Cognitive Remediation in Schizophrenia

Cognitive deficits are routinely evident in schizophrenia, and are of sufficient magnitude to influence functional outcomes in work, social functioning and illness management. Cognitive remediation is an evidenced-based non-pharmacological treatment for the neurocognitive deficits seen in schizophrenia. Narrowly defined, cognitive remediation is a set of cognitive drills or compensatory interventions designed to enhance cognitive functioning, but from the vantage of the psychiatric rehabilitation field, cognitive remediation is a therapy which engages the patient in learning activities that enhance the neurocognitive skills relevant to their chosen recovery goals. Cognitive remediation programs vary in the extent to which they reflect these narrow or broader perspectives but six meta-analytic studies report moderate range effect sizes on cognitive test performance, and daily functioning. Reciprocal interactions between baseline ability level, the type of instructional techniques used, and motivation provide some explanatory power for the heterogeneity in patient response to cognitive remediation.     

Pharmacological Cognitive Enhancement in Schizophrenia

Cognitive impairments in schizophrenia are common and severe. These impairments are also related to functional disability in schizophrenia. As a result, efforts are underway to enhance cognition in schizophrenia through a variety of pharmacological mechanisms. As part of this effort, a designated research design has been developed for this process, through an extensive consensus and validation effort. This paper reviews the methods for pharmacological cognitive enhancement, as well as previous results of efforts in the pharmacological domains. These domains include cholinergic, noradrenergic, serotonergic, glutamatergic, and GABA-ergic mechanisms. While previous results have not been particularly encouraging, there are many challenges that need to be overcome and many of the reasons for past failures may be due to resolvable issues. It is likely that this will be an area of research that will be developing extensively over the next decade and expanding to other conditions as well.     

Reliability and validity of the Cognitive Slippage Scale in two populations.

Analyses of responses from a clinical sample of 120 patients (primarily schizophrenics) and from 158 college students to the Cognitive Slippage Scale, a scale designed by Miers and Raulin to identify speech deficits and confused thinking in schizophrenic and schizotypal personality disorders showed high internal reliability; Cronbach's coefficients alpha were .89 and .86 in the clinical and college student samples, respectively. The mean scale scores significantly differentiated the two samples. Also, change scores over 4 wk. showed adequate stability for both samples. Item analysis indicated Items 11, 20, 21, and 28 may not reliably discriminate between schizophrenic and college student samples. Over-all, these preliminary results are consistent with the reliability and validity of the scale.     

Approaches to Cognitive Remediation of Neuropsychological Deficits in Schizophrenia: A Review and Meta-Analysis

A review and critique of the literature pertaining to the use of cognitive remediation techniques in patients with schizophrenia is presented. The review is organized into three sections, according to the neuropsychological deficit targeted for remediation: 1) executive-function, 2) attention, and 3) memory. With regards to executive-function, despite an initial report suggesting that Wisconsin Card Sorting Test performance cannot be remediated, subsequent studies suggest that performance can be improved on a variety of dependent measures including perseverative errors, categories achieved, and conceptual level responses. These observations were confirmed by a meta-analytic investigation that revealed large mean effects sizes (d ₊ = 0.96) for these studies. Effect sizes were homogenous across discrepant remediation strategies and dependent measures. With regards to attention, serial scanning can be improved with instruction and reinforcement, whereas there is mixed evidence suggesting that practice-based attention drills can improve performance on measures of sustained attention in schizophrenia. With regards to memory, relatively simple semantic and affective elaborate encoding strategies elevates verbal list-learning memory in patients with schizophrenia to levels consistent with controls. A similar encoding procedure, combined with vigilance training, produces substantial improvement in social cue recognition. Avenues for future research are discussed.     

Cognitive Behaviour Therapy for Schizophrenia in Patients with Mild to Moderate Substance Misuse Problems

Rates of substance misuse are high among patients with schizophrenia. Cognitive therapies have been developed separately for both problems but little is known about outcome for this group of dual diagnosed patients. Data from a major trial of cognitive behaviour therapy for psychosis was therefore sub‐analysed to determine whether this therapy is effective in those with schizophrenia and mild to moderate substance misuse. During the original study patients received a brief cognitive behaviour therapy‐based intervention for schizophrenia delivered by trained and supervised nurses. The control group received care as usual. The outcome measures included: total psychopathology using the Comprehensive Psychopathological Rating Scale (CPRS) and Health of the Nation Outcome Scale (HoNOS), change in schizophrenic positive symptoms using Schizophrenia Change Scale (SCR), anxiety using the Brief Scale for Anxiety (BAS), depression using the Montgomery‐Asberg Depression Rating Scale (MADRS) and insight using the Assessment of Insight Scale, at baseline and end of therapy. In the original study, patients who received cognitive behaviour therapy showed improvement in overall symptomatology (p = 0.01), insight (p = 0.00) and depression (p = 0.00) compared with the control group. In the present sub‐analysis, no interaction was found between treatment group and presence or absence of substance misuse. There was a reduction in substance misuse after treatment in both the cognitive behaviour therapy and control groups but this did not differ between them. It appears that mild to moderate degrees of substance misuse did not change the outcome of cognitive behaviour therapy for psychosis in this sub‐analysis.     

