Cognitive Enhancement in Schizophrenia

2017 ◽  
Author(s):  
James Gilleen
Keyword(s):  
Drug Development ◽  
Cognitive Training ◽  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Cognitive Enhancement ◽  
Cognitive Impairments ◽  
Cognitive Remediation ◽  
Current Status ◽  
Positive Symptoms ◽  
Social Deficits

Schizophrenia is characterized by a constellation of heterogeneous symptoms including hallucinations and delusions, motivational and social deficits, and cognitive impairments. Although positive symptoms have historically been the target for drug development, in recent years, attention has turned to cognitive and negative symptoms. Cognitive deficits in schizophrenia are associated with significant impairments in functional, social, and employment outcomes, and although they are widely researched and relatively well understood, there are no currently approved compounds to treat them. This chapter provides a selective review of the current status of approaches developed to improve cognition in schizophrenia. It covers pharmacological approaches as well as cognitive training and cognitive remediation techniques. It also explores the various study design issues and challenges that contribute to the difficulties in discovering reliable ways to improve the cognitive deficits present in schizophrenia.

Symptômes Positifs Et Négatifs De La Schizophrénie: Une Mise à jour

1994 ◽  
Vol 39 (7) ◽  
pp. 407-414 ◽  
Author(s):  
Marc-André Roy ◽  
Xavier Devriendt
Keyword(s):  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Three Dimensions ◽  
Positive Symptoms ◽  
Research Questions

The purpose of this article is to summarize the results of studies examining the validity of the positive and negative sub-types of schizophrenia as proposed by Crow. The authors summarized Crow's model's predictions in the form of 12 research questions and examined whether its predictions were confirmed. The following predictions are generally confirmed by the data collected: (i) it is possible to measure negative symptoms with accuracy; (ii) the negative symptoms predict a deterioration; (Hi) the negative symptoms are generally correlated with overall cognitive deficits; (iv) each dimension appears to have distinct neurobiological substrata. However, several elements of the Crow model are not supported by the data collected. Among the necessary modifications, the most important are as follows: (i) it appears more productive to conceive of the negative symptoms as distinct dimensions, rather than distinct diseases; (ii) at least three dimensions exist for describing the symptoms of schizophrenia; (Hi) the negative symptoms are not necessarily intrinsic to the schizophrenic process, and they may be due to other causes; (iv) the negative symptoms are not necessarily irreversible, and can be improved under ataractics; (v) the positive symptoms, in particular those relating to disorganization, can also be correlated with cognitive deficits.

Combination Treatments for Schizophrenia

CNS Spectrums ◽  
2004 ◽  
Vol 9 (S9) ◽  
pp. 19-23 ◽  
Author(s):  
Alexander L. Miller
Keyword(s):  
Electroconvulsive Therapy ◽  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Current Evidence ◽  
Positive Symptoms ◽  
Combination Therapies ◽  
Safety And Efficacy ◽  
Combination Treatments ◽  
Improved Outcomes ◽  
Expert Recommendations

ABSTRACTCombination treatments, especially combinations of antipsychotics, are used frequently for schizophrenia, despite a paucity of evidence regarding their safety and efficacy. Because the literature basis is weak and expert recommendations are largely lacking, providers should be vigilant in documenting improved outcomes for patients thought to benefit from combination treatments. Target symptoms that have been studied include psychosis, cognitive deficits, and negative symptoms. The strongest evidence is for augmentation of clozapine with another antipsychotic or with electroconvulsive therapy for persistent positive symptoms. Combination treatments for cognitive deficits and negative symptoms are being actively investigated, but current evidence is insufficient to recommend available agents for these components of schizophrenia. It is important that appropriate monotherapies be given adequate trials before resorting to combination therapies.

