Chapter 34 - Neuropsychological rehabilitation of schizophrenia Flashcards
Which “trouble” / symptom is regarded as the enduring core feature of schizophrenia, in that it is what causes the most trouble for the sufferer?
The cognitive dysfunctions.(p. 704)
In fact it is argued that the definition of schizophrenia should be based on basic cognitive disturbances rather than on phenomenology (p . 704f)
- Cognitive functions have also shown to be of much greater significance in the prediction of prognosis and outcome
than the symptoms of the illness (p. 705)
Can you name some of the dysfunctions and their functional outcomes, that schizophrenic people experience?
◆ Verbal memory is related to all types of functional outcomes.
◆ Vigilance predicts social problem-solving and the acquisition of social
skills.
◆ Executive functioning predicts the ability to function in the
community (Sharma 1999).
◆ Impairment in cognitive processing seems to mediate the acquisition
of behavioural competencies in schizophrenia.. (p. 705)
Which cognitive symptoms have a high diagnostic efficiency?
cognitive prodromal symptoms. (p. 705)
These symptoms have high specificity and positive
predictive powers as well as satisfactory percentages of false-positive
predictions and a good classification rate.
Does the intervention for schizophrenia target the cognitive deficits?
Targeting of cognitive and neuropsychological deficits in
schizophrenia for therapeutic interventions has so far been greatly neglected.
- It’s only targeted indirectly with psychosis medicine.
Theres two therapeutic approaches, as interventions for schizophrenia; which?
1) The content-oriented approach to therapy.
2) The process-oriented approach to cognitive therapy
What is the content-oriented approach to therapy?
This is carried out according to the principles of cognitive therapy for the treatment of depression and
other emotional disorders.. (p. 706). These principles are modified to accommodate the severely disturbed patients.
What is the process-oriented approach to cognitive therapy?
This approach focuses on remediation of deficits in cognitive processes
rather than changing distorted thoughts, attitudes, beliefs, or
hallucinations (p. 706)
What is the integrated psychological therapy (IPT) programme?
IPT is a multi-element hierarchical programme in which there is an attempt to
enhance basic cognitive capacities before problem-solving and motor
skills training is implemented.
It is a step-by-step procedure devised
for groups of 5–7 patients.
The rationale behind the IPT is that remediation of cognitive deficits
will facilitate acquisition and maintenance of more complex skills.
What are the 5 subprogrammes of IPT?
◆ cognitive differentiation; ◆ social perception; ◆ communication skills; ◆ interpersonal problem-solving; ◆ social skills training.
Three cognitive domains have been the main target for cognitive training / rehabilitation; which?
Remediation of conceptual skills
Remediation of attentional skills
Remediation of memory.
What are the results of cognitive training regarding conceptual skills?
It has not been possible to
demonstrate any evidence of generalization for improved executive - patients exhibited a marked improvement on the trained task, but not on other tasks.
So better conceptual skills in the specific assignment, but not overall conceptual skills.
What are the results of cognitive training regarding attentional skills?
Attention: Results showed improved performance on
the training tasks for the experimental group. However, no significant
changes on the outcome measures were observed
What are the results of cognitive training regarding Memory?
Memory: patients were able to increase recall on a memory task to levels close to
that of normal control subjects when their encoding was aided by ratingstimuli (words) in terms of pleasantness
What is the Oslo Cognitive Training Programme?
The development of the Oslo Cognitive Training
Programme is based on research demonstrating that the most significant
dysfunctions in schizophrenia can be related to the areas of attention,
memory, and executive functions. Using the ‘Oslo approach’, we have
attempted to develop a programme that covers all these areas of
dysfunction. (p. 709)
an example of the full Oslo program is to be found from p. 709-712, as an example of a full intervention.
Does the Oslo Cognitive Programme work?
well yes, in some aspects. - It is possible to remediate some basic cognitive functions, but these does not affect ALL other aspects of the patients’ lives.
