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Schizophrenia not as intractable as was thought: study

Feb. 22, 2012
Courtesy of Cell Press
and World Science staff

Peo­ple suf­fer­ing from the mind-altering men­tal ill­ness of schiz­o­phre­nia aren’t as trapped in their dis­or­der as many sci­en­tists have thought, a new study re­ports.

In­stead, re­search­ers found that a form of com­pu­ter­ized train­ing can lead to marked im­prove­ments in pa­tients, whose con­di­tion causes a loss of tou­ch with real­ity.

The stu­dy, pub­lished in the Feb. 23 is­sue of the jour­nal Neu­ron, found that 16 weeks of in­ten­sive cog­ni­tive train­ing is al­so as­so­ci­at­ed with im­proved so­cial func­tion­ing sev­er­al months lat­er.

“These find­ings raise the ex­cit­ing like­li­hood that the neu­ral im­pair­ments in schiz­o­phre­nia—and un­doubtedly oth­er neu­ro­psy­chi­atric ill­nesses—are not im­mutably fixed, but in­stead may be ame­na­ble to well-de­signed in­ter­ven­tions,” said So­phia Vino­gradov, sen­ior au­thor of the stu­dy.

Schiz­o­phre­nia is as­so­ci­at­ed with se­vere symp­toms such as hal­lu­cina­t­ions and delu­sions, as well as sub­stant­ial so­cial and cog­ni­tive deficits. “Pa­tients strug­gle with ‘real­ity mon­i­tor­ing,’ the abil­ity to sep­a­rate the in­ner world from the out­er real­ity,” Vino­gradov said. “Although there are drugs that re­duce the clin­i­cal symp­toms of schiz­o­phre­nia, cur­rent med­ica­t­ions do not im­prove cog­ni­tive deficits. In ad­di­tion, con­ven­tion­al psychoth­erapy has not prov­en to be suc­cess­ful.”

The sci­en­tists from the Uni­vers­ity of Cal­i­for­nia, San Fran­cis­co, started from the prem­ise that “in or­der to im­prove com­plex cog­ni­tive func­tions in neu­ro­psy­chi­atric ill­ness, we must in­i­tially tar­get im­pair­ments in lower-lev­el per­cep­tu­al pro­cesses, as well as higher-or­der work­ing mem­o­ry and so­cial cog­ni­tive pro­cesses,” said Srikan­tan Na­gara­jan, a co-sen­ior au­thor.

The pa­tients were trained on bas­ic rec­og­ni­tion of sounds, words, sights and fa­cial emo­tion ex­pres­sions in a se­ries of in­creas­ingly com­plex tasks, as well as on the abil­ity to rec­og­nize the ex­ist­ence of thoughts and emo­tions in oth­er peo­ple, the sci­en­tists ex­plained.

Re­search­er Ka­ru­na Sub­ra­ma­niam, who con­ducted the study and an­a­lyzed the da­ta, found that pa­tients who re­ceived 80 hours of com­pu­ter­ized train­ing over 16 weeks per­formed bet­ter on com­plex real­ity-monitoring tasks after­ward. They al­so ex­pe­ri­enced great­er ac­tiva­t­ion of their me­di­al pre­fron­tal cor­tex or mPFC, a brain re­gion be­lieved to sup­port real­ity monitoring. This ac­tiva­t­ion “was al­so linked with bet­ter so­cial func­tion­ing six months af­ter train­ing,” she said. “In con­trast, pa­tients in a con­trol group who played com­put­er games for 80 hours did not show any im­prove­ments,” show­ing these were spe­cif­ic to the tar­get­ed train­ing.


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People suffering from the mind-altering mental illness of schizophrenia aren’t as trapped in their disorder as many scientists have thought, a new study has found. Instead, researchers found that a form of computerized training can lead to marked improvements in patients, whose condition causes a loss of touch with reality. The study, published in the Feb. 23 issue of the journal Neuron, found that 16 weeks of intensive cognitive training is also associated with improved social functioning several months later. “These findings raise the exciting likelihood that the neural impairments in schizophrenia—and undoubtedly other neuropsychiatric illnesses—are not immutably fixed, but instead may be amenable to well-designed interventions,” said Sophia Vinogradov, senior author of the study. Schizophrenia is associated with severe symptoms such as hallucinations and delusions, as well as substantial social and cognitive deficits. “Patients struggle with ‘reality monitoring,’ the ability to separate the inner world from the outer reality,” Vinogradov said. “Although there are drugs that reduce the clinical symptoms of schizophrenia, current medications do not improve cognitive deficits. In addition, conventional psychotherapy has not proven to be successful.” The scientists from the University of California, San Francisco, started from the premise that “in order to improve complex cognitive functions in neuropsychiatric illness, we must initially target impairments in lower-level perceptual processes, as well as higher-order working memory and social cognitive processes,” said Srikantan Nagarajan, a co-senior author. The patients were trained on basic recognition of sounds, words, sights and facial emotion expressions in a series of increasingly complex tasks, as well as on the ability to recognize the existence of thoughts and emotions in other people, the scientists explained. Researcher Karuna Subramaniam, who conducted the study and analyzed the data, found that patients who received 80 hours of computerized training over 16 weeks performed better on complex reality-monitoring tasks. They also experienced greater activation of their medial prefrontal cortex or mPFC, a brain region believed to support successful reality-monitoring processes. “The level of mPFC activation was also linked with better social functioning six months after training,” said Subramaniam. “In contrast, patients in a control group who played computer games for 80 hours did not show any improvements,” showing the “improvements were specific to the computerized training patient group.”