New dopaminergic and non-dopaminergic theories in schizophrenia and their therapeutic impact

1997 ◽  
Vol 9 (2) ◽  
pp. 64-67
Author(s):  
R.S. Kahn
Keyword(s):  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Dopamine Neurons ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
The Core ◽  
Schizophrenic Patients ◽  
Core Symptoms ◽  
Influential Theory

The dopamine (DA) hypothesis of schizophrenia, postulating that schizophrenia is characterized by increased dopamine function, has been the most influential theory on the pathogenesis of schizophrenia. It has recently been revised based on the appreciation that the core symptoms of schizophrenia may not be the positive (psychotic) symptoms, but rather the negative symptoms and the cognitive deficits found in schizophrenic patients. This revision has prompted the hypothesis that schizophrenia is characterized by both decreased prefrontal dopamine activity (causing deficit symptoms) and increased dopamine activity in mesolimbic dopamine neurons (causing positive symptoms).Notwithstanding this revision of a role for dopamine in schizophrenia, it has become increasingly evident that dysfunction of other monoaminergic systems may be as important in contributing to the pathophysiology of schizophrenia. Specifically, the putative role of serotonin (5-hydroxytryptamine, 5-HT) in schizophrenia is gaining considerable attention. Several observations, such as the ability of the 5-HT antagonist, ritanserin, to alleviate schizophrenic symptoms and, when added to haloperidol (Haldol®), to decrease its extrapyramidal side-effects (EPS), have stimulated studies into a role of 5-HT in schizophrenia. The finding that clozapine (Leponex®), clinically superior to conventional neuroleptics, is a weak DA2 antagonist but a potent 5-HT1c and 5-HT2 antagonist has further stimulated 5-HT-related research in schizophrenia.

scholarly journals Cognitive Remediation in Schizophrenia: Current Status and Future Perspectives

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Stefano Barlati ◽  
Giacomo Deste ◽  
Luca De Peri ◽  
Cassandra Ariu ◽  
Antonio Vita
Keyword(s):  
At Risk ◽  
Cognitive Deficits ◽  
Scientific Literature ◽  
Cognitive Remediation ◽  
Intervention Programs ◽  
Current Status ◽  
Early Course ◽  
Electronic Search ◽  
Pubmed Database ◽  
Meta Analyses

Objectives. This study is aimed to review the current scientific literature on cognitive remediation in schizophrenia. In particular, the main structured protocols of cognitive remediation developed for schizophrenia are presented and the main results reported in recent meta-analyses are summarized. Possible benefits of cognitive remediation in the early course of schizophrenia and in subjects at risk for psychosis are also discussed.Methods. Electronic search of the relevant studies which appeared in the PubMed database until April 2013 has been performed and all the meta-analyses and review articles on cognitive remediation in schizophrenia have been also taken into account.Results. Numerous intervention programs have been designed, applied, and evaluated, with the objective of improving cognition and social functioning in schizophrenia. Several quantitative reviews have established that cognitive remediation is effective in reducing cognitive deficits and in improving functional outcome of the disorder. Furthermore, the studies available support the usefulness of cognitive remediation when applied in the early course of schizophrenia and even in subjects at risk of the disease.Conclusions. Cognitive remediation is a promising approach to improve real-world functioning in schizophrenia and should be considered a key strategy for early intervention in the psychoses.

A role for cognitive remediation therapy for job seekers with neuropsychiatric disorders

2020 ◽  
Vol 26 (1) ◽  
pp. 22-25
Author(s):  
Kamonnet Wannasewok
Keyword(s):  
Cognitive Processes ◽  
Cognitive Deficits ◽  
Cognitive Impairments ◽  
Cognitive Remediation ◽  
Neuropsychiatric Disorders ◽  
Cognitive Tasks ◽  
Cognitive Remediation Therapy ◽  
Job Seekers ◽  
People With Mental Illness ◽  
Attention Memory

AbstractPeople with mental illness and traumatic brain injury experience difficulties in gaining and maintaining employment and have a higher unemployment rate because of their symptoms and poor social skills including cognitive impairments. Cognitive remediation is an intervention developed to improve cognitive functioning such as attention, memory, and problem-solving, by providing them with specific designed cognitive exercises. After practicing those cognitive tasks repetitively and massively, people with cognitive deficits will improve cognitive processes which lead to better cognitive performance. There is evidence supporting the benefits of cognitive remediation in improving employment-related outcome. Thus, it might have a role for job seekers with neuropsychiatric disorders and cognitive dysfunctions.

scholarly journals Adjunctive pharmacotherapy for cognitive deficits in schizophrenia: meta-analytical investigation of efficacy

2013 ◽  
Vol 203 (3) ◽  
pp. 172-178 ◽  
Author(s):  
Kee-Hong Choi ◽  
Til Wykes ◽  
Matthew M. Kurtz
Keyword(s):  
Learning And Memory ◽  
Spatial Learning ◽  
Cognitive Deficits ◽  
Effect Size ◽  
Negative Symptoms ◽  
Verbal Learning ◽  
Spatial Learning And Memory ◽  
Positive Symptoms ◽  
Small Effect Size ◽  
Moderate Effect

