impact on daily functioning? This study aims to explore the role of cognitive improvement, evaluated both quantitatively and qualitatively through the use of Italian equivalent scores, on the daily functioning of patients. As secondary goal, the influence of demographic, clinical and neuropsychological variables on functional outcome was also systematically investigated.
One hundred subjects with a diagnosis of schizophrenia underwent 36 sessions of Cognitive Remediation and were evaluated at baseline and after the training with the Brief Assessment of Cognition in Schizophrenia and the Quality of Life Scale.
A total of 70% of patients improved in at least one cognitive domain and over 50% obtained a normalized score. Among the clinical and neurocognitive factors examined, the only significant predictor of quality of life's improvement was the proportion of cognitive functions that reached an equivalent score of "normal".
This study suggests that improvements in daily functioning depend on the achievement of a cognitive profile as much as possible "normal", harmonious and balanced, supporting the idea that a qualitative leap in cognition is needed in order to gain an advantage in real life activities.
Several studies suggested that anxiety can significantly affect the outcome of schizophrenia. Despite this evidence, non-pharmacological interventions targeting anxiety are still heterogenous. This ...study aims to test the efficacy of a novel training specifically designed to target anxiety in patients with schizophrenia. Innovatively, this training, beyond psychoeducation and problem solving, also targets Theory of Mind, as it provides coping strategies.
Twenty-seven outpatients with schizophrenia received a novel rehabilitative training targeting anxiety (Anxiety Management Group AMG) combined with a Computer-Assisted Cognitive Remediation (CACR), and twenty received CACR plus a control intervention (Control Newspaper discussion Group CNG). All patients were assessed at baseline and after treatment for quality of life, neurocognition and anxiety.
After training, patients treated with AMG+CACR showed significantly greater improvements on anxiety. A significant increase in quality of life was observed only for AMG+CACR group. Moreover, the participants' appraisal showed a significant difference between treatment groups with higher ratings among patients who received the AMG+CACR.
This study thus suggests feasibility and efficacy of the proposed intervention, that could be implemented in rehabilitative programs for patients with schizophrenia with potential benefits also on disease course and outcome.
Abstract “Theory of mind” (ToM) is the ability to judge the mental states of the self and others. It is currently considered as a part of the broader concept of social cognition, known to influence ...the social behaviour of patients affected by schizophrenia. Recently it has been hypothesized that the impairment of ToM is a trait that can be detected both in patients with schizophrenia and in non-psychotic relatives of patients, but it still not clear what the contribution of the familial patterns of cognitive impairment is. The aim of this study is to assess parental impairments of ToM performance considering the effects of the neurocognitive abilities known to be impaired in their first-degree relatives and to influence ToM in schizophrenic patients. Patients, their parents and control trios were assessed with the Wisconsin Card Sorting Test (WCST), the Symbol Coding Task and the ToM Picture Sequencing Task. The ANCOVA analysis on 47 trios including a schizophrenic offspring and 47 healthy trios showed a statistically significant poorer performance of patients and their parents in comparison to control trios at Symbol Coding Task and ToM task. Moreover a regression analysis showed that the neuropsychological abilities tested were significant predictors of ToM performance only in patients. Results confirm a ToM impairment among parents of patients with schizophrenia that is not directly correlated to other aspects of neurocognitive functioning.
Abstract Glutamate is the major excitatory neurotransmitter in the brain, with up to 40% of all synapses being glutamatergic. An altered glutamatergic transmission could play a critical role in ...working memory deficts observed in schizophrenia and could underline progressive changes such as grey matter loss throughout the brain. The aim of the study was to investigate if gray matter volume and working memory could be modulated by a genetic polymorphism related to glutamatergic function. Fifty schizophrenia patients underwent magnetic resonance and working memory testing outside of the scanner and were genotyped for rs4354668 EAAT2 polymorphism. Carriers of the G allele had lower gray matter volumes than T/T homozygote and worse working memory performance. Poor working memory performance was associated with gray matter reduction. Differences between the three genotypes are more relevant among patients showing poor performance at the 2-back task. Since glutamate abnormalities are known to be involved in excitotoxic processes, the decrease in cortical thickness observed in schizophrenia patients could be linked to an excess of extracellular glutamate. The differential effect of EAAT2 observed between good and poor performers suggests that the effect of EEAT2 on gray matter might reveal in the presence of a pathological process affecting gray matter.
A Metacognitive Training for Schizophrenia patients (MCT) was developed to target the cognitive biases that characterize the illness. Results suggest positive MCT effects encompassing several aspects ...of psychopathology and subjective well-being. There are still open questions concerning the effect on different cognitive biases and the interplay between them and both psychopathology and neurocognition. Specifically, the bias against disconfirmatory evidence (BADE) has never been tested in previous trials on MCT. In this study we evaluated the feasibility of MCT combined with a cognitive remediation therapy (CACR) in schizophrenia and its effect on BADE. Moreover, we investigated the relationships between BADE and both neuropsychology and psychopathology, taking into account mutual influences on the degree of improvement.
Fifty-seven schizophrenia outpatients were randomly assigned to CACR + control group or MCT+CACR and assessed at baseline and after treatment for psychopathology, neurocognition and BADE.
After MCT+CACR patients showed significantly greater improvements on BADE. Although BADE baseline performances correlated with several cognitive domains, no association was found between BADE improvement and neurocognitive nor psychopathological measures.
This study enlightened for the first time the efficacy of MCT+CACR on BADE in schizophrenia, suggesting the importance to develop a more specific intervention tailored on individual needs of patients.
This study aimed at using latent variable modelling to explore the significantly contributing variables to functioning in schizophrenia patients.
The study cohort comprised 296 schizophrenia patients ...evaluated once for demographic characteristics, functioning (FROGS, SWN-K, QLS) and symptomatology (Positive and Negative Syndrome Scale PANSS). First exploratory multivariate analyses were conducted and then a model with functioning as a latent variable was proposed and tested with the data.
Symptomatology as negative, cognitive and excitation factor are significant predictors of functioning assessed through FROGS (P<0.0001), SWN-K and QLS (P<0.001). The model was constructed with functioning defined as a latent variable, indicators are subscores on FROGS, SWN-K, QLS and exogenous variable included symptomatology, Duration of Untreated Psychosis (DUP) and educational level.
Using the five clinical dimensions of the PANSS, (Positive, Negative, Cognitive, Anxiety/Depression and Excitation) the negative and cognitive dimensions are highly correlated via the latent variable to the three dimensions of functioning evaluated by the FROGS: "daily life", "social functioning" and "treatment" and the QLS subscores (interpersonnal, common object, instrumental role). Educationnal level is positively linked to functioning but not DUP. The model emphasizes the need for treatment strategies that have an effect on cognitive-factors, to improve functioning in schizophrenia.
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