The effects of neurocognitive remediation on executive processing in patients with schizophrenia.
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Approaches to cognitive remediation have differed across studies. Most of the larger studies have concentrated on group treatments designed without the benefit of recent laboratory-based studies. The current study describes a randomized trial of an intensive cognitive remediation program involving individual daily sessions of 1 hour for up to 3 months. It targets executive functioning deficits (cognitive flexibility, working memory, and planning) that are known to be problematic in people with schizophrenia. Procedural learning, as well as the principles of errorless learning, targeted reinforcement, and massed practice, was the basis of the intervention. The program was compared with an alternative therapy (intensive occupational therapy) to control for some of the effects of therapeutic contact. Some improvements in cognition followed both therapies. A differential effect in favor of cognitive remediation therapy was found for tests in the cognitive flexibility and the memory subgroups. There was a trend for those receiving atypical antipsychotic medication to benefit more from cognitive remediation for tests of cognitive flexibility. Although there were no consistent changes in symptoms or social functioning between groups, if improvement in cognitive flexibility tasks reached a threshold then there is some evidence that social functioning improved, even over the short duration of the trial. In addition, cognitive remediation differentially improved self-esteem. This study supports the view that cognitive remediation can reduce cognitive deficits and that this reduction may affect social outcome, at least in the short term. (+info)
Should schizophrenia be treated as a neurocognitive disorder?
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The search is on for meaningful psychopharmacological and cognitive/behavioral interventions for neurocognitive deficits in schizophrenia. Findings in this area are emerging rapidly, and in the absence of integrating frameworks, they are destined to emerge chaotically. Clear guidelines for testing neurocognitive interventions and interpreting results are critical at this early stage. In this article, we present three models of increasing complexity that attempt to elucidate the role of neurocognitive deficits in schizophrenia in relation to treatment and outcome. Through discussion of the models, we will consider methodological issues and interpretive challenges facing this line of investigation, including direct versus indirect neurocognitive effects of antipsychotic medications, selection of particular neurocognitive constructs for intervention, the importance of construct validity in interpreting cognitive/behavioral studies, and the expected durability of treatment effects. With a growing confidence that some neurocognitive deficits in schizophrenia can be modified, questions that seemed irrelevant only a few years ago are now fundamental. The field will need to reconsider what constitutes a successful intervention, what the relevant outcomes are, and how to define treatment efficacy. (+info)
Effects of a phonologically driven treatment for dyslexia on lactate levels measured by proton MR spectroscopic imaging.
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BACKGROUND AND PURPOSE: Dyslexia is a language disorder in which reading ability is compromised because of poor phonologic skills. The purpose of this study was to measure the effect of a phonologically driven treatment for dyslexia on brain lactate response to language stimulation as measured by proton MR spectroscopic imaging. METHODS: Brain lactate metabolism was measured at two different time points (1 year apart) during four different cognitive tasks (three language tasks and one nonlanguage task) in dyslexic participants (n = 8) and in control participants (n = 7) by using a fast MR spectroscopic imaging technique called proton echo-planar spectroscopic imaging (1 cm3 voxel resolution). The age range for both dyslexic and control participants was 10 to 13 years. Between the first and second imaging sessions, the dyslexic boys participated in an instructional intervention, which was a reading/science workshop. RESULTS: Before treatment, the dyslexic boys showed significantly greater lactate elevation compared with a control group in the left anterior quadrant (analysis of variance, P = .05) of the brain during a phonologic task. After treatment, however, brain lactate elevation was not significantly different from that of the control group in the left anterior quadrant during the same phonologic task. Behaviorally, the dyslexic participants improved in the phonologic aspects of reading. CONCLUSION: Instructional intervention that improved phonologic performance in dyslexic boys was associated with changes in brain lactate levels as measured by proton echo-planar spectroscopic imaging. (+info)
Remedial education: can this doctor be saved?
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In the first two years of the program 30 physicians have completed the program. A list of the distribution of specialties/practice areas [table: see text] served is provided in Table 1. The data reveal that the distribution of practice areas corresponds approximately to the distribution of physicians practicing in the state. The UF C.A.R.E.S Program provides a great benefit to physicians and their patients. It provides an atmosphere of professional collaboration and encouragement to address specific educational needs and underscores a commitment to providing continuing medical education, meaningful doctor-to-doctor collaboration, better patient care, and reflects a medical model of diagnosis and treatment of specific problems. (+info)
Increasing intervention implementation in general education following consultation: a comparison of two follow-up strategies.
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This study examined two strategies for increasing the accuracy with which general education teachers implemented a peer tutoring intervention for reading comprehension. The intervention was implemented for 5 elementary school students who had been referred for consultation services. Initial implementation of the intervention by the teachers was variable, and the data exhibited a downward trend. When consultants held brief daily meetings with the teachers to discuss the intervention, implementation improved for 2 of 5 participants. Four of the teachers implemented the intervention at levels substantially above baseline during the performance feedback condition, whereas implementation for 1 teacher increased following discussion of an upcoming follow-up meeting with the principal. Student reading comprehension scores improved markedly during the peer tutoring intervention. Three students maintained these gains 4 weeks after the intervention ended. The implications of these findings for the maintenance of accurate treatment implementation in applied settings are discussed. (+info)
Partial remediation of speaker and listener behaviors in people with severe dementia.
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We investigated the effects of contingent reinforcement (Intervention 1) and contingent reinforcement with modeling (Intervention 2) on speaker and listener behaviors in 5 people with severe dementia. Intervention 1 generally increased listener behavior; there was no clear effect on tacting, but echoic behavior increased in the one case investigated. Given the weak baseline repertoires of these clients and the paucity of other effective interventions, even the small increases in verbal behaviors found here are important. Further gains may be achieved, for example, if reinforcement opportunity per trial type were to be increased from one to several per day or if participants were trained to echo the listener stimulus in mand compliance tasks. (+info)
The remediation of problem-solving skills in schizophrenia.
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Efforts to remediate the problem-solving deficits of patients with schizophrenia have met with circumscribed success. This could be viewed as a sign of the immutability of the deficit or, alternatively, as a reflection of the inefficacy of the training techniques used. This study examined the feasibility of using problem-solving teaching techniques developed within educational psychology for remediating the problem-solving deficits of inpatients with schizophrenia spectrum disorders. These techniques rely on intrinsic motivation and task engagement, which are promoted through contextualization, personalization, and control of learning activities. A sample of 54 patients who demonstrated problem-solving and memory deficits on psychometric testing were randomly assigned to a problem-solving group, a memory training group, or a control group. Patients who received ten sessions of problem-solving remediation showed significantly more improvement on the outcome measure that assessed problem-solving skills required for independent living. Patients who received ten sessions of memory training did not improve on problem-solving measures. These results suggest that patients with schizophrenia spectrum disorders are responsive to problem-solving training techniques that promote intrinsic motivation and task engagement. (+info)
Memory training for children with Down syndrome.
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One well-established fact concerning cognitive and language development in individuals with Down syndrome is that working memory is particularly poor, with auditory working memory worse than visual working memory. Working memory serves the functions of control, regulation, and active maintenance of information and is critical in daily complex cognitive activities. Thus, there is a strong need to find effective and practical interventions targeted at improving working memory in individuals with Down syndrome. The present paper reviews research on rehearsal training and concludes that it can be used successfully to increase working memory in individuals with Down syndrome. However, there are still questions about whether auditory working memory can be improved reliably, whether improvement can be maintained over the long term, and whether improvement exists beyond any effect of increased attention. We describe our in-progress study which addresses these concerns. (+info)