Theory of Mind Deficit in Schizophrenia and Associated Cognitive Functions

This study examined the Theory of Mind (ToM) ability of schizophrenic persons in association with other cognitive functions like memory, executive functioning and attention. Results showed evidence of relationship between ToM and cognitive functions i.e. executive function, working memory and intelligence but no uniform predictive model was found across all the ToM tasks. It was also noted that predicting variables related to different cognitive domains varied markedly for schizophrenia and control groups. It seems that there are multiple cognitive pathways to ToM mechanism, although these different forms may not have an additive effect.     

Cognitive Processing in Specifically Language-Impaired Children

Eighteen language-impaired children and 25 non-language-impaired children were evaluated to investigate the relationship between language ability and selected aspects of the five-component problem-solving process defined by Kagan and Kogan (1970). Non-impaired children performed better than language-impaired children on nearly all components of the problem-solving process. Language-impaired children had particular difficulties in the areas of coding and hypothesis generation. In fact, coding ability was inversely related to the number of errors made in hypothesis evaluation. Coding ability was also positively correlated with language ability. The exact causal relationship between coding ability, language ability, and error-making in hypothesis evaluation is unclear; however, improving coding skills through training may increase automaticity and lead to improved performance in the higher levels of the problem-solving process.     

Adult Attachment in Children Raised by Parents with Schizophrenia

Maternal schizophrenia is known to have an adverse effect on the quality of mother–infant interaction; and children of parents with severe mental illness run a higher risk of poor mental health and social outcomes. Hence, children raised by a parent with schizophrenia may be less likely to attain secure attachment, although there is less evidence so far to support this. Moreover, there is a lack of research in this field that focusses on the needs and experiences, the strengths and vulnerabilities, of the children themselves. Qualitative methods are thus needed to generate new insights and hypotheses. The present study uses semi-structured interviews with 23 adults who, as children, were raised with a parent who experienced schizophrenia. This reveals a range of attachment problems, resulting in difficulties in forming secure adult relationships. Problems with trust and intimacy were found to be common.     

Psychological Distress in Orphan,Vulnerable Children and Non-Vulnerable Children in High Prevalence HIV/AIDS Communities

The degree of psychological distress and access social support is investigated in children (n = 741) living in nine high prevalence HIV/AIDS communities. They comprised (i) vulnerable, maternally-orphaned (n = 319); (ii) vulnerable and not orphaned (n = 276); and (iii) typically developing (n = 146). The following psychometric tests were administered: The Trauma Symptom Checklist for Children (Townsend, 2002); the Reynolds Depression Scale for Children (Reynolds, 1989); and the Social Support Scale (Beale Spencer, Cole, Jones & Phillips Swanson, 1997). Primary caregivers completed the Conners' Parent Rating Scale (Conners, Parker, Sitarenios, & Epstein, 1998) and an Adversity Index (Killian, 2004a) to establish the vulnerability status of each child. The data were analysed to distinguish the groups from each other regarding profiles of distress. The findings suggest that vulnerable children, be they orphaned or not, manifest similar degrees of emotional distress and perceived themselves as unable to access social support. Interventions should address the needs of both orphans and other vulnerable children, without prioritising the needs of orphans over other vulnerable children.     

Cognitive Tempo in Educable Mentally Retarded Children

The present study investigated the relationship of time and errors on the Matching Familiar Figures test to the mental age of 40 Caucasian male, educable mentally retarded (EMR) children. The children, who ranged in age from six to 18 years, had intelligence test scores of less than 80, were exhibiting problems in adaptive behavior, and were all receiving special education services. An ANOVA revealed that with increasing mental age, elapsed time to first response increased and errors decreased, thus indicating a mental age developmental decrease in impulsivity. For all subjects, time was inversely related to errors. The data suggest that the development of cognitive tempo in EMR children parallels that of nonhandicapped children.     