BackgroundA growing number of studies have investigated the efficacy of novel, adjunctive pharmacotherapies for treatment of cognitive deficits in schizophrenia with conflicting results.AimsTo investigate the comparative efficacy of these agents on cognition and symptoms in schizophrenia, and to identify promising cognitive domains and candidate medications that can be incorporated in treatment trials combined with cognitive remediation to maximise treatment effects.MethodA total of 26 double-blind, placebo-controlled studies investigating medications targeted at cholinergic, glutamatergic or serotonergic receptor classes and with participants with schizophrenia or schizoaffective disorder were identified.ResultsMedications targeted at the cholinergic receptor class produced marginal improvements in verbal learning and memory (d = 0.23, P = 0.06), and donepezil, a specific type of cholinergic agonist, produced a moderate effect (d = 0.58) on spatial learning and memory. Cholinergic and glutamatergic agents produced moderate effect-size improvements on negative symptoms (d = 0.54 and d = 0.62 respectively), and small effect-size improvements on general symptoms (d = 0.46 and d = 0.41 respectively). Serotonergic agents produced small effect-size improvements in positive symptoms (d = 0.33).ConclusionsCholinergic medications produced marginal improvement in verbal learning and memory and moderate improvements on spatial learning and memory, although there was no evidence to support the use of glutamatergic or serotonergic medications as a stand-alone treatment for improving cognitive function. Cholinergic and glutamatergic agents improved negative and general symptoms, whereas serotenergic medications improved positive symptoms.

scholarly journals Potential Web Based Cognitive Exercises in Remediation of Mind (ReMind) Programme for Schizophrenia Recovery

2019 ◽  
Vol 8 (12S2) ◽  
pp. 621-629
Keyword(s):  
Cognitive Deficits ◽  
Processing Speed ◽  
Educational Software ◽  
Cognitive Enhancement ◽  
Group Discussion ◽  
Cognitive Remediation ◽  
Web Based ◽  
Need Analysis ◽  
Global Cognition ◽  
Potential Tool

The use of computerized cognitive exercises is recognized in cognitive remediation (CR) which designed specifically for a rehabilitation purpose in psychiatric illness particularly schizophrenia. Specific criteria of cognitive exercises were analyzed in a need analysis as a potential tool to ameliorate cognitive deficits in the Remediation of Mind (ReMind) programme with targeted processing speed for early intervention that influence cognitive enhancement effects. The existing educational software and commercial web based cognitive training were identified and explored in participants who attended 15 sessions of CR through a focus group discussion for the viability and effectiveness to enhance global cognition performance and functional outcome..

scholarly journals Cognition and addiction

2019 ◽  
Vol 21 (3) ◽  
pp. 281-290 ◽  
Keyword(s):  
Decision Making ◽  
Executive Functions ◽  
Cognitive Training ◽  
Cognitive Deficits ◽  
Current Knowledge ◽  
Cognitive Remediation ◽  
Cognitive Testing ◽  
Future Research ◽  
Reward Expectancy ◽  
Individualized Prediction

In this targeted review, we summarize current knowledge on substance-use disorder (SUD)-related cognitive deficits, the link between these deficits and clinical outcomes, and the cognitive training, remediation, and pharmacological approaches that have the potential to rescue cognition. We conclude that: (i) people with SUDs have moderate deficits in memory, attention, executive functions, and decision-making (including reward expectancy, valuation, and learning); (ii) deficits in higher-order executive functions and decision-making are significant predictors of relapse; (iii) cognitive training programs targeting reward-related appetitive biases, cognitive remediation strategies targeting goal-based decision-making, and pharmacotherapies targeting memory, attention, and impulsivity have potential to rescue SUD-related cognitive deficits. We suggest avenues for future research, including developing brief, clinically oriented harmonized cognitive testing suites to improve individualized prediction of treatment outcomes; computational modeling that can achieve deep phenotyping of cognitive subtypes likely to respond to different interventions; and phenotype-targeted cognitive, pharmacological, and combined interventions. We conclude with a tentative model of neuroscience-informed precision medicine.

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