Addressing executive functioning and cognitive rehabilitation in the treatment of schizophrenia.

ABSTRACT. Schizophrenia spectrum disorders are currently viewed as having a neuropsychological basis included in the etiology. Cognitive deficits that occur in schizophrenia are primarily observed in the areas of attention–concentration, memory, and planning. These abilities are commonly viewed under the broader spectrum of executive functioning. Research has shown that these executive functioning skills can be improved through the use of cognitive rehabilitation interventions. This article includes a case study documenting the use of cognitive rehabilitation strategies with a patient diagnosed with schizophrenia who possessed documented deficits in executive functioning. The discussion illustrates the possible progress that may be made in the treatment of schizophrenia when this additional tier of intervention is used. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multimodal Integrative Cognitive Stimulating Group Therapy: Moving Beyond the Reduction of Psychopathology in Schizophrenia.

The authors present a group therapy for schizophrenia called multimodal integrative cognitive stimulating group therapy (MICST). MICST is founded upon a theoretical model that views schizophrenia as a condition characterized by information-processing and memory deficits, which interfere with communication. MICST is designed to stimulate clients' cognitive and memory functioning, improve information processing, and enhance clients' abilities to engage in reality-based conversations. The therapy combines elements of social skills relaxation exercise, cognitive rehabilitation, and traditional psychotherapy but also emphasizes accessing clients' "intact" cognitive functioning by using both visual and auditory modalities. MICST's long-term use, its eager acceptance by clients and staff, and results from various outcome measures support its potential value. However, formal studies are required to more firmly establish MICST's efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive rehabilitation: how it is and how it might be

This paper suggests there are, at present, four main kinds of cognitive rehabilitation programs for brain injured people. The first attempts to rehabilitate cognitive deficits through drills and exercises. The second uses theoretical models from cognitive psychology to identify deficits in order to remediate them. The third is primarily a patient-driven approach that uses a combination of learning theory, cognitive psychology, and neuropsychology to identify and remediate cognitive difficulties. The fourth is the holistic approach that has, as its basic philosophy, a belief that cognitive functions cannot be divorced from emotion, motivation, or other noncognitive functions, and consequently all aspects of functioning should be addressed in rehabilitation programs. Despite some overlap between these approaches, there are major differences. The two main arguments offered in this paper are (1) that the first two approaches do not lead to good clinical rehabilitation practice; and (2) that a synthesis of the second two approaches would result in the best cognitive rehabilitation model.     

Demographic, clinical, and neurocognitive correlates of everyday functional impairment in severe mental illness.

Although cognitive deficits often accompany severe mental illness, their implications for everyday functioning remain poorly understood. In this study, an occupational therapist (OT) rated the everyday functioning of 105 adult psychiatric patients. Using demographic, clinical, and cognitive variables, the authors tested alternative models to account for the observed variability in OT ratings. Although age, education, and the presence of schizophrenia each contributed to a model that accounted for 27% of the variation in functional independence, adding terms for auditory divided attention and verbal learning increased the proportion of explained variance to 45% and decreased the beta weights for age and education—but not schizophrenia—to nonsignificant levels. These findings demonstrate the relevance of cognitive performance to everyday functioning in severe mental illness. They are discussed with respect to hypothesized determinants of psychiatric disability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term psychosocial adjustment following very severe closed head injury.

Examined the cognitive, psychological, and social functioning of 18 community-dwelling male patients who had experienced a severe closed head injury (CHI) at least 18 mo previously and still required contact with rehabilitation services. Results from Ss with CHI were compared with those from 27 normal control Ss. Information on Ss' behavior was also obtained from their significant others. Results show that Ss with CHI exhibited deficits in their cognitive and social functioning but showed no signs of emotional or psychiatric disturbance. Attempts to find a relationship between the cognitive impairment and social functioning of Ss with CHI were partially successful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric rehabilitation as the preferred response to the needs of individuals with severe psychiatric disability.

