Giacomo Deste

Cognitive Functioning in Prodromal Psychosis: A Meta-analysis

CONTEXT A substantial proportion of people at clinical high risk (HR) of psychosis will develop a psychotic disorder over time. Cognitive deficits may predate the onset of psychosis and may be useful as markers of increased vulnerability to illness. OBJECTIVE To quantitatively examine the cognitive functioning in subjects at HR in the literature to date. DATA SOURCES Electronic databases were searched until January 2011. All studies reporting cognitive performance in HR subjects were retrieved. STUDY SELECTION Nineteen studies met the inclusion criteria, comprising a total of 1188 HR subjects and 1029 controls. DATA EXTRACTION Neurocognitive functioning and social cognition as well as demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors. DATA SYNTHESIS Subjects at HR were impaired relative to controls on tests of general intelligence, executive function, verbal and visual memory, verbal fluency, attention and working memory, and social cognition. Processing speed domain was also affected, although the difference was not statistically significant. Later transition to psychosis was associated with even more marked deficits in the verbal fluency and memory domains. The studies included reported relatively homogeneous findings. There was no publication bias and a sensitivity analysis confirmed the robustness of the core results. CONCLUSIONS The HR state for psychosis is associated with significant and widespread impairments in neurocognitive functioning and social cognition. Subsequent transition to psychosis is particularly associated with deficits in verbal fluency and memory functioning.

Progressive loss of cortical gray matter in schizophrenia: a meta-analysis and meta-regression of longitudinal MRI studies

Cortical gray matter deficits have been found in patients with schizophrenia, with evidence of progression over time. The aim of this study was to determine the extent of progressive cortical gray matter volume changes over time in schizophrenia, their site and time of occurrence, and the role of potential moderators of brain changes. English language articles published between 1 January 1983 and 31 March 2012 in the MEDLINE and EMBASE databases were searched. Longitudinal magnetic resonance imaging studies comparing changes in cortical gray matter volume over time between patients with schizophrenia and healthy controls were included. Hedges g was calculated for each study. Analyses were performed using fixed- and random-effects models. A subgroup analysis was run to explore the pattern of brain changes in patients with first-episode schizophrenia. A meta-regression statistic was adopted to investigate the role of potential moderators of the effect sizes (ESs). A total of 19 studies, analyzing 813 patients with schizophrenia and 718 healthy controls, were included. Over time, patients with schizophrenia showed a significantly higher volume loss of total cortical gray matter, left superior temporal gyrus (STG), left anterior STG, left Heschl gyrus, left planum temporale and posterior STG bilaterally. Meta-analysis of first-episode schizophrenic patients showed a more significant pattern of progressive loss of whole cerebral gray matter volume involving the frontal, temporal and parietal lobes, and left Heschl gyrus compared with healthy controls. Clinical, pharmacologic and neuroradiological variables were found to be significant moderators of brain volume changes in patients with schizophrenia. The meta-analysis demonstrates that progressive cortical gray matter changes in schizophrenia occur with regional and temporal specificity. The underlying pathological process appears to be especially active in the first stages of the disease, affects the left hemisphere and the superior temporal structures more and is at least partly moderated by the type of pharmacological treatment received.

Brain structural abnormalities at the onset of schizophrenia and bipolar disorder: a meta-analysis of controlled magnetic resonance imaging studies.

A number of structural brain imaging studies and meta-analytic reviews have shown that multiple subtle brain abnormalities are consistently found in schizophrenia and bipolar disorder. Several studies suggest that schizophrenia and affective psychoses share a largely common pattern of brain abnormalities. Aim of the present study was to compare, by means of a meta-analytic approach, brain structural abnormalities, as detected by Magnetic Resonance Imaging (MRI), found at the onset of schizophrenia and bipolar disorder in order to address the question of the specificity of brain abnormalities across diagnostic groups. Forty-five studies were identified as suitable for analysis. In both schizophrenic and bipolar patients significant overall effect sizes were demonstrated for intracranial, whole brain, total grey and white matter volume reduction as well as for an increase of lateral ventricular volume at disease onset. Thus, the available literature data strongly indicate that some brain abnormalities are already present in first-episode schizophrenia or bipolar disorder and that there is a significant overlap of brain abnormalities in affective and non-affective psychotic disorders at the onset of the disease. However, whole grey matter volume deficits and lateral ventricular enlargement appear to be more prominent in first-episode schizophrenia whereas white matter volume reduction seems more prominent in bipolar disorder. The common vs specific trajectories of brain pathomorphology in schizophrenia and bipolar disorder are discussed.

Effectiveness of different modalities of cognitive remediation on symptomatological, neuropsychological, and functional outcome domains in schizophrenia: a prospective study in a real-world setting.

OBJECTIVES The efficacy of cognitive remediation interventions in schizophrenia has been demonstrated in several experimental studies. However, the effectiveness of such treatments in the usual setting of care of schizophrenia and a direct comparison of different modalities of interventions have not been systematically analyzed. The aim of the study was to assess the effectiveness of the cognitive subprograms of Integrated Psychological Therapy (IPT-cog) and of a computer-assisted cognitive remediation (CACR) method on symptomatological, neuropsychological and functional outcome measures in schizophrenia. METHODS Ninety patients with schizophrenia were assigned to IPT-cog, CACR or usual rehabilitative interventions (REHAB) in a naturalistic setting of care. Clinical, neuropsychological, and functional outcome variables were assessed at baseline and after 24 weeks of treatment. RESULTS Both the IPT-cog and CACR groups improved more than the comparison group with respect to all outcome variables. The more responsive cognitive domains were speed of processing and working memory. The effectiveness of the 2 remediation methods on the outcome dimensions considered was comparable. However, IPT-cog, but not CACR, was more effective than REHAB on speed of processing, and the CACR group had better outcome than both the REHAB and the IPT-cog groups when the Health of the Nation Outcome Scale was considered. Few correlations between neurocognitive and functional outcome changes were found. CONCLUSIONS The study demonstrates the effectiveness, although nongeneralized, of IPT-cog and CACR in schizophrenia when applied within a psychiatric and psychosocial treatment regimen representative of the usual setting and modality of care, with no evident superiority of any of the methods, and indicates that the changes in functional outcome during treatment are modestly mediated by improvement in specific cognitive domains.

