SHOULD MEASUREMENT OF COGNITION BE PART OF RECOVERY PROGRAMS FOR PATIENTS WITH PSYCHOTIC ILLNESS?

The recovery model of schizophrenia is central to the devlopment of community services for patients with schizophrenia. However often when applying the recovery model of psychosis, often formal identification of cognitive imparements is not carried out, nor are interventions to improve cognitive functioning offered in a targeted way. Here we discuss how these issues relate to each other and argue for the use of cognitive testing in order to elp recovery in schizophrenia

IS THERE AN OPTIMAL COGNITIVE APPLICATION TO BE USED FOR COGNITIVE REMEDIATION IN CLINICAL PSYCHIATRIC PRACTICE?

Cognitive dysfunction is a common characteristic across a number of psychiatric conditions. With growing technological advances, application based cognitive remediation (cognitive apps) is becoming steadily popular due to its accessibility, ease of use and minimal interference with the activities of daily life. However, despite a number of benefits that application based cognitive training possesses, it is not clear, whether the utilisation of these apps is a reliable approach that can be recommended in clinical psychiatric practice in order to restore cognition. In the present review, we have analysed eleven applications which trained the cognitive domains of memory, attention, language, processing speed, executive function and perception with respect to the structure and function of the applications, duration of use and measuring and monitoring of user progress and assessed them, based on the published data, for efficacy in the general population and clinical subgroups of the population. We conclude that, given that there are differences between the apps, given that there is a difference between the general population using these apps and groups suffering pathological conditions using them, given that cognitive deficits are caused by different pathological processes in different illnesses and that different illnesses present with different ranges of deficits, it is not possible to make blanket recommendations for the use of the apps. Nor is there sufficient published evidence for any of the apps to be specifically recommended for cognitive remediation. More evidence, such as trials of specific apps in different conditions, trials of specific apps against therapist guided techniques and blind trials of different apps against each other are necessary before recommendations of particular apps for particular remedial treatments can be made. Nor can ‘brain training’ in normal populations be seen as preventing cognitive decline or be seen as proof that cognitive remediation can improve cognition in pathological groups. Our paper serves as a useful reference to what apps are available, how they compare, and what the published evidence is, with a view to planning further research

NEUROCOGNITIVE FUNCTIONING IN DRUG-NAIVE PATIENTS WITH FIRST EPISODE OF PSYCHOSIS BEFORE AND AFTER TREATMENT

Cognitive deficit is a core feature of schizophrenia mostly grasping memory, psychomotor processing, attention, thinking, and executive functioning and is already present in the prodromal phase of the illness and is detected at the onset. Recent studies have been focused on the differentiation of cognitive functioning in relation to the diagnostic categories, which reveal cognitive heterogeneity in schizophrenia and schizophrenia spectrum disorders. The study demonstrated that along with changes in the clinical state, specifically, with reduction of psychopathological symptoms, patients with schizoaffective disorders show more positive dynamics with better chances to back up while in schizophrenia the cognitive dysfunction is more defoned and less prone to improvement

NEUROCOGNITIVE FUNCTIONING IN DRUG-NAIVE PATIENTS WITH FIRST EPISODE OF PSYCHOSIS BEFORE AND AFTER TREATMENT

Cognitive deficit is a core feature of schizophrenia mostly grasping memory, psychomotor processing, attention, thinking, and executive functioning and is already present in the prodromal phase of the illness and is detected at the onset. Recent studies have been focused on the differentiation of cognitive functioning in relation to the diagnostic categories, which reveal cognitive heterogeneity in schizophrenia and schizophrenia spectrum disorders. The study demonstrated that along with changes in the clinical state, specifically, with reduction of psychopathological symptoms, patients with schizoaffective disorders show more positive dynamics with better chances to back up while in schizophrenia the cognitive dysfunction is more defoned and less prone to improvement

COMPARATIVE ANALYSIS OF THEORY OF MIND TESTS IN FIRST EPISODE PSYCHOSIS PATIENTS

The research is based on comparative analysis of \u27Hinting Task\u27, \u27Faux Pas\u27, and \u27Reading the Mind in the Eyes\u27 tests sensitivity in detection of Theory of Mind deficits. The study included 20 subjects with schizophrenia and schizophrenia spectrum disorders with the first episode of psychosis. Every subject performed the three proposed tests. It was shown that success rate of the three tests differed significantly. The non-verbal test \u27Reading the Mind in the Eyes\u27 caused the most difficulties. The success rate percentage of this test performance correlated negatively with the severity of psychopathological symptoms evaluated according to the PANSS scale. Thus, \u27Reading the Mind in the Eyes\u27 test is the most sensitive out of the three to Theory of Mind deficits detection, which may be used for diagnostic purposes

NEUROCOGNITIVE DEFICIT CHANGES IN RELATION TO THE COURSE OF SCHIZOPHRENIA AND SCHIZOPHRENIA SPECTRUM DISORDERS: 5-YEAR FOLLOW-UP STUDY