Defines severe psychiatric disability (SPD) and discusses the demographic characteristics of persons with SPD. Two groups with SPD have become sources of public policy debate: the homeless and young adults (aged 18–35 yrs). Attempts to impact client rehabilitation outcome are noted. It is suggested that interventions based on a rehabilitation model show promise as a way to reduce psychiatric disability. These interventions are based on strategies aimed at increasing a person's skills and supports. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preliminary evaluation of the incidence and control of insects--pest control in Polish hospitals

The influence of environmental factors upon the social skills in schizophrenia is beyond doubt. The family environment of schizophrenic patients has been extensively described. Some research revealed those features of emotional context of the family, which influence the exacerbation of schizophrenia. Those features are called the Expressed Emotion Index (EE). The Expressed Emotion Index has great prognostic value and it seems interesting to examine the influence of the family environment as described by EE, upon the social skills. This paper contains both a characterization of the family environment described by various aspects of EE and an analysis of its influence on the social skills. Possible connections of EE with premorbid functioning of schizophrenic patients, and with psychopathological symptoms, as well as cognitive processes are also described. In the analysis of interrelation of EE and the social skills it is very important to consider both qualitative and quantitative aspects of Expressed Emotion Index. Various aspects of the family environment seem to be connected with specific cognitive dysfunctions and various psychopathological symptoms. In a similar way, various social skills seem to be determined by different internal and external factors.     

The illusion of reality: A review and integration of psychological research on hallucinations.

Hallucinations are among the most severe and puzzling forms of psychopathology. Although usually regarded as first-rank symptoms of schizophrenia, they are found in a wide range of medical and psychiatric conditions. Moreover, a substantial minority of otherwise normal individuals report hallucinatory experiences. The purpose of this article is to review the considerable research into the cognitive mechanisms underlying (particularly psychotic) hallucinations that has been carried out and to integrate this research within a general framework. The available evidence suggests that hallucinations result from a failure of the metacognitive skills involved in discriminating between self-generated and external sources of information. It is likely that different aspects of these skills are implicated in different types of hallucinatory experiences. Further research should focus on specific metacognitive deficits associated with different types of hallucinations and on treatment strategies designed to train hallucinators to reattribute thoughts to themselves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive, clinical, and functional characteristics of verbally superior schizophrenia patients.

The existence of small numbers of schizophrenia patients with superior ability in specific cognitive domains is implied by meta-analytic evidence as well as by occasional empirical reports. The authors identified 25 patients with superior (i.e., ≥90th percentile) ability on the Vocabulary subtest of the Wechsler Adult Intelligence Scale 3rd edition (Wechsler, 1997). These cognitively advantaged patients were compared with 22 healthy participants performing at the superior level and with 126 schizophrenia patients and 50 healthy participants scoring below the superior range. Verbally superior schizophrenia patients and verbally superior healthy participants had similar cognitive profiles and life skills performance, but diverged markedly in terms of independent "real-world" functioning. Verbally superior patients significantly outperformed more typical patients in other aspects of cognitive performance, life skills, and support requirements. However, severity of positive and negative symptoms was equivalent in the patient groups. Detailed biobehavioral study of cognitively exceptional patients may offer new insights into mechanisms mediating psychotic disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using positive psychology with special mental health populations.

In our clinical practice, we have attempted to use a positive psychology approach in working with people with schizophrenia and youths with behavioral disorders. We present three clinical applications that use a positive psychology approach with these populations: group treatment with persons with schizophrenia; individual cognitive stimulation therapy with persons with schizophrenia; and computer-facilitated dialogue and therapy with persons with schizophrenia and adolescents with behavioral disorders. These three clinical applications using positive psychology are consistent with those traditional treatment goals that aim to increase clients' functioning and improve their quality of life. Given that many people with long-standing emotional "problems" have difficulties initiating change or internalizing feedback regarding their behavioral deficits, the therapeutic environment and clinical interactions need to focus equally on clients' strengths and skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of a rehabilitation psychology program for persons with schizophrenia: Changes in the treatment environment.

