Cognitive Remediation Program for Family Caregivers in Schizophrenia (CIRCUS): Study of the Effectiveness of a Guided AND WEB-BASED Compensatory Cognitive Remediation: A Randomized Pilot Study

BackgroundCognitive impairments are extremely common in schizophrenia and strongly predict deficits in daily functioning, poor management of medication, and multiple hospitalizations. Cognitive remediation is recognized to have a positive impact on cognitive impairments by engaging preserved cognitive functions or by implementing environmental supports that sustain independent living.Velligan et al. [1] developed and tested a manualized intervention, called Cognitive Adaptation Training (CAT). In this program, trained mental health specialists implemented compensatory techniques such as environmental supports in the individual’s living environment in order to live more independently and achieve greater self-sufficiency.However, implementing this program requires a lot of professionals and time to maintain CAT effect. This type of intervention is not widely available in community care which may explain the large number of patients who are dependent on family members for daily living activities. Training family members in this form of intervention would be an appropriate way to resolve these issues. Family expressed a real interest in these types of home-support strategies that CAT offers. Recently, Kidd et al. [2] developed a CAT version for Families and created a manual accessible to people without any knowledge of cognitive deficits. This manual helps families to select specific cognitive-adaptative strategies with their relative to achieve targeted goals. This method has been translated in French.The aim of this study is to examine whether Web-based Family Cognitive Adaptation Training can improve functioning, medication adherence and negative symptoms for individuals with schizophrenia as well as reduce burden for the family members.Methods/DesignA total of 60 Dyads consisting of one caregiver and one supported individual with schizophrenia will be randomized to either Web-based family cognitive adaptation training or an internet-based control condition (psycho-education). The primary outcome measure will be the total score on the life skills profile. Secondary outcome measures will include the global score of the Zarit burden Interview, the PANSS negative score, the CAINS score, patient medication adherence, and patient and caregiver quality of life.DiscussionWe hope that this type of intervention could be developed in territorial areas where professionals are not trained to cognitive remediation and therefore substantially lower the barrier to the deployment of cognitive interventions with other psychosocial interventions for individuals with schizophrenia and their caregivers.Trial registration: ClinicalTrials.gov Identifier: NCT04173598. Registered on November 22th 2019

The Impact of Workplace Violence Toward Psychiatric Mental Health Nurses: Identifying the Facilitators and Barriers to Supportive Resources

BACKGROUND: When compared with all other health care professions, the psychiatric nursing profession has the highest prevalence of workplace violence. The effects of workplace violence can be psychologically and physically devastating. Supportive resources are not always available or fully utilized when available. Aims: The purpose of this study is to explore the true impact of workplace violence toward psychiatric mental health nurses, as well as their personal perspectives on the types of supportive resources necessary for future implementation. Additionally, this study strives to identify the facilitators and barriers to acquiring supportive resources. Methods: A qualitative descriptive study design was utilized. The theory of cognitive adaptation provided an underlying conceptual framework. Data were collected using REDCap software to identify the nature and extent of workplace violence in the study setting (Survey 1) and solicit detailed responses to focus group questions designed to address the study aims (Survey 2). RESULTS: Six pertinent themes were discovered: frequent exposure to workplace violence, attempt to understand workplace violence, the need for supportive means, barriers to accessing supportive means, increase administrative support, and workplace violence has a detrimental impact on various aspects of life. CONCLUSIONS: Although psychiatric mental health nurses express a desire for more psychological support postassault, the underlying meaning and cognitive adaptation following the workplace violence experience is not well understood, and there are barriers to the acquisition of services. The findings from this study are being used to inform a multifaceted program to effectively support psychiatric mental health nurses experiencing workplace violence.

Changing the Type of Predicate as a Means of Cognitive Adaptation in Translation

The linguistic worldview is a reflection of the national cognitive worldview. ‘Worldview’ is often defined as a way of perceiving the surrounding reality, yet the way people perceive their personal inner world also reflects their national self-identification. It is difficult to compare how people of different nations experience emotions and perceive such experiences because these processes are not available for direct observation and objective assessment. The most complete representation of the way a person experiences a particular emotion can be found in fiction. Contrastive analysis of how this process is reflected in different languages can be based on a comparison of a literary text with its translation into another language, since, in this case, both texts present the same character in the same situations that cause certain emotions. To exclude the influence of the translator’s personality, in our analysis we have used three different translations of selected passages from Dostoevsky’s The Idiot. A quantitative analysis of the means employed by the translators shows that representation of emotions in English does indeed reflect the way of perceiving the world that is typical of the national linguistic worldview as a whole. In all the three English texts, state predicates prevail over ac-tion predicates, and predicatively used adjectival words prevail over those used attributively. It means that emotional states are mostly perceived by English speakers as something that, while not permanent or inherent to a person, is, at the same time, static: less a process than a result of that process. In contrast, native speakers of Russian perceive emotional states as actions, and the Russian text reveals no inclination toward perceiving emotional states as personal characteristics, whether temporary or permanent. All these regularities are statistical and not absolute, which means that they reflect usage and not the linguistic norm, and, thus, the change of predicates in translation should be regarded as a way of cognitive adaptation rather than a structural transformation.

