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PubMed2006

Guidelines for clinical treatment of early course schizophrenia.

Several practice guidelines have been developed for the management of schizophrenia based on the current evidence base, but only a few have focused on the early course of this illness. In this article, we review the current literature on the approaches to management of early schizophrenia (ie, the prodromal, psychotic, and recovery phases of this illness). The efficacy of psychosocial and antipsychotic agents in the prodromal phase is an area of active research. Atypical antipsychotics are the mainstay of treatment for stabilization of the acute psychotic phase. Effective approaches in the recovery phase include combining medications with individual and family interventions, supported employment, assertive community treatment, cognitive remediation, and social skills training. Although evidence-based interventions have generated new optimism among those with the illness, more efforts are needed to increase access to care in community settings.

Antipsychotic Agents↗
PubMed2001

Neurocognitive enhancement therapy with work therapy: effects on neuropsychological test performance.

BACKGROUND: Cognitive deficits are a major determinant of social and occupational dysfunction in schizophrenia. In this study, we determined whether neurocognitive enhancement therapy (NET) in combination with work therapy (WT) would improve performance on neuropsychological tests related to but different from the training tasks. METHODS: Sixty-five patients with schizophrenia or schizoaffective disorder were randomly assigned to NET plus WT or WT alone. Neurocognitive enhancement therapy included computer-based training on attention, memory, and executive function tasks; an information processing group; and feedback on cognitive performance in the workplace. Work therapy included paid work activity in job placements at the medical center (eg, mail room, grounds, library) with accompanying supports. Neuropsychological testing was performed at intake and 5 months later. RESULTS: Prior to enrollment, both groups did poorly on neuropsychological testing. Patients receiving NET + WT showed greater improvements on pretest-posttest variables of executive function, working memory, and affect recognition. As many as 60% in the NET + WT group improved on some measures and were 4 to 5 times more likely to show large effect-size improvements. The number of patients with normal working memory performance increased significantly with NET + WT, from 45% to 77%, compared with a decrease from 56% to 45% for those receiving WT. CONCLUSIONS: Computer training for cognitive dysfunction in patients with schizophrenia can have benefits that generalize to independent outcome measures. Efficacy may result from a synergy between NET, which encourages mental activity, and WT, which allows a natural context for mental activity to be exercised, generalized, and reinforced.

Adult↗
PubMed1992

Influence of direct computer experience on older adults' attitudes toward computers.

This research examined whether older adults' attitudes toward computers became more positive as a function of computer experience. The sample comprised 101 community-dwelling older adults aged 57 to 87. The intervention involved a 2-week computer training program in which subjects learned to use a desktop publishing software program. A multidimensional computer attitude measure was used to assess differential attitude change and maintenance of change following training. The results indicated that older adults' computer attitudes are modifiable and that direct computer experience is an effective means of change. Attitude change as a function of training was found for the attitude dimensions targeted by the intervention program: computer comfort and efficacy. In addition, maintenance of attitude change was established for at least two weeks following training.

Aged↗
PubMed2005

[A global intervention program for institutionalized demented patients].

INTRODUCTION: Over the last decades many approaches have been developed to manage cognitive and behavioral disturbances in dementia. The present work describes a global intervention program carried out with moderately to severely demented institutionalized patients. The aims of the intervention program are to stimulate and maintain the preserved abilities of demented patients in a supportive context, to decrease the behavioral disturbance and to avoid burnout of care-unit staff. METHODS: This intervention combines different means: psychosocial care (validation therapy, social interaction), cognitive stimulation (memory and verbal training), and motor and sensitive stimulation. The global intervention program requires a special trained team composed of a supervisor, six aid-nurses, an occupational therapist, a speech therapist, a psychomotor therapist and a psychologist. The team cared for the patients five days per week over a three-month period. Assessments were conducted before and after the intervention program to measure the benefit. RESULTS: Positive effects were shown for cognitive abilities, nutritional problems and staff burnout. However, due to the small sample size for this study, more research is needed to verify the effectiveness of this global intervention program, particularly the implications for nutrition. CONCLUSION: This global intervention combined with pharmacological treatment seems to be useful for managing psychological and behavioral disorders of institutionalized demented patients.

