Guillem Masana

Executive function needs to be targeted to improve social functioning with Cognitive Remediation Therapy (CRT) in schizophrenia.

While the role of impaired cognition in accounting for functional outcome in schizophrenia is generally established, the relationship between cognitive and functional change in the context of treatments is far from clear. The current paper tries to identify which cognitive changes lead to improvements in daily functioning among persons with chronic schizophrenia who had current negative symptoms and evidenced neuropsychological impairments. In a previous work, Cognitive Remediation Therapy (CRT) was compared with a control therapy, involving similar length of therapist contact but different targets. At the end of treatment, CRT conferred a benefit to people with schizophrenia in cognition and functioning [Schizophrenia Research, 87 (2006) 323-331]. Subsequently, analyses of covariance (ANCOVA) were conducted with baseline and cognitive change scores as covariates to test whether cognitive change predicted change in functioning. Additionally, statistical tests to establish the mediation path with significant variables were performed. Although verbal memory, but not executive functioning, was associated with functioning at baseline, it was the improvement in executive functioning that predicted improved daily functioning. Verbal memory played a mediator role in the change process. Consequently, in order to improve daily functioning with CRT, executive function still needs to be targeted in despite of multiple cognitive impairments being present.

Continuation/Maintenance Treatment with Nortriptyline Versus Combined Nortriptyline and ECT in Late-Life Psychotic Depression : A Two-Year Randomized Study

OBJECTIVE The identification of effective continuation and maintenance strategies for elderly patients with psychotic depression is a critical issue that has not been fully explored. The aim of this study was to assess the tolerability and efficacy of continuation/maintenance electroconvulsive therapy (ECT) in elderly patients with psychotic depression after acute ECT remission. METHODS The authors used a longitudinal, randomized, single-blind design to compare by survival analysis the 2-year outcome of two subgroups of elderly patients with psychotic unipolar depression who were ECT (plus nortriptyline) remitters. One group was treated with a continuation/maintenance nortriptyline regimen (N = 17) and the other with combined continuation/maintenance ECT plus nortriptyline (N = 16). RESULTS Over 2 years of treatment in elderly, psychotic, unipolar depressed ECT (plus nortriptyline) remitters, the mean survival time was significantly longer in the combined ECT plus nortriptyline subgroup than in the nortriptyline subgroup. No differences were observed between treatments with regard to tolerability. CONCLUSIONS This study supports the judicious use of combined continuation/maintenance ECT and antidepressant treatment in elderly patients with psychotic unipolar depression who are ECT remitters.

Is memory impairment a rate limiter in cognitive behavioural therapy for chronic schizophrenia

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Tratamiento electroconvulsivo de mantenimiento en la depresión unipolar psicótica del anciano

Fundamento y objetivo Este estudio se ha disenado para evaluar la seguridad y la eficacia del tratamiento electroconvulsivo (TEC) de continuacion/ mantenimiento en los pacientes ancianos que han experimentado una depression mayor psicotica y que respondieron durante el episodio indice al TEC. Pacientes y metodo Estudio longitudinal comparative aleatorizado de 2 anos de duracion. Se comparan dos subgrupos de pacientes ancianos afectados de una depresion mayor unipolar psicotica y con respuesta al TEC agudo: uno de los subgrupos realizo tratamiento de mantenimiento con nortriptilina (n = 13) y el otro, tratamiento de mantenimiento combinado con TEC y nortriptilina (n = 6). Resultados Tras un periodo de seguimiento y tratamiento de 2 anos, la tasa de recaida/recurrencia fue significativamente superior en el grupo de tratamiento con nortriptilina que en el grupo de tratamiento combinado TEC y nortritptilina. Por el contrario, la tolerabilidad de ambos tratamientos fue similar. Conclusiones Este estudio refuerza el uso del tratamiento de mantenimiento combinado con TEC y antidepresivos en la depresion mayor psicotica del anciano con antecedente personal de buena respuesta al TEC agudo.BACKGROUND AND OBJECTIVE This study was designed to assess the safety and efficacy of continuation/maintenance electroconvulsive therapy (ECT) in elderly psychotic major depressed patients after ECT remission. PATIENTS AND METHOD Using a longitudinal randomized single-blind design, we compared the two-year outcome of two subgroups of psychotic unipolar depressed elderly patients who were ECT remitters: one treated with a maintenance nortriptyline regimen (n = 13) and one treated with combined maintenance ECT plus nortriptyline (n = 6). RESULTS During 2 years of maintenance treatment in elderly psychotic unipolar depressed ECT remitters, relapse/recurrence rates were significantly higher in the nortriptyline subgroup than in the combined ECT plus nortriptyline subgroup. The tolerability of both treatments was similar. CONCLUSIONS This study supports the use of combined maintenance ECT and antidepressant treatment in elderly psychotic unipolar depressed patients who are ECT remitters.

S25. COGNITIVE REMEDIATION THERAPY AND ITS EFFECTS ON BDNF SERUM LEVELS

Abstract Background Brain-derived neurotrophic factor (BDNF) has been proposed as a biomarker of schizophrenia and, more specifically, as a biomarker of cognitive recovery. Unfortunately, it has only been tested once with cognitive remediation treatment (CRT). Methods A randomized and controlled trial (NCT02341131) with 70 schizophrenia outpatients and 15 healthy volunteers was conducted. The participants with schizophrenia were randomly assigned to either CRT or the control group. All the participants were assessed in terms of cognition, quality of life, and their serum BDNF levels at both baseline and after the intervention. Additionally, comparisons of the effects of the different genotypes of the Val66Met polymorphism at the BDNF gene on the outcome variables were also performed. Results The patients in the CRT group presented with improvements in cognition. However, no significant changes were detected in the serum levels of BDNF. Interestingly, we found a significant positive interaction effect between the serum BDNF levels and the different BDNF genotypes. The Val/Val group showed significantly higher serum levels after the CRT treatment. Discussion The replication of the previous finding of increased serum BDNF levels after cognitive remediation in clinically stable individuals with schizophrenia was not achieved. However, our data indicated that genetic variability may be mediating serum BDNF activity in the context of CRT. All in all, the current consideration of BDNF as a biomarker of cognitive recovery in schizophrenia is promising but still premature.