Integrating Cognitive Neuroscience Research and Cognitive Behavioral Treatment with Neurofeedback Therapy in Drug Addiction Comorbid with Posttraumatic Stress Disorder: A Conceptual Review

ABSTRACT

Persons with co-occurring mental and substance use disorders have a more persistent and refractory illness course than those without dual diagnosis. However, few studies have assessed the effects of cognitive-behavioral and biobehavioral treatments on brain function and behavioral indices in people with comorbid drug abuse and posttraumatic stress disorder (PTSD). In this conceptual review, we propose an integrated approach to assessment and treatment utilizing cognitive neuroscience methods, conventional psychotherapeutic treatment and neurofeedback therapy to assess the recovery of cognitive and emotional functions affected by chronic psychostimulant drug abuse co-occurring with PTSD. We review cognitive and motivational factors (e.g., craving, hypersensitivity to drug- and threat-related cues, deficient executive top-down control etc.) involved in addiction and PTSD, and discuss reasons for their persistence and high vulnerability to relapse in cocaine and methamphetamine users with co-morbid PTSD undergoing behavioral treatment. Incorporating neuroscience assessment methods to assess the effects of psychotherapy and neurofeedback interventions for comorbid disorders may provide significant potential for identifying side-by-side psychophysiological with clinical markers of treatment progress, and may also provide useful information for planning interventions.     

The Norwegian standardization of the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery

This is the first international reference study of neurocognitive function as assessed by the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery (MCCB). Two hundred and fifty healthy Norwegian men and women between the ages of 12 and 59 years were tested. The results were broken down across gender, age, and education level. In the adult group, women performed better than men on Speed of Processing and Verbal Learning, and men outperformed women on Attention/Vigilance and Reasoning/Problem Solving tasks. There were substantial reductions in most domains of cognitive function with increasing age. The effect of education on cognitive performance was more modest. Although our results are somewhat divergent from the US normative study, we conclude that the MCCB is well suited for research purposes and clinical use in Norway.     

精神分裂症认知功能成套测验中文版临床信度及效度的研究

目的 对中文版精神分裂症认知功能成套测验(MCCB)的信度及效度进行临床测试.方法 对122例符合美国精神障碍诊断与统计手册第4版精神分裂症诊断标准的住院患者(患者组)进行MCCB测验,4周后重测,同期接受威斯康星卡片分类测验(WCST)、瑞文推理测验(RAVEN)、色词测验(Stroop)及阳性和阴