Edorta Elizagarate

Processing speed mediates the relationship between verbal memory, verbal fluency, and functional outcome in chronic schizophrenia

Verbal fluency and verbal memory have been reported to be diminished in patients with schizophrenia. These deficits could partially predict functional disability in this pathology. However, processing speed often mediates the relationship among cognitive processes in the disorder. Our goal was to analyse the influence of processing speed as mediator of the relation between verbal fluency-verbal memory and functional disability in chronic schizophrenia. We examined 90 hospitalized patients and 30 healthy controls (matched for gender, age and years of education). The neuropsychological battery included tests for verbal fluency, verbal memory, motor speed and processing speed. Outcome measures included Disability Assessment Schedule (DAS-WHO) and number of hospitalizations (NH). Results confirmed chronicity on clinical symptoms (PANSS total X=48.94+14.97 PANSS negative X=27.81+10.18, PANSS positive X=23.51+10.81) and impairment on functional disability (DAS-WHO X=13.62+4.28). As expected, verbal fluency was severely impaired in patients and significantly predicted functional outcome. Immediate and Delayed Verbal Memory were also severely impaired and predicted functional outcome. However, when processing speed was entered in the regression analyses the significance of verbal fluency and verbal memory decreased significantly. Sobels equation was significant, suggesting full mediation. Our findings suggest that processing speed may be a central factor in the relation between cognitive symptoms and functional outcome in chronic schizophrenia.

Hierarchical structure of the cognitive processes in schizophrenia: the fundamental role of processing speed

OBJECTIVE Decreased processing speed (PS) is a key feature of schizophrenia with respect to cognition, functional outcome and clinical symptoms. Our objective was to test whether PS slowing mediates other neuropsychological deficits among patients with chronic schizophrenia. METHOD One hundred patients with schizophrenia and 53 healthy adults completed a series of neuropsychological measures that assess six cognitive domains. In addition to PS these included attention, verbal memory, visual memory, working memory, and executive functioning. Confirmatory factor analysis (CFA) was used to evaluate the fit of the 6-factor model. The cognitive performances of both groups were compared before and after controlling for the effect of PS, but also after controlling for the effect of each cognitive factor at a time. Finally, the PS-related variance was removed and the effect of the other cognitive factors was tested again. RESULTS CFA supported the hypothesized 6-factor cognitive structure. As expected, the patients and controls differed on all cognitive measures. However, after controlling for the effects of PS, group differences on the other five cognitive factors decreased substantially. Controlling for other factors produced smaller attenuation of group differences, and these effects were also partially accounted for by decreased PS. CONCLUSIONS PS deficits account for most of the differences in cognition between patients with schizophrenia and healthy controls. PS slowing appears to be a core feature of schizophrenia, one that underlies impairments of working memory, executive functioning, and other abilities.

Verbal fluency in schizophrenia: does cognitive performance reflect the same underlying mechanisms in patients and healthy controls?

Verbal fluency is impaired in patients with schizophrenia, but the association with other cognitive domains remains unclear. Forty-seven patients with schizophrenia (DSM-IV) and 47 controls matched by age, gender, years of education, and vocabulary (Wechsler Adult Intelligence Scale-III) were assessed in terms of sociodemographic, clinical, and cognitive variables. Healthy controls performed significantly better than patients with schizophrenia in all cognitive measures. However, the way these cognitive domains were related differed across groups. Semantic fluency (SF) and phonological fluency (PF) were predicted by working memory (WM) in patients with schizophrenia, whereas the predictor in the healthy controls was processing speed (PS). Moreover, after dividing the sample of patients according to their performance on fluency tests, we found that a worse performance on SF or PF was predicted by WM. However, for patients with a better performance on fluency, the pattern was similar to that of healthy controls. Cognition may show a different pattern of interaction in schizophrenia, with less impaired patients showing a closer pattern to healthy controls. Therefore, we suggest that, depending on the severity of cognitive deficits, performance on neuropsychological tests may not reflect the same underlying mechanisms.

Study of the influence of electroconvulsive therapy on the regional cerebral blood flow by HMPAO-SPECT

STUDY OBJECTIVE The aim of this preliminary study is to investigate the regional blood flow in response to ECT (electroconvulsive therapy) and to identify any responsive-pattern to the treatment. METHODS STUDY DESIGN Single longitudinal prospective study of cohorts. SUBJECTS For this preliminary study ten patients, female sex, mean age 70.8 years with major mood disorder (CID-10 investigation criteria) were studied after signature consent. INTERVENTIONS The intervention consisted in the administration of bilateral brief pulse ECT three times a week, during 6 to 12 sessions according to the standards of the Psychiatric Department of the Santiago Hospital in Victoria. MEASUREMENT Clinical evaluation of depression was evaluated by Hamilton Depression Scale, Montgomery and Asberg Scale, Newcastle Scale and regional cerebral blood flow (rCBF) using the HMPAO-SPECT. RESULTS The pattern of distribution on the regional cerebral flow during the ECT showed changes from the basal pattern in all patients. All patients had a relative increased perfusion of the temporal lobes and basal ganglia. Other changes from the basal study were areas of decreased perfusion of the occipital lobe (6 patients) and parietal lobe (3 patients). CONCLUSIONS Brain perfusion SPECT study of the patients with major depression shows changes during ECT. Further analysis are needed to understand the relationship between mechanisms of treatment and recovery in affective illness.