4~8岁儿童认知风格的发展及其对问题解决的影响

认知风格是个体获取和加工信息的一贯模式,影响诸多认知活动。本研究测量了98名4-8岁儿童的认知风格和积木拼图中的问题解决行为,主要发现:（1）4-8岁儿童总体上表现为整体型认知风格,但分析型认知风格随着年龄增长在逐渐发展;（2）认知风格影响问题解决策略：越偏整体型认知风格的儿童越多使用主体参照策略（即先拼主体图形再补充其他部分）,并且越少使用线索推断策略（按照行/列的线索顺序依次拼图）和局部定位策略（根据某一局部图案的具体位置摆放积木）。本实验首次探索了低龄儿童认知风格的年龄差异,发现认知风格在发展早期就已影响问题解决行为。研究结果有助于理解儿童认知风格的发展及其作用,为儿童问题解决能力的培养实践提供一定的理论依据。     

A Meta-Analysis of Cognitive Deficits in Adults with a Diagnosis of Schizophrenia

This review identified 1275 studies examining cognitive deficits in people with schizophrenia, published between 1990 and 2003. Data from 113 studies (4365 patients and 3429 controls) were combined in a meta-analysis carried out on the five cognitive domains of IQ, memory, language, executive function, and attention. Studies were excluded where they lacked a suitable control group or failed to present complete information. In all five cognitive domains, analysis indicated a consistent trend for patients to perform more poorly than healthy controls, with significant heterogeneity across studies. Sources of heterogeneity were analyzed and a need to ensure more appropriate composition of patient and control groups and to adopt a more refined and methodologically correct, hypothesis-driven approach was identified.     

Turning it Upside Down: Areas of Preserved Cognitive Function in Schizophrenia

Patients with schizophrenia demonstrate marked impairments on most clinical neuropsychological tests. These findings suggest that patients suffer from a generalized form of cognitive impairment, with little evidence of spared performance documented in several large meta-analytic reviews of the clinical literature. In contrast, we review evidence for relative sparing of aspects of attention, procedural memory, and emotional processing observed in studies that have employed experimental approaches adapted from the cognitive and affective neuroscience literature. These islands of preserved performance suggest that the cognitive deficits in schizophrenia are not as general as they appear to be when assayed with clinical neuropsychological methods. The apparent contradiction in findings across methods may offer important clues about the nature of cognitive impairment in schizophrenia. The documentation of preserved cognitive function in schizophrenia may serve to sharpen hypotheses about the biological mechanisms that are implicated in the illness.     

Cognitive Behavior Therapy with Children:

No abstract available for this article.     

3～5岁幼儿表情认知的发展研究

研究通过"命名复制"、"选择建构"和"自由绘画"三种任务,考察了"嘴""眼""眉"等情绪标签在幼儿情绪识别中的优势效应。结果表明:(1)幼儿识别高兴、悲伤和愤怒要早于惊讶,识别高兴的成绩最好,3～4岁是识别悲伤和惊讶的快速发展期;(2)幼儿识别情绪过程中并未出现典型的"嘴部优势"效应,不同情绪具有不同的代表性的情绪标签,识别高兴和惊讶时嘴部是优势区域,而识别悲伤和愤怒时眼睛和眉毛是优势区域;(3)不同顺序的任务差异显著,先前的情绪命名和复制、建构等任务会显著提高儿童的自由绘画成绩。     

Guided Affective and Cognitive Imagery to Enhance Self-esteem Among Hawaiian Children

This article discusses the use of guided affective and cognitive imagery to enhance self-esteem among children of Hawaiian ancestry. Children who participated in the intervention strategy, which consisted of 10 group sessions, had significantly higher scores on some areas of self-esteem.     

A Randomized Trial of Mindfulness-Based Cognitive Therapy for Children: Promoting Mindful Attention to Enhance Social-Emotional Resiliency in Children

Mindfulness-based cognitive therapy for children (MBCT-C) is a manualized group psychotherapy for children ages 9–13 years old, which was developed specifically to increase social-emotional resiliency through the enhancement of mindful attention. Program development is described along with results of the initial randomized controlled trial. We tested the hypotheses that children randomized to participate in MBCT-C would show greater reductions in (a) attention problems, (b) anxiety symptoms, and (c) behavior problems than wait-listed age and gender-matched controls. Participants were boys and girls aged 9–13 (N = 25), mostly from low-income, inner-city households. Twenty-one of 25 children were ethnic minorities. A randomized cross-lagged design provided a wait-listed control group, a second trial of MBCT-C, and a 3-month follow-up of children who completed the first trial. Measures included the Child Behavior Checklist, State-Trait Anxiety Inventory for Children, and Multidimensional Anxiety Scale for Children. Participants who completed the program showed fewer attention problems than wait-listed controls and those improvements were maintained at three months following the intervention [F (1, 1, 18) = 5.965, p = .025, Cohen’s d = .42]. A strong relationship was found between attention problems and behavior problems (r = .678, p < .01). Reductions in attention problems accounted for 46% of the variance of changes in behavior problems, although attention changes proved to be a non-significant mediator of behavior problems (p = .053). Significant reductions in anxiety symptoms and behavior problems were found for those children who reported clinically elevated levels of anxiety at pretest (n = 6). Results show that MBCT-C is a promising intervention for attention and behavior problems, and may reduce childhood anxiety symptoms.