Brain-Environment Alignment during Movie Watching Predicts Cognitive-Affective Function in Adulthood

BOLD fMRI studies have provided compelling evidence that the human brain demonstrates substantial moment-to-moment fluctuations in both activity and functional connectivity patterns. While the role of brain signal variability in fostering cognitive adaptation to ongoing environmental demands is well-documented, the relevance of moment-to-moment changes in functional brain architecture is still debated. To probe the role of architectural variability in naturalistic information processing, we used neuroimaging and behavioural data collected during movie watching by the Cambridge Centre for Ageing and Neuroscience (N = 642, 326 women) and the Human Connectome Project (N = 176, 106 women). Both moment-to-moment and contextual change-evoked architectural variability increased from young to older adulthood. However, coupling between moment-to-moment changes in functional brain architecture and concrete environmental features was stronger at younger ages. Architectural variability (both momentary and context-evoked) was associated with age-distinct profiles of network communication, specifically, greater functional integration of the default mode network in older adulthood, but greater informational flow across neural networks implicated in environmentally driven attention and control (cingulo-opercular, salience, ventral attention) in younger adulthood. Whole-brain communication pathways anchored in default mode regions relevant to episodic and semantic context creation (i.e., angular and middle temporal gyri) contributed to greater brain reconfiguration in response to narrative context changes, as well as stronger coupling between moment-to-moment changes in functional brain architecture and changes in concrete environmental features. Cognitive adaptation was directly linked to levels of brain-environment alignment, but only indirectly associated with levels of architectural variability. Specifically, stronger coupling between moment-to-moment variability in brain architecture and concrete environmental features predicted poorer cognitive adaptation (i.e., fluid IQ) and greater affectively driven environmental vigilance. Complementarily, across the adult lifespan, higher fluid (but not crystallized) IQ was related to stronger expression of the network communication profile underlying momentary and context-based architectural variability during youth. Our results indicate that the adaptiveness of dynamic brain reconfiguration during naturalistic information processing changes across the lifespan due to the associated network communication profiles. Moreover, our findings on brain-environment alignment complement the existing literature on the beneficial consequences of modulating brain signal variability in response to environmental complexity. Specifically, they imply that coupling between moment-to-moment variability in functional brain architecture and concrete environmental features may index a bias towards perceptually-bound, rather than conceptual processing, which hinders affective functioning and strategic engagement with the external environment.

Evaluation of an Adaptive Implementation Program for Cognitive Adaptation Training for People With Severe Mental Illness: Protocol for a Randomized Controlled Trial

Background Cognitive Adaptation Training is a psychosocial intervention that focuses on reducing the negative effects of cognitive disorders, especially executive functions such as planning and targeted action. International research has shown that Cognitive Adaptation Training enhances multiple aspects of daily functioning in people with severe mental illnesses. Despite this evidence, implementation of the intervention into routine care remains a challenge. Objective In this implementation research, a newly developed implementation program based on previous experience and scientific literature, is tested. The primary aim of this research is to assess the effectiveness of the implementation program. The secondary aim of this study is to evaluate the factors that impede or facilitate the implementation of Cognitive Adaptation Training. Methods To test the effectiveness of the implementation program, a multicenter cluster randomized controlled trial was conducted comparing the implementation program to a single training program in four mental health institutions in The Netherlands. Focus groups, semistructured interviews, and questionnaires were used at multiple levels of service delivery (service user, professional, team, organization) to identify factors that may hamper or facilitate implementation. The RE-AIM framework was applied to measure the implementation effectiveness. Following this framework, the primary outcomes were Reach, Intervention Effectiveness, Adoption, Implementation, and Maintenance. These are assessed before, during, and after implementation. The research had a total duration of 14 months, with a follow-up measurement at 14 months. Data will be analyzed using multilevel modeling. Results The study was funded in April 2018. Data collection occurred between November 2018 and January 2020. In total, 21 teams of 4 mental health institutions agreed to participate. Data analysis is ongoing and results are expected to be published in December 2020. Conclusions This implementation research may provide important information about the implementation of psychosocial interventions in practice and may result in a program that is useful for Cognitive Adaptation Training, and possibly for psychosocial interventions in general. Trial Registration The Netherlands Trial Register (NL7989); https://www.trialregister.nl/trial/7989. International Registered Report Identifier (IRRID) DERR1-10.2196/17412