Reports the changes that occurred over a 4-yr period at a therapeutic community for persons with schizophrenia when a rehabilitation psychology program was added to the traditional inpatient treatment and eventually replaced it. Data collected (from patients and staff members over the 4 yrs) using the Community Oriented Programs Environment Scale revealed several significant and desirable changes in the quality of the perceived treatment environment, including increases in practical orientation and autonomy. Specific interventions that accounted for improvement in the rehabilitation potential of the treatment environment are described. Conceptual differences between the traditional inpatient psychiatric model and the rehabilitation psychology model are outlined. Value differences between these 2 models are presented as an explanation for the failure of rehabilitation services offered adjunctively with traditional psychiatric services. The treatment environment changed only when rehabilitation became a central part of the treatment philosophy. The fundamental differences between these 2 treatment approaches are related to reports of improved outcome from programs using psychosocial models. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immunohistochemistry diagnosis of fungal infections

BACKGROUND: A potential beneficial outcome of treatment with certain of the atypical neuroleptics is the reduced risk of cognitive impairment, stemming from purported low affinity for cholinergic receptors. In vitro experiments have shown that clozapine is highly anticholinergic and risperidone is minimally so. In vivo tests of the anticholinergic burden imposed by these medications and its potential cognitive consequences are needed. This study examines anticholinergic burden in schizophrenia patients taking clozapine and risperidone and tests whether this burden is associated with cognitive deficits. METHOD: Serum anticholinergic levels were determined in a sample of 22 chronic schizophrenia patients using the radioreceptor assay method of Tune and Coyle (1980). Fifteen patients received clozapine; 7 received risperidone. Mean +/- SD age of the sample, comprising 12 men and 10 women (68% white), was 44.7 +/- 8.4 years. Mean +/- SD age at onset of schizophrenia illness was 23.5 +/- 7.4 years. Two anticholinergic assays based on blood samples collected 1 week apart were available on each patient. RESULTS: Data indicated that clozapine patients had significantly (p < .001) higher anticholinergic levels at both collection points, and levels for both drugs remained stable over time. The clozapine and risperidone patients had essentially equivalent scores on the cognitive measure. CONCLUSION: These data suggest that anticholinergicity distinguishes clozapine and risperidone in vivo but that this effect is not associated with differences in global cognitive functioning. Results suggest that clozapine, despite producing moderately high in vivo serum anticholinergic levels, still holds clinical advantage over standard neuroleptics in terms of cognitive side effects. Reasons for this lowered risk of cognitive impairment are discussed.     

Integration and synthesis. Cognitive behavioral therapies within the biological paradigm

1. In today's managed care environments, where more emphasis is placed on cost-effective management of patients, the role of medications along with psychotherapy is becoming an accepted standard for psychiatric care. 2. Blind acceptance of the biological model tends to trivialize cognitive behavioral and psychoeducational interventions and casts doubt on the outcome of rehabilitation and retraining. 3. For complete and comprehensive care of patients, psychiatric nursing should embrace both biological and behavioral paradigms and view them as complementary rather than competitive.     

Evaluation of social problem solving in schizophrenia.

Examined social problem solving in schizophrenia. 27 schizophrenic patients in an acute hospital, 19 patients with bipolar disease, and 17 demographically matched nonpatient controls were tested on an empirically developed problem-solving battery that assessed the ability to generate solutions to problems, the ability to evaluate the effectiveness of solutions, and the ability to implement solutions in a role-playing format. Schizophrenic Ss were impaired on all 3 problem-solving domains compared with the nonpatient controls, but bipolar Ss were equally impaired. Several alternative explanations for these findings were considered. The most compelling hypothesis is that the deficits resulted from different factors: cognitive impairment for schizophrenic Ss and acute illness for bipolar Ss. However, longitudinal studies are required to determine whether problem-solving deficits in schizophrenic patients persist during periods of remission. Implications for rehabilitation strategies are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blood parameter and heart rate response to training in Andalusian horses