Combining social cognitive treatment, cognitive remediation, and functional skills training in schizophrenia: a randomized controlled trial

This study examined the efficacy of an integrative cognitive remediation program (REHACOP) in improving cognition and functional outcome in patients with schizophrenia. The program combines cognitive remediation, social cognitive intervention, and functional skills training. Few studies have attempted this approach. One hundred and eleven patients diagnosed with schizophrenia were randomly assigned to either the cognitive remediation group (REHACOP) or an active control group (occupational activities) for 4 months (three sessions per week, 90 min). Primary outcomes were change on general neurocognitive performance and social cognition, including theory of mind (ToM), emotion perception (EP), attributional style, and social perception (SP). Secondary outcomes included changes on clinical symptoms (Positive and Negative Syndrome Scale) and functional outcome (UCSD Performance-Based Skills Assessment and the Global Assessment of Functioning). The trial was registered with clinicaltrials.gov (NCT02796417). No baseline group differences were found. Significant differences were found in the mean change between the REHACOP group and control group in neurocognition (ηp2=0.138), SP (ηp2=0.082), ToM (ηp2=0.148), EP (ηp2=0.071), negative symptoms (ηp2=0.082), emotional distress (ηp2=0.136), Global Assessment of Functioning (ηp2=0.081), and UCSD Performance-Based Skills Assessment (ηp2=0.154). The combination of cognitive remediation, social cognitive intervention, and functional skills training demonstrated statistically significant and clinically meaningful changes in neurocognition, social cognition, negative, and functional disability.

It is feasible and effective to help patients with severe mental disorders to quit smoking: An ecological pragmatic clinical trial with transdermal nicotine patches and varenicline

Despite the proven association between smoking and high rates of medical morbidity and reduced life expectancy in people with severe mental disorders (SMD), their smoking rates do not decline as they do in the general population. We carried out a non-randomized, open-label, prospective, 9-month follow-up multicentre trial to investigate the clinical efficacy, safety and tolerability of a 12-week smoking cessation programme for patients with SMD in the community under real-world clinical conditions. Eighty-two adult outpatients with schizophrenic/bipolar disorder smoking ≥15 cigarettes/day were assigned by shared decision between doctors and patients to transdermal nicotine patches (TNP) [36(46.2%)] or varenicline [39(50%)]. Short-term efficacy: The 12-week 7-day smoking cessation (self-reported cigarettes/day=0 and breath carbon monoxide levels≤9ppm) prevalence was 49.3%, without statistically significant differences between medications (TNP 50.0% vs varenicline 48.6%, chi-square=0.015, p=1.000). Long-term efficacy: At weeks 24 and 36, 41.3 and 37.3% of patients were abstinent, with no statistically significant differences between treatments. Safety and Tolerability: no patients made suicide attempts/required hospitalization. There was no worsening on the psychometric scales. Patients significantly increased weight [TNP 1.1(2.8) vs varenicline 2.5(3.3), p=0.063], without significant changes in vital signs/laboratory results, except significant decreases in alkaline phosphatase and low-density lipoprotein-cholesterol levels in the varenicline group. Patients under varenicline more frequently presented nausea/vomiting (p<0.0005), patients under TNP experienced skin reactions more frequently (p=0.002). Three patients under varenicline had elevated liver enzymes. In conclusion, we have demonstrated that in real-world clinical settings it is feasible and safe to help patients with stabilized severe mental disorders to quit smoking.

Déficit atencionales y respuesta al tratamiento farmacológico en pacientes con esquizofrenia resistente al tratamiento: Resultados mediante análisis factorial confirmatorio

