User:Atcovi/Psychopathology/Paper1

Japan Research Paper Review/Summarization
Aim? Does 'cognitive remediation' improve cognitive/social functions in folks with schizophrenia

Method? 60 outpatients, randomly assigned in 'normal treatment' or 'cognitive remediation program' (cognitive training using CogPack, 2x a week in/and [?] a weekly group for 12+ weeks).

Measured? Cognitive/social functioning measured using BACS and LASMI before and after.

Results? 60 folks with schizo, 29 into 'cognitive remediation group' (CRG) and 31 were in 'normal treatment'. MASSIVE changes seen in CR Group, with improvements in processing speed, functioning, and BACS scored. Improvement in interperson relationships and LASMI work skills. Verbal fluency increased as well.

Conclusions? This cognitive remediation group + normal rehabilitation resulted in improve cognitive/social functioning.

Introduction

 * Many methods, such as puzzles and neuro tests, have been used to try and aid schizo patients - but computer software programs are the latest innovation.
 * Evidence points that cognitive functioning improves in schizo, but unclear about the social functioning (living and interacting properly in the real world).
 * East Asian studies show cognitive remeditation supporting improvement in vocational, clinical, psych and neurocognitive outcomes.
 * The researchers wanted to see if cognitive remeditation using cognitive training software improves cognitive + social functioning in schizos. Also wanted to see if cognitive remeditation would increase effects of rehabilitation on improving social functioning and observe the associated change between cognitive functioning and social functioning.

Method
Inclusion criteria:

Picked through referrals, were attending 'day treatment services' (as described/highlighted in the study itself) and patients still had freedom to attend. Changes to pharmacological treatment was almost nill unless very necessary.
 * Diagnosis of schizophrenia
 * ages 20-50
 * the medical facility in question agrees
 * can and will give consent
 * no aintipsychotics as primary medication (antipsychotics can skew the results since they have a significant affect on cognitive functioning)
 * want to work, but haven't worked yet

Design and Setting
Study took place in multiple psychiatric facilities in Japan.

Interventions

 * Cognitive remediation group: Cognitive remediation done through CogPack. 64 cognitive tasks. 24 cognitive training sessions, twice a week, each session lasting 45-60 minutes. Work adhered to the 'Thinking Skills for Work' program.

All participants had regular outpatient treatment.

Outcomes

 * Primary: Cognitive functioning measured through BACS-J test.
 * Secondary: Social functioning and psychopathology were measured through LASMI. Symptom severity measured through PANSS, scored according to 3-factor model (+, -, and general psychopathology). PANSS composed of 30 items, from 1 (absent) to 7 (extreme).

Statistical Analysis

 * Reduce allocation bias, Spearmen correlations[?], ethics was on point

Results
Patient Flow and Baseline Characteristics


 * 60 clients were randomized, 29 to the CR group while 31 were in usual group. Patients were at same wavelength when it comes to basline evaluation scores for cognition, socialness and psychiatric symptoms.
 * "intention-to-treat"(?), 4 participants declined posttest.
 * ANCOVA showed significant improvement in all domains of BACS-J (highlighted).

Efficacy of CR group in improving social functioning and psychotic symptoms

 * Greater improvement in interpersonal relationships on the LASMI; cognitive remediation group work skills have improved.
 * PANSS score improved greatly in the CR group than treatment.

Correlations Between Improvements on Cognitive and Social Functioning

 * Significant correlations between changes in BACS-J verbal memory and LASMI interpersonal relationships.
 * Significant correlations between changes in BACS-J verbal fluency and changes in LASMI interpersonal relationships.
 * Significant correlations between changes in BACS-J attention/vigilance and changes in LASMI work skills.
 * Significant correlations between changes in BACS-J executive functioning and changes in LASMI work skills.

Discussion

 * Greater improvement in cognitive/social functioing + psychiatric symptoms when with the CR GROUP.
 * Traditional treatment is good, but CR proved to be even better.
 * CR mediation needs to be provided with psychiatric rehabilitation/social skills training in order to see improvement in psychosocial functioning.
 * Psychiatric symptems seen on PANSS improved in CR group.
 * Overall, IMPROVEMENT SEEN IN COGNITIVE/SOCIAL FUNCTIONING FROM CR GROUP.