Activities of Daily Living↗
PubMed2005

Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial.

OBJECTIVE: To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome. DESIGN: Randomised controlled trial. SETTING: 10 general practices in London. PARTICIPANTS: 149 patients with moderate or severe irritable bowel syndrome resistant to the antispasmodic mebeverine. INTERVENTIONS: Cognitive behaviour therapy delivered by trained primary care nurses plus 270 mg mebeverine taken thrice daily compared with mebeverine treatment alone. MAIN OUTCOME MEASURES: Primary measures were patients' scores on the irritable bowel syndrome symptom severity scale. Secondary measures were scores on the work and social adjustment scale and the hospital anxiety and depression scale. RESULTS: Of 334 referred patients, 72 were randomised to mebeverine plus cognitive behaviour therapy and 77 to mebeverine alone. Cognitive behaviour therapy had considerable initial benefit on symptom severity compared with mebeverine alone, with a mean reduction in score of 68 points (95% confidence interval 103 to 33), with the benefit persisting at three months and six months after therapy (mean reductions 71 points (109 to 32) and 11 points (20 to 3)) but not later. Cognitive behaviour therapy also showed significant benefit on the work and social adjustment scale that was still present 12 months after therapy (mean reduction 2.8 points (5.2 to 0.4)), but had an inconsistent effect on the hospital anxiety and depression scale. CONCLUSION: Cognitive behaviour therapy delivered by primary care nurses offered additional benefit over mebeverine alone up to six months, although the effect had waned by 12 months. Such therapy may be useful for certain patients with irritable bowel syndrome in primary care.

Adolescent↗
PubMed2007

Cognitive plasticity in people at risk for dementia: optimising the testing-the-limits-approach.

A topic of great interest in gerontology research is the prediction of cognitive deterioration which marks the transition from mild cognitive impairment (MCI) to dementia. In this area, the term cognitive plasticity can be of great interest. We examined the utility of the Adaptive Figure Series Learning Test (ADAFI) to evoke cognitive plasticity and to show whether reduced plasticity can be found in people with MCI. In a pre-test-intervention-post-test design, intervention with the ADAFI was compared to an unspecific brain jogging task in MCI participants and healthy controls. A total of 42 subjects were included. Independent of mental health status only using the ADAFI led to pronounced improvements in post-test performances, but MCI participants profited less from the intervention with the ADAFI than healthy controls, that is, showed lower cognitive plasticity. Thus, the overlap in performance distributions between healthy participants and MCI individuals at pre-test was reduced at the time of post-test once the ADAFI had been given as intervention. The findings of the present article indicate that plasticity oriented information can be gained when the ADAFI is given as an intervention in a pre-test-training-post-test-design. The cognitive plasticity approach seems potentially useful for purposes of early identification of dementia.

Aged↗
PubMed2001

Generalized anxiety disorder. An important clinical concern.

GAD is common, often follows a chronic course, and usually is associated with extensive psychiatric and medical comorbidity. This disorder often presents in a primary care setting, commonly with somatic symptoms; it is important for primary care physicians to be aware of its existence, forms of presentation, and different treatments. GAD appears to be twice as common in women than men. There is some evidence that the neurobiologic basis of GAD may involve abnormalities in neurochemical, neuroendocrine, neurophysiologic, and neuroanatomic factors. Research on psychosocial treatment of GAD has favored the combination of cognitive therapy and relaxation techniques or anxiety management training. It also appears that relapse rates after termination of cognitive-behavioral therapy are low. Taking into consideration that GAD generally is chronic and associated frequently with depressive symptoms, the ideal pharmacotherapy may be a drug that can treat these comorbid disorders adequately. New antidepressants, especially those with action in the serotonin system and possibly noradrenergic, may be the appropriate option: They not only treat anxiety, but also treat or prevent the development of comorbid depression; they should be effective ideally during prolonged periods without risks related to addiction or withdrawal, such as may happen with benzodiazepines and some antidepressants. The role of newly emerging drugs, such as some anticonvulsants, in GAD needs to be defined more clearly. More research is warranted to address issues such as (1) whether pharmacotherapy is as effective, less effective, or more effective than cognitive-behavioral therapy; (2) whether antidepressants improve the rate of wellness or remission; and (3) whether prolonged antidepressant therapy for GAD protects against later emergent depression.