Cognitive Remediation in Schizophrenia: Current Status and Future Perspectives

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.

Cognitive Remediation in the Early Course of Schizophrenia: A Critical Review

BACKGROUND The aim of cognitive remediation is to target the cognitive impairments of patients with psychosis, including attentional deficits, memory problems, and limitations in planning and problem solving. It is hoped that by addressing these deficits, patients will be more able to take advantage of other interventions and will be more able to function in social and other domains. Many results in controlled trials of cognitive remediation in adult patients affected by schizophrenia have demonstrated its effectiveness on different cognitive domains and on patients functioning. Some researchers speculate that deficits in cognition are more amenable to remediation during earlier phases of illness than when chronicity has developed. For these reasons cognitive rehabilitation should be a key component of early intervention programs, seeking to produce durable functional changes in the early course of schizophrenia. Although there is strong evidence that cognitive remediation is effective in adult schizophrenia, there is little evidence about its efficacy and long-term generalized effectiveness in the early course of the disease, and its possible application in the prodromal phase of the disease. PURPOSE OF REVIEW The aim of this paper is to review the available literature on cognitive remediation in the prodromal phase and in the early course of schizophrenia. This review summarizes especially findings of cognitive changes induced in the early course or in the prodromal phases of schizophrenia by different remediation methods. Controlled studies of cognitive training are discussed in more detail. CONCLUSION Few studies on the effects of cognitive training programs have been conducted in first episode or in early schizophrenia and only one study has been conducted in the prodromal phase of the disease. Although preliminary positive results have been achieved, more empirical research is needed to confirm the efficacy of cognitive remediation in the early course of schizophrenia, and future studies should address the issue of the usefulness of cognitive remediation in the prodromes of psychosis.

Persistence of effectiveness of cognitive remediation interventions in schizophrenia: A 1-year follow-up study

OBJECTIVES Cognitive remediation interventions are effective in patients with schizophrenia, but the durability of their effects is still under debate. This study aimed to investigate the 1-year persistence of the effectiveness of cognitive remediation. METHODS Patients with schizophrenia treated with cognitive remediation or usual rehabilitation were reassessed with clinical, neuropsychological and functional measures 1year after cognitive remediation. RESULTS At the 1-year follow-up, the advantages of cognitive remediation remained significant for clinical variables and specific cognitive domains. Functional measures showed increasing improvement at follow-up. CONCLUSIONS The study suggests that the effectiveness of cognitive remediation in schizophrenia persists after 1year.

Does cognitive remediation modify the use of psychiatric services and the patterns of care of patients with schizophrenia

The use of inpatient and outpatient psychiatric services were assessed in the 12months before and after a cognitive remediation (CR) intervention or treatment as usual (TAU) in a sample of 84 patients with schizophrenia who previously underwent an effectiveness study of CR. A smaller number and shorter duration of hospitalizations in acute wards and a higher total number of outpatient and rehabilitative interventions, as well as a more constant, intensive and articulated rehabilitation in the 12months after the intervention were found in patients who received CR, compared with those who received TAU. CR may modify the use of psychiatric services and the patterns of care of patients with schizophrenia.

Tecniche di rimedio cognitivo nella schizofrenia: ambiti di intervento ed evidenze di efficacia

Il rimedio cognitivo si pone l’obiettivo di migliorare e/o ripristinare le funzioni cognitive utilizzando un ampio spettro di strategie. Le piu recenti strategie si basano sul modello di recovery piuttosto che su quello di deficit (Lieberman et al., 2008). Gli interventi di rimedio cognitivo possono essere classificati secondo due principali modelli: compensatorio e riparativo/restorativo (Medalia e Choi, 2009). Gli interventi di tipo compensatorio cercano di eliminare o bypassare il deficit cognitivo, facendo affidamento sulle abilita cognitive residue e/o sulle risorse ambientali (Velligan et al., 2000; 2002), mentre gli interventi di tipo ripartivo/restorativo si basano sulle conoscenze acquisite nel campo delle neuroscienze, con particolare riferimento alla plasticita neurale, alla possibilita di una concreta riparazione dei processi neurali compromessi e alla capacita da parte del cervello di svilupparsi ed evolvere per tutta la durata della vita (Lindenmayer et al., 2008; Wexler et al., 2000).

Autism Spectrum Disorder and Schizophrenia: Do They Overlap?

Starting from Kanner’s description of autism, suggesting a similarity with schizophrenia, the question of comorbid association or phenotypic variations between autism and schizophrenia has been raised many times. These disorders are currently conceptualized as distinct illnesses. However, in the last years, the possible overlap between the two disorders has been investigated under several aspects: environmental risks factors, alterations in neural development, genetics, neural anatomy, neurocognitive and social cognitive impairment. Several studies underline the possibility that autism spectrum disorder and schizophrenia share at least some pathogenetic mechanisms and that similar alterations in brain developmental pathways might underline part of the phenotypic spectrum of these disorders. This review briefly summarizes the commonalities and overlapping features between autism spectrum disorder and schizophrenia. Exploring the commonalities between autism spectrum disorder and schizophrenia could provide new insight to better understand the etiology, pathophysiology, treatment, and prevention of these disorders.