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.     

Cognitive Slippage in Children Vulnerable to Schizophrenia

Psychological deficit research with adult schizophrenics has been hindered by numerous methodological problems that may be avoided by the prospective study of children vulnerable to the disorder. An object sorting task was administered to 156 children of schizophrenic patients, 102 children of depressed patients, and 139 children of normal parents. The children were between 6 and 15 years old. The children of schizophrenic parents made fewer superordinate sorting responses than those of normal parents, and more complex sorts (a category of inadequate responses) than children of either normal or depressed parents. Our analyses showed that these deficits could not be explained by differences in intelligence. These deficits in conceptual performance may reflect the genotypic predisposition to schizophrenia and/or represent an early precursor of later maladjustment.This research was supported by grant MH 21145 from the National Institutes of Mental Health and by funds from the William T. Grant Foundation. We would like to thank Linda Doll, Diane Liebert, and Jean C. Sullivan for testing the children, and Barbara Mosbacher and Rochelle Weinberger for scoring the protocols.     

Cognitive Enhancement and the Value of Cognitive Achievement

Cognitive enhancement has an increasingly wider influence on our life. The main issue that concerns epistemologists is what its epistemological implications are. Adam Carter and Duncan Pritchard argue that cognitive enhancement improves cognitive achievement, but this view faces axiological objections. A worry exists that cognitive enhancement undermines achievements and erodes intellectual character. Crucially, two parties seem to talk past each other because the nature of cognitive enhancement and the value of cognitive enhancement are not clearly distinguished. To end the stand‐off between the two parties, I take insight from Gwen Bradford’s work and argue that, other things being equal, cognitive enhancement either decreases the value of cognitive achievement or undermines cognitive achievement. In the face of this threat, I further submit that we could learn to live with cognitive enhancement in an integrated way so that the lost value can be restored.     

The Internet as Cognitive Enhancement

Science and Engineering Ethics - The Internet has been identified in human enhancement scholarship as a powerful cognitive enhancement technology. It offers instant access to almost any type of...     

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.     

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.     

Panic Disorder: Cognitive Behavioral and Pharmacological Treatment Strategies

The past decade has seen significant advances in both psychosocial, notably cognitive behavioral (CBT), and pharmacological treatments for panic disorder. Given the widely acknowledged efficacy of both forms of treatment, it is reasonable to consider that the combination of approaches should yield an extremely potent strategy to treating panic disorder. The present report summarizes scientific evidence for the singular and combined treatment approaches to panic disorder. Data across studies indicate that combined treatments yield immediate and short-term benefits above those provided by either pharmacologic treatment or CBT alone. In the long-term, however, these benefits disappear. In fact, the combination of benzodiazepines and CBT appears to produce poorer end-state functioning than CBT alone. Other data indicate that the sequencing of pharmacotherapy and CBT may be useful for benzodiazepine fading. Although these data are preliminary, combined treatments do not appear to be the treatment of choice for patients with panic disorder. Treatment algorithms are suggested based on existing data.     

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 and Moral Enhancement: A Practical Proposal

According to Persson and Savulescu, the risks posed by a morally corrupt minority's potential to abuse cognitive enhancement make it such that we have an urgent imperative to first pursue moral enhancement of humankind – and, consequently, if we are a long way from safe, effective moral enhancement, then we have at least one good reason to consider opposing further cognitive enhancement. However, as Harris points out, such a proposal seems to support delaying life-saving cognitive progress. In this article, we first show that Harris's worry can be expanded to show that Persson and Savulescu's proposal also threatens the development of moral enhancement – precisely what they suggest we have pro tanto reason to pursue. From there, we offer our own, alternative proposal – one on which cognitively enhanced researchers play a key role in the production of moral enhancement, and those in the general population who wish to be cognitively enhanced must first accept moral enhancement as an entry requirement. We engage with four substantive objections to our proposal and use these objections to refine and strengthen the details.     

Cognitive Enhancement: Methods, Ethics, Regulatory Challenges

Cognitive enhancement takes many and diverse forms. Various methods of cognitive enhancement have implications for the near future. At the same time, these technologies raise a range of ethical issues. For example, they interact with notions of authenticity, the good life, and the role of medicine in our lives. Present and anticipated methods for cognitive enhancement also create challenges for public policy and regulation.     

Effects of Cognitive Behavioral Therapy and Vocational Rehabilitation on Metacognition and Coping in Schizophrenia

The Indianapolis Vocational Intervention Program (IVIP) is a cognitive behaviorally based program of group and individual interventions that seeks to help persons with schizophrenia improve vocational function and sustain hope. In this study we compared baseline and follow-up assessments of coping and metacognition among 50 participants with schizophrenia spectrum disorders offered a six-month job placement and randomized to receive IVIP (n = 25) or standard services (n = 25). ANCOVA controlling for baseline suggest that the IVIP group gained greater ability to think about their own thinking and to cope by seeing what were previously perceived as negative stressors in more positive light. An erratum to this article can be found at     

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.     

Cognitive Style, Schizophrenia, and the Family: Methodological Implications of Contextual Effects

The study of a single case of a family with one schizophrenic daughter is reported here. A variety of measures were used in the study and it was carried out in a number of different contexts. The study has substantive interest in regard to the inter-connections of schizophrenia and of individual and familial patterns of cognition and perception. In addition it raises important methodological considerations stemming from the variability of the measures across differing contexts.     

基于非侵入性脑刺激的认知增强：方法、伦理和应用

作为人类追求卓越的方式之一,基于非侵入性脑刺激的认知增强成为众多学科和公众关注的问题。首先阐述了非侵入性脑刺激的两种主要技术手段(经颅磁刺激和经颅直流刺激)的技术原理及其在提升健康个体认知功能上的应用,并分析了这两种技术可能带来的安全、自主选择、公平等伦理问题,最后总结了该认知增强技术在体育和军事等两个具体领域的应用。未来可进一步提高技术手段的深部脑区刺激能力及该增强技术的持续和真实效果。