Anti-Anxiety Agents↗
PubMed2005

A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method.

OBJECTIVES: To validate a chart-based method for identification of delirium and compare it with direct interviewer assessment using the Confusion Assessment Method (CAM). DESIGN: Prospective validation study. SETTING: Teaching hospital. PARTICIPANTS: Nine hundred nineteen older hospitalized patients. MEASUREMENTS: A chart-based instrument for identification of delirium was created and compared with the reference standard interviewer ratings, which used direct cognitive assessment to complete the CAM for delirium. Trained nurse chart abstractors were blinded to all interview data, including cognitive and CAM ratings. Factors influencing the correct identification of delirium in the chart were examined. RESULTS: Delirium was present in 115 (12.5%) patients according to the CAM. Sensitivity of the chart-based instrument was 74%, specificity was 83%, and likelihood ratio for a positive result was 4.4. Overall agreement between chart and interviewer ratings was 82%, kappa=0.41. By contrast, using International Classification of Diseases, Ninth Revision, Clinical Modification, administrative codes, the sensitivity for delirium was 3%, and specificity was 99%. Independent factors associated with incorrect chart identification of delirium were dementia, severe illness, and high baseline delirium risk. With all three factors present, the chart instrument was three times more likely to identify patients incorrectly than with none of the factors present. CONCLUSION: A chart-based instrument for delirium, which should be useful for patient safety and quality-improvement programs in older persons, was validated. Because of potential misclassification, the chart-based instrument is not recommended for individual patient care or diagnostic purposes.

Aged↗
PubMed2006

Issues in the design of training for quality and safety.

The US healthcare delivery system is in a state of change. Medical science and technology are advancing at an unprecedented rate, while cost containment and productivity pressures on clinicians make the clinical environment less than ideal for training. Training is one of the vehicles for addressing new knowledge requirements and for enhancing human and system based performance. Yet the theoretical underpinnings and design aspects of training have been largely unrecognized and unexamined in health care. This paper first explores changes in the practice of medicine and the healthcare delivery environment. It then describes how healthcare training and education can benefit from findings in the behavioral and cognitive sciences. It describes the systems approach to training and explores the extent to which a systems approach can be applied to the clinical environment. Finally, the paper examines innovative training and education techniques that are already gaining acceptance in health care.

Curriculum↗
PubMed2006

Androgens' performance-enhancing effects in the inhibitory avoidance and water maze tasks may involve actions at intracellular androgen receptors in the dorsal hippocampus.

Androgens can have performance-enhancing effects in some cognitive tasks, but the mechanism of these effects has not been established. Experiments examined whether androgens' actions to bind to intracellular androgen receptors (ARs) in the hippocampus are necessary to enhance cognitive performance in the inhibitory avoidance and water maze tasks. If androgens' binding at ARs are essential, then blocking them through intrahippocampal administration of flutamide, an AR receptor antagonist, should attenuate androgens' performance-enhancing effects in the inhibitory avoidance and water maze tasks. In Experiments 1 and 2, flutamide was administered through intrahippocampal inserts to intact male rats immediately pre- and post-training in the inhibitory avoidance and water maze tasks. Both pre- and post-training administration of flutamide to the dorsal hippocampus, but not missed sites, produced significantly poorer performance in the inhibitory avoidance and water maze tasks, without influencing control measures such as flinch/jump threshold or swim speed. In Experiment 3, flutamide administration to the hippocampus was delayed two hours following training in the inhibitory avoidance and water maze tasks. There was no significant effect of delayed administration of flutamide on performance in either of these tasks. Together, these findings suggest that blocking ARs in the dorsal hippocampus with flutamide administration immediately pre- or post-training can produce decrements in cognitive performance, which implies that androgens' performance-enhancing effects may occur, in part, through binding at intracellular androgen receptors in the dorsal hippocampus.