Cognitive deficit is present in most of schizophrenia cases and even better explains functional outcomes then positive and negative symptoms. There have been less consensus regarding the long-term course of cognitive functioning after onset of the illness. In our study we used a neuropsychological test battery based on Luria`s systematic approach in testing of patients at their first episode of schizophrenia and schizophrenia spectrum disorders and during 5-year follow-up. The results indicated that patients with various types of course of schizophrenia and schizophrenia spectrum disorders and hence, good and poor outcomes demonstrated different patterns of dynamic of cognitive decline during the follow-up

NEUROCOGNITIVE DEFICIT CHANGES IN RELATION TO THE COURSE OF SCHIZOPHRENIA AND SCHIZOPHRENIA SPECTRUM DISORDERS: 5-YEAR FOLLOW-UP STUDY

Cognitive deficit is present in most of schizophrenia cases and even better explains functional outcomes then positive and negative symptoms. There have been less consensus regarding the long-term course of cognitive functioning after onset of the illness. In our study we used a neuropsychological test battery based on Luria`s systematic approach in testing of patients at their first episode of schizophrenia and schizophrenia spectrum disorders and during 5-year follow-up. The results indicated that patients with various types of course of schizophrenia and schizophrenia spectrum disorders and hence, good and poor outcomes demonstrated different patterns of dynamic of cognitive decline during the follow-up

Disrupted Sense of Agency as a State Marker of First-Episode Schizophrenia: A Large-Scale Follow-Up Study

Background: Schizophrenia is often characterized by a general disruption of self-processing and self-demarcation. Previous studies have shown that self-monitoring and sense of agency (SoA, i.e., the ability to recognize one's own actions correctly) are altered in schizophrenia patients. However, research findings are inconclusive in regards to how SoA alterations are linked to clinical symptoms and their severity, or cognitive factors. Methods: In a longitudinal study, we examined 161 first-episode schizophrenia patients and 154 controls with a continuous-report SoA task and a control task testing general cognitive/sensorimotor processes. Clinical symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Results: In comparison to controls, patients performed worse in terms of recognition of self-produced movements even when controlling for confounding factors. Patients' SoA score correlated with the severity of PANSS-derived “Disorganized” symptoms and with a priori defined symptoms related to self-disturbances. In the follow-up, the changes in the two subscales were significantly associated with the change in SoA performance. Conclusion: We corroborated previous findings of altered SoA already in the early stage of schizophrenia. Decreased ability to recognize self-produced actions was associated with the severity of symptoms in two complementary domains: self-disturbances and disorganization. While the involvement of the former might indicate impairment in self-monitoring, the latter suggests the role of higher cognitive processes such as information updating or cognitive flexibility. The SoA alterations in schizophrenia are associated, at least partially, with the intensity of respective symptoms in a state-dependent manner

IN SEARCH OF NEURAL MECHANISMS OF MIRROR NEURON DYSFUNCTION IN SCHIZOPHRENIA: RESTING STATE FUNCTIONAL CONNECTIVITY APPROACH

It has been repeatedly shown that schizophrenia patients have immense alterations in goal-directed behaviour, social cognition, and social interactions, cognitive abilities that are presumably driven by the mirror neurons system (MNS). However, the neural bases of these deficits still remain unclear. Along with the task-related fMRI and EEG research tapping into the mirror neuron system, the characteristics of the resting state activity in the particular areas that encompass mirror neurons might be of interest as they obviously determine the baseline of the neuronal activity. Using resting state fMRI, we investigated resting state functional connectivity (FC) in four predefined brain structures, ROIs (inferior frontal gyrus, superior parietal lobule, premotor cortex and superior temporal gyrus), known for their mirror neurons activity, in 12 patients with first psychotic episode and 12 matched healthy individuals. As a specific hypothesis, based on the knowledge of the anatomical inputs of thalamus to all preselected ROIs, we have investigated the FC between thalamus and the ROIs. Of all ROIs included, seed-to-voxel connectivity analysis revealed significantly decreased FC only in left posterior superior temporal gyrus (STG) and the areas in visual cortex and cerebellum in patients as compared to controls. Using ROI-to-ROI analysis (thalamus and selected ROIs), we have found an increased FC of STG and bilateral thalamus whereas the FC of these areas was decreased in controls. Our results suggest that: (1) schizophrenia patients exhibit FC of STG which corresponds to the previously reported changes of superior temporal gyrus in schizophrenia and might contribute to the disturbances of specific functions, such as emotional processing or spatial awareness; (2) as the thalamus plays a pivotal role in the sensory gating, providing the filtering of the redundant stimulation, the observed hyperconnectivity between the thalami and the STGs in patients with schizophrenia might explain the sequential overload with sensory inputs that leads to the abnormal cognitive processing