Cognitive Remediation Flashcards
What three psychological therapies have been noted as effective and cost effective?
CBT, Family therapy and social skills training
Why was family therapy developed?
Due to the high relapse rate when patients return home.
Due to emotional stress of environment.
Aims:
For family to understand the nature of the psychosis
Negotiate new relationship
What is Social Skills training and why was it developed?
Developed to help individuals reintegrate back into society.
Aims:
How to interpret expressions
How to start conversations
How to respond
Improves skills, but long term evidence lacking
What is CBT and how effective is it?
Talking collaborative therapy aimed at challenges thoughts and beliefs to alleviate stress and disruption to goals.
Overall reduces positive symptoms.
Good for Chronic patients
Reduces condition of delusions
Relapse reduced
Why was Cognitive Remediation developed?
To improve cognitive problems as the other therapies did not address this.
How long have we know about the cognitive difficulties in Schizophrenia?
Since Bluer and Kraeplin.
But no agreement if it got worse.
What are the four domains for cognition?
Executive function, long term memory. working memory, Attention.
Why has cognition taken so long to be introduced into therapies?
Long believed it cannot be changed
Chronic vs First episode don’t show difference
Longitudinal studies, no difference over time
What evidence is there for cognitive problems leading psychosis?
Jama: Gur: Those who develop psychosis are developmentally 6-18 months behind, higher severity higher-worse cognitive disruption
Cannon: Impairments exhibited at 3 years old
Caspi: Israeli soldiers: Psychosis group performed lower than health on all domains.
Seldman: 7 years old, 40% cognitively deficit
How does cognitive capacity relate to cost of care?
Camberwell:
Cost of Cognitive impairment much higher than Schizophrenia.
Severity of cognitive impairment predicts cost.
What prompted the development of CR?
Goldberg’s study of Wisconsin Card Sorting test.
Patients could not keep increased performance without support.
Others replicated work, some evidence that training could help-start of CR
What did the survey by Rethink show those with Psychosis wanted help with?
Holding down a Job, having meaningful relationships, looking after themselves, being independent
How is cognition related to work?
Study of work habits, personal presentation and work quality all have a high precentage of cognitive elements.
Bell and Bryson
How is cognition related to social skills?
Smith et al,
Working memory linked to social behaviour recovery
How is cognition related to life skills?
Cognition limited amount (40%) one could learn for programmes designed to teach these skills.
How is cognition related to independence?
60% of dependence on service related to thinking flexibly, more than psychotic symptoms
What is Cognitive Remediation?
It is a psychological therapy
Helping individuals achieve functional recovery based goals
Development of strength and cognitive skills
Personalised learning
What learning principles does CR use?
Scaffolding: learning support that is gradually taken away
Massed Practice: repetitive and gradual increase in challenge
Errorless Learning
Using strategies
Verbal monitoring
Is CR effective and what two factors does it rely on?
Meta analysis says yes.
Also useful for Function and less so for symptoms.
Teaching strategies and rehabilitation.
How does CR interact with Supportive Employment?
No difference in high functioning individuals, but significant in low functioning.
Results last longer
Increase chances that they will work for more hours and money and stay in programme.
What effect does CR on the brain?
Shown to increase use of DLPFC
Perserved grey matter areas lost in control group
What accounts for the discrepancy in cognitive functions and work quality?
Cognitive functions account for only 15%.
Potentially the other 85% is meta-cognition.
Particularly,
Met cognition Knowledge: What effects yours and other thinking
Meta regulation:
What is CIRCUITS?
A computerised programs designed around the 4 domains of cognition.
Then apply them in real situations and rate them
What does the current model of CR show as targets?
Motivation, Cognition, Function and coping skills
Also effected by Age