Analysis of Variance↗
PubMed2005

[A nursing experience of cognitive therapy with a major depression patient].

The increasing number of major depressive patients with negative thinking warrants that cognitive therapy be recommended to correct negative-automatic thinking and inculcate positive thinking as a way to face problems. The purpose of this paper was to describe the nursing experience and effectiveness of implementing individual cognitive therapy on a patient with major depression in an acute ward over a one-month period. Through observation, interviewing, and comprehensive nursing assessment, the patient's negative thinking toward herself and her problems was identified, and her thoughts of suicide emerged. The following three major health problems were identified: risk of suicide, disturbed sleep pattern and ineffective coping. The patient underwent homework training throughout the ten individual cognitive therapy sessions, and was expected to use positive thinking instead of automatic thinking. After the intervention, the patient's depressive mood, sleep quality, and coping ability were improved. In addition, the patient no longer talked of suicide and was able to show stable emotions, maintain a homework, and attend church activities on her own initiative after discharge. It is therefore, suggested that cognitive therapy can be an effective intervention for nurses planning to care for this group of people.

Cognitive Behavioral Therapy↗
PubMed2003

Interventions for trauma-related emotional disturbances in adult victims of crime.

This paper provides an overview of several treatment interventions for trauma-related disturbances in adult victims of crime. Following a brief discussion of mental health service utilization among crime victims, we describe interventions for acute and chronic reactions to trauma. We present some controlled studies of psychosocial treatments for posttraumatic stress disorder (PTSD) that have gained empirical support and are recommended as first line interventions by expert consensus (E. B. Foa, J. R. T. Davidson, & A. Francis, 1999) including exposure therapy, cognitive therapy, and stress inoculation training, followed by a brief summary of selected studies examining the efficacy of pharmacological treatment for PTSD. Finally, we discuss multicultural issues, factors associated with treatment outcome, and challenges we have encountered in treating crime victims.

Adult↗
PubMed2006

Offline persistence of memory-related cerebral activity during active wakefulness.

Much remains to be discovered about the fate of recent memories in the human brain. Several studies have reported the reactivation of learning-related cerebral activity during post-training sleep, suggesting that sleep plays a role in the offline processing and consolidation of memory. However, little is known about how new information is maintained and processed during post-training wakefulness before sleep, while the brain is actively engaged in other cognitive activities. We show, using functional magnetic resonance imaging, that brain activity elicited during a new learning episode modulates brain responses to an unrelated cognitive task, during the waking period following the end of training. This post-training activity evolves in learning-related cerebral structures, in which functional connections with other brain regions are gradually established or reinforced. It also correlates with behavioral performance. These processes follow a different time course for hippocampus-dependent and hippocampus-independent memories. Our experimental approach allowed the characterization of the offline evolution of the cerebral correlates of recent memories, without the confounding effect of concurrent practice of the learned material. Results indicate that the human brain has already extensively processed recent memories during the first hours of post-training wakefulness, even when simultaneously coping with unrelated cognitive demands.

Adult↗
PubMed2005

Predictors of seizure reduction after self-regulation of slow cortical potentials as a treatment of drug-resistant epilepsy.

