Computerized Exercises to Promote Transfer of Cognitive Skills to Everyday Life.

In recent years, computerized and non-computerized cognitive remediation programs have been designed for both individual and group settings. We believe, however, that a common misconception lies in considering the efficiency of a cognitive remediation therapy as resulting from the sole use of a computer. This omits that metacognitive skills need also to be trained throughout the remediation phase. RECOS is a theory-based therapeutic approach designed to promote the transfer of cognitive skills to functional improvements. It involves working with one person at a time using both paper/pencil tasks and a set of interactive computer exercises. Paper/pencil exercises are used to promote problem-solving techniques and to help patients to find appropriate suitable strategies. During the following computerized 1-h session, therapists guide participants to the procedural dimension of the action, which refers to knowledge about doing things and relies on retrospective introspection. We assume that each patient has a rich and underestimated procedural knowledge he/she is not aware of. By providing complex and interactive environments, computerized exercises are recommended to bring this knowledge to light. When strategies used by the participant become conscious, conditional knowledge determines when and why to use them in real-life situations

A first step toward cognitive remediation of voices: a case study.

Several studies have shown that source-monitoring errors are related to verbal hallucinations in schizophrenia. An exploratory pilot study has been carried out to investigate the possibility of training patients in how to avoid errors in source-monitoring. One patient with paranoid schizophrenia and persistent thought insertions was trained for 6 hours to use mnemonic techniques to compensate specific deficits in source-monitoring. Results show that the patient was able to improve his performance and maintain the acquired progress at a 1-month follow-up assessment. These preliminary results are interesting for developing a larger controlled study of cognitive remediation of source-monitoring deficits

Pertinence d'un programme de remédiation cognitive pour patients schizophrènes : l'hypothèse de la plasticité cérébrale

L'importance des déficits neurocognitifs des patients schizophrènes a conduit la section «E. Minkowski» du Département universitaire de psychiatrie adulte de Lausanne à développer un programme de remédiation cognitive pour jeunes patients schizophrènes. Les résultats préliminaires de ce programme indiquent une très nette amélioration des performances cognitives chez la plupart des patients. Les mécanismes cérébraux responsables de ces progrès ne sont cependant pas élucidés. De nouveaux éléments concernant les mécanismes de plasticité synaptique sont évoqués pour expliquer les modifications cérébrales associées aux fonctions cognitives exercées

Increased activation in Broca's area after cognitive remediation in schizophrenia.

Functional magnetic resonance imaging (fMRI) was used to measure changes in cerebral activity in patients with schizophrenia after participation in the Cognitive Remediation Program for Schizophrenia and other related disorders (RECOS). As RECOS therapists make use of problem-solving and verbal mediation techniques, known to be beneficial in the rehabilitation of dysexecutive syndromes, we expected an increased activation of frontal areas after remediation. Executive functioning and cerebral activation during a covert verbal fluency task were measured in eight patients with schizophrenia before (T1) and after (T2) 14 weeks of RECOS therapy. The same measures were recorded in eight patients with schizophrenia who did not participate in RECOS at the same intervals of time (TAU group). Increased activation in Broca's area, as well as improvements in performance of executive/frontal tasks, was observed after cognitive training. Metacognitive techniques of verbalization are hypothesized to be the main factor underlying the brain changes observed in the present study

Programme de remédiation cognitive pour patients présentant une schizophrénie ou un trouble associé (Recos) : résultats préliminaires [Cognitive remediation program for individuals living with schizophrenia (Recos): preliminary results].

BACKGROUND: Nowadays, cognitive remediation is widely accepted as an effective treatment for patients with schizophrenia. In French-speaking countries, techniques used in cognitive remediation for patients with schizophrenia have been applied from those used for patients with cerebral injury. As cognitive impairment is a core feature of schizophrenia, the Département de psychiatrie du CHUV in Lausanne (DP-CHUV) intended to develop a cognitive remediation program for patients with a schizophrenia spectrum disease (Recos-Vianin, 2007). Numerous studies show that the specific cognitive deficits greatly differ from one patient to another. Consequently, Recos aims at providing individualized cognitive remediation therapy. In this feasibility trial, we measured the benefits of this individualized therapy for patients with schizophrenia. Before treatment, the patients were evaluated with a large battery of cognitive tests in order to determine which of the five specific training modules - Verbal memory, visuospatial memory and attention, working memory, selective attention, reasoning - could provide the best benefit depending on their deficit. OBJECTIVES: The study was designed to evaluate the benefits of the Recos program by comparing cognitive functioning before and after treatment. METHOD: Twenty-eight patients with schizophrenia spectrum disorders (schizophrenia [n=18], schizoaffective disorder [n=5], schizotypal disorder [n=4], schizophreniform disorder [n=1], DSM-IV-TR) participated in between one and three of the cognitive modules. The choice of the training module was based on the results of the cognitive tests obtained during the first evaluation. The patients participated in 20 training sessions per module (one session per week). At the end of the training period, the cognitive functioning of each patient was reevaluated by using the same neuropsychological battery. RESULTS: The results showed a greater improvement in the cognitive functions, which were specifically trained, compared to the cognitive functions, which were not trained. However, an improvement was also observed in both types of cognitive functions, suggesting an indirect cognitive gain. CONCLUSION: In our view, the great heterogeneity of the observed cognitive deficits in schizophrenia necessitates a detailed neuropsychological investigation as well as an individualized cognitive remediation therapy. These preliminary results need to be confirmed with a more extended sample of patients

Comparisons of verbal fluency brain correlates between adults and adolescents suffering from schizophrenia spectrum disorders: A pilot study

Els projectes dâadministració electrònica són actualment el principal factor de canvi de les organitzacions públiques. Aquest canvi, que es pot considerar imparable, té implicacions importants pel que fa a la gestió i la conservació dels documents administratius generats per les tramitacions electròniques. Aquest article analitza la problemàtica metodològica, legal i cultural que es deriva de la inclusió del paradigma arxivístic en els projectes dâadministració electrònica, i també les conseqüències que pot tenir per als arxius. Finalment, proposa un conjunt de solucions metodològiques per identificar els documents electrònics amb valor evidencial, determinar-ne el cicle de vida, definir una política de preservació i crear un arxiu digital. | The projects dealing with e-government are currently the principal factor in instigating the changes taking place within the public administration. This change, which is considered unstoppable, has important implications regarding the management and conservation of administrative documents generated by electronic transactions. This article analyses the methodological, legal and cultural challenges that come about when the archives paradigm is included within e-government projects and also the consequences that this may have on the archives themselves. In conclusion the author proposes a set of methodological solutions for identifying those electronic documents with evidential value, determining their life cycle, defining a preservation policy and creating a digital archive. | Los proyectos de administración electrónica son actualmente el principal factor de cambio de las organizaciones públicas. Este cambio, que se puede considerar imparable, tiene implicaciones importantes en lo que respecta a la gestión y a la conservación de los documentos administrativos generados por las tramitaciones electrónicas. Este artículo analiza la problemática metodológica, legal y cultural que se deriva de la inclusión del paradigma archivístico en los proyectos de administración electrónica, y también las consecuencias que puede tener para los archivos. Finalmente, propone un conjunto de soluciones metodológicas para identificar los documentos electrónicos con valor evidencial, determinar su ciclo de vida, definir una política de preservación y crear un archivo digital