The psychopathology and associated disabilities experienced by persons with schizophrenia have only partially responded to conventional pharmacological and psychosocial treatment approaches. Biobehavioral treatment and rehabilitation employs behavioral assessment, social learning principles, skills training, and a focus on the recovery process to amplify the effects of pharmacotherapy. Utilizing the Medline database, we review a selection of English-language studies published from 1970 to 1994 that support the effectiveness of each of the components of biobehavioral therapy, such as case management, psychopharmacology with behavioral assessment, psychoeducation, family involvement, and social skills training. An integrated biobehavioral therapy directed toward early detection and treatment of schizophrenic symptoms, collaboration between consumers and caregivers in managing treatment, family and social skills training, and teaching coping skills and self-help techniques has been documented to improve the course and outcome of schizophrenia, as measured by symptom recurrence, social functioning, and quality of life. A case vignette is presented to illustrate the successful integration of biobehavioral therapies into a treatment system that focuses on consumers' attempts to become increasingly responsible for recovering from illness.     

Identical neural risk factors predict cognitive deficit in dyslexia and schizophrenia.

In previous work, the authors found that an anatomical risk index created from the combination of 7 neuroanatomical measures predicted reading and oral language skills in individuals with learning disabilities. Individuals with small auditory brain structures and reduced asymmetry had more deficits than those with large structures and exaggerated asymmetry. In the present study, the same anatomical index predicted reading and other cognitive abilities in 45 individuals with chronic schizophrenia. The anatomical risk index was significantly associated with broad cognitive ability (Pearson r = .53, p     

Psychological rehabilitation, skills-building, and self-efficacy.

Suggests features that should be incorporated with the skills building model suggested by W. A. Anthony (see record 1978-12897-001). This model of rehabilitation emphasizes the identification and elimination of skills deficits, that is, those performance deficits that have prevented Ss from functioning in the community. Reintegration of Ss into the community is the main goal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Context-processing deficits in schizophrenia: Diagnostic specificity, 4-week course, and relationships to clinical symptoms.

Previous research on schizophrenia suggests that context-processing disturbances are one of the core cognitive deficits present in schizophrenia. However, it is not clear whether such deficits are specific to schizophrenia as compared with other psychotic disorders. To address this question, the authors administered a version of the AX Continuous Performance Test designed to assess context processing in a sample of healthy controls, patients with schizophrenia, and patients with other psychotic disorders. Participants were tested at index (when medication naive and experiencing their first contact with psychiatric services) and 4 weeks later, following medication treatment. At index, patients with schizophrenia and the psychotic comparison group demonstrated similar impairments in context processing. However, context-processing deficits improved in the psychotic comparison group at 4 weeks but did not improve in patients with schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention deficit disorder and neuropsychological functioning in children with Tourette's syndrome.

Neuropsychological deficits in Tourette's syndrome (TS) may result from comorbid psychiatric disorders. This study compared the neuropsychological performance of TS children with and without attention deficit disorder (ADD). Participants were 82 children between 6 and 18 yrs of age with TS, 36 of whom had ADD. ADD children did not differ from non-ADD children in age or in onset or duration of TS but did display more severe complex tics and obsessive-compulsive symptoms. After statistical control for these characteristics, ADD children demonstrated significant deficits in various elements of attention, including encoding, sustaining, and focusing/ executing, and in academic achievement. They did not differ in IQ, non-attentional cognitive skills, or sensorimotor functions. The comorbid psychiatric disorders associated with TS yield distinct patterns of neuropsychological functioning that may reflect overlapping neuroanatomic substrates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social networks as assets and liabilities in recovery from stroke by geriatric patients.

Interactions in the social networks of 48 elderly stroke patients were examined as factors influencing outcomes after hospital discharge. Structured interviews assessed the frequency of perceived positive and negative interactions, as well as patients' behavioral independence, time use, personal adjustment, and cognitive functioning. Negative interactions occurred less frequently than positive ones. After controlling for status at hospital discharge, negative and positive interactions differentially explained variance in morale, psychiatric symptoms, and cognitive functioning. Although negative interactions were associated with poorer morale and greater psychiatric symptoms, positive interactions were associated with less mental confusion. Patients' reporting and not reporting negative interactions did not differ significantly on a variety of social and demographic variables previously shown to predict social interactions and well-being. Findings indicate that social interactions may both impede and facilitate rehabilitation for older adults and have implications for both theories of social support and the design of therapeutic interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)