Variables were identified that predict seizure reduction following self-regulation of slow cortical potentials (SCPs) as part of a behavioral self-management program. A sequence analysis across 52 weeks determined 14 patients to have greater than 50% seizure reduction, 8 patients with less than 50% reduction, and 12 patients without improvement. Three variables accounted for 70% of treatment success: (1) cortical excitability at the beginning of training, (2) epileptic focus, and (3) personality variables. Reduction of complex partial and secondary generalized seizures covaried with SCP control attained in the last training session. EEG spectral parameters and cognitive function appeared unrelated to treatment outcome. Successful patients may be those without large negative SCP amplitudes at the beginning of training, without a left temporal epileptic focus, and who score low on life satisfaction and are highly reactive to stress. Patients with complex partial and secondarily generalized seizures may be more likely to experience seizure reduction if they demonstrate good SCP control at the end of their training.

Adolescent↗
PubMed1995

Memory and attention test performance of young and elderly subjects after retest practice.

The effects of training on two memory and two attention tasks were investigated in 24 healthy elderly and 23 young subjects. Two training periods, each consisting of four sessions, were performed, and the effects of training were assessed during two test sessions 1 week thereafter. Significant age-related effects at the pretraining test session were found for reaction times to a simple visual stimulus, retrieval time of information from long-term storage, and the speed of focusing attention. In both age groups, performance of the first two tasks was significantly improved by training; however, the age-related effect remained significant after training. In the focused attention task, the age difference at baseline disappeared after training due to an opposite learning trend in young and elderly subjects. Thus, the cognitive performance of elderly subjects could be trained to a large extent. Significant age differences, however, could be decreased only if the test performance of young subjects did not improve.

Adult↗
PubMed1983

[Sensorimotor training in children with motor retardation].

Sensory motor training is often prescribed for children with a delayed motor development. This training is preceded by a determination of their motory level by a test. The Oseretsky test is the one we mostly use for this purpose. If the test is performed before and after the training, the effect of the training can be evaluated. In theory, sensomotory development is often looked upon as a foundation for further development, especially for the cognitive development. The effect of this training is not the same for all children; 54% of the children, who have been trained by us, scored a motory profit on ony year or more.

Child↗
PubMed2003

Cognitive retraining in epilepsy.

Epilepsy is the commonest neurological disorder, so there is a need to establish more effective remedial programmes for the deficits in cognitive functioning associated with epilepsy. The present paper studies the relative change in the targeted skill areas as a consequence of cognitive retraining. For this purpose, a pre- and post-multiple baseline design was adopted with the intention of treating specific deficient skill. The measures of neuropsychological functioning adopted were a composite of tests/tasks, with specific emphasis on attention, memory and emotional status. The subject was targeted to a special neuro-rehabilitation programme comprised of cognitive retraining, supportive therapy and a deep breathing relaxation exercise. A regular home intervention programme was conducted simultaneously. Cognitive retraining included both paper and pencil tasks and real life activities. The training programme covered a 6-week period and each weekly session lasted approximately 1 hour. The results showed an overall improvement in cognitive performance across sessions, and the regular home intervention sessions were found to have enhanced the subject's performance. In conclusion, it was noted that by identifying cognitive deficits, effective training programmes can be devised that will be of substantial benefit to patients with epilepsy.

Adult↗
PubMed1987

A controlled trial of treatments for generalized anxiety.

Treatments for chronic anxiety have received considerable interest recently. Firstly, there is a body of research which has shown problems of dependence and habituation in the long-term use of anti-anxiety drugs. A second development is that of psychological treatments for anxiety. Because of the problems involved in the use of benzodiazepines, it is important to determine whether or not psychological treatments are a reasonable alternative when treating chronic anxiety. This study was designed to test the relative effectiveness of cognitive-behavioural therapy, anxiety management training and treatment by benzodiazepines against a waiting list control. Measures were taken on both the process and outcome of treatment. The most immediate and greatest improvements in anxiety were seen in the group receiving drugs. However, these improvements reduced as the trial progressed and were minimal at the end of therapy. Both psychological treatment groups improved as the trial progressed with the most significant and consistent changes seen in the cognitive-behaviour therapy group. However, at follow-up there was no difference between the two groups receiving psychological treatments. Because of their lack of sustained improvement, over half of the group receiving drugs refused to wait without treatment until the follow-up assessment.

Adult↗