INTRODUCTION There are no experimental data that demonstrate whether patients with neuroleptic-resistant schizophrenia differ or not in their pattern of neuropsychological functioning from patients with adequate drug response. METHOD Fifty-two patients with drug-resistant psychosis (DRP) and 42 patients with schizophrenia not resistant to treatment (NDRP) were recruited following the criteria of Kane et al (1988). A sample of 45 healthy controls matched by age, sex and educational level was also recruited. The clinical evaluations used were the Positive and Negative Symptom Scale (PANSS), functional disability (WHO-DAS) and the Clinical Global Impression (CGI) scale. RESULTS Through the use of confirmatory factor analysis, we obtained a latent cognitive structure of six cognitive factors: attention, processing speed, verbal memory, working memory, verbal fluency and executive functions. As expected, the control group performed better than the two patient groups (both DRP and NDRP) in all neuropsychological domains. Additionally, the DRP group scored significantly worse in attention than the NDRP group even though no differences between these two groups were found in age of disease onset, number of hospitalizations or length of hospitalization. From a clinical point of view, the DRP group showed greater severity of positive symptoms (p<0.01) and higher global deterioration (p<0.01), which did not translate into greater functional disability. CONCLUSIONS The results obtained do not allow us to conclude that there is a specific neuropsychological profile in neuroleptic-resistant patients. The only differential parameter was performance in the attentional domain. Our findings better fit the hypothesis of a «clinical continuum» and differ from the categoric classification of this mental disorder.

Mechanisms of functional improvement through cognitive rehabilitation in schizophrenia.

Whereas the efficacy of cognitive rehabilitation in schizophrenia is widely known, studies examining mechanisms for functional improvement are still scarce. The aim of the study was to examine the mediational mechanisms through which cognitive rehabilitation improves functioning in schizophrenia. One hundred and eleven schizophrenia patients were randomly assigned to either a 4-month cognitive rehabilitation group or an active control group. Patients underwent a neurocognitive battery (including processing speed, verbal memory, working memory and executive functioning) and social cognition assessment (emotion perception, theory of mind and social perception). Functioning was assessed by the combined use of a performance-based instrument, the UCSD Performance-based Skills Assessment (UPSA) and an observer-rated instrument, the Global Assessment of Functioning (GAF). The trial was registered in clinicaltrials.gov (NCT02796417). Multiple mediational analyses revealed that the effect of cognitive rehabilitation on functional improvement was partially mediated by changes in processing speed and verbal memory, but not by the domains of social cognition and negative symptoms. More specifically, verbal memory partially mediated the treatments effect on performance-based functioning (UPSA), whereas processing speed acted as a partial mediator for observer-rated functioning (GAF). The effect of rehabilitation on functioning did not take place through all the domains that showed significant improvement. Verbal memory and processing speed emerged as the most crucial factors. However, these complex interactions need further research.

Clinical (but not cognitive) recovery in schizophrenia through the experience of fictional cinema

Introduction One of the criticisms of rehabilitation techniques is their limited application to the patient’s daily life. In the past, cinema has been used as a psychiatric rehabilitation tool, with the primary objective of facilitating training in social abilities and communication. In this study, we consider the use of film not only as a clinical recovery tool but also as a novel cognitive recovery tool for additional rehabilitation not only for communication and social abilities but also for all of the basic cognitive and social cognition processes. Methods In this randomized clinical trial, 48 patients with schizophrenia were assigned to an experimental or control group. Both of the groups received treatment sessions that included viewing episodes of the television series The Sopranos. Next, the experimental group participated in a structured cognitive training session that featured questions and exercises based on the episodes. The control group participated in an idea-sharing session (of the same duration and frequency) about what the group members saw in the episode. Results At the end of the treatment, both the positive and negative clinical symptoms of the experimental group improved significantly compared with the control group. However, this improvement was not observed in basic or social cognitive functions. Discussion A brief intervention based on transforming the activities of daily life can be an effective tool for psychiatric rehabilitation. However, the study’s current characteristics and sample did not produce benefits in cognitive parameters.

P03-122 - Cognitive rehabilitation in executive functioning and processing speed in schizophrenia and first-episode psychosis

Objectives Processing speed and executive functioning are among the more impaired cognitive domains in schizophrenia, do not improve despite antipsychotic medication, and are associated with poor long-term functioning and quality of life. Cognitive remediation therapy for psychosis (REHACOP) try to improve cognitive deficits by teaching information processing strategies through guided mental exercises. The objective of this study is to evaluate the effectiveness of cognitive remediation therapy (REHACOP), compared to other treatments, on processing speed and executive functioning difficulties. Material and methods Fifty-seven patients with DSM-IV schizophrenia and 29 with first-episode psychosis were randomly allocated into one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy group. The REHACOP group received 3 months structured group rehabilitation sessions (3 per week) focused on tasks requiring attention, language, memory, speed, executive functioning and activities of daily living. All subjects underwent a neuropsychological assessment pre- and post treatment, which included tests for processing speed (Trail-Making Test-A, Digit Symbol, and Stroop-Color) and executive functioning (Stroop Word-Color part and interference) Results Repeated measures of MANOVA showed that the interaction term groupXtime was significant for the executive functioning ( F = 9.88, p F = 5.92, p Conclusions Results suggest that REHACOP is effective to improve executive dysfunction and processing speed deficits in first-episode psychosis and schizophrenia compared to occupational therapy.