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.

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This is the first time that brain activation changes in a seriously disabled group of patients with schizophrenia can be associated clearly with psychological rather than pharmacological therapy.

BackgroundThe results of one randomised control trial testing a psychological rehabilitation programme aimed at information processing strategies showed improvements in cognition post-treatment.AimsTo determine whether there are concomitant brain activation changes as a result of engaging in cognitive remediation therapy (CRT).MethodThree groups (patients receiving control therapyor CRT and a healthy control group) were investigated in a repeated measures design using the two-back test. Functional magnetic resonance imaging (fMRI) data and a broad assessment of executive functioning were completed at baseline and post-treatment. Brain activation changes were identified after accounting for possible task-correlated motion artefact.ResultsfMRI analyses indicate that the control group showed decreased activation butthetwo patient groups showed an increase in activation over time. The patient group that received successful CRT had significantly increased brain activation in regions associated with working memory particularly the frontocortical areas.ConclusionsThis isthefirsttimethat brain activation changes in a seriously disabled group of patients with schizophrenia can be associated clearly with psychological rather than pharmacological therapy.

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A 28-year-old woman with acquired brain damage suffered subsequent profound mental disability and an intense hyperphagic syndrome complete with life-threatening pica. She was the single subject of two consecutive experiments. In the first, Naltrexone, an orally administered opiate blocker, was given to reduce hyperphagia and distress, but was associated with even greater urgency when eating meals and a manifest increase in distress. While distress reduced to premedication levels on withdrawal of treatment, urgency of eating did not reduce so quickly. In the second experiment a laser acupuncture procedure was used at 2.5 Hz and 10 Hz for 10 days each with an intervening 10-day placebo condition to increase the availability of the subject's endogenous opiates, and thus hopefully produce opposite effects to the first experiment and effect a positive treatment. The 10 Hz condition produced a significant but transient reduction in pica measured by attempts at pica on a supervised walk shortly after each treatment. The subject was also easier to manage on walks, and appeared happier. Further studies using physical exercise or acupressure to achieve similar or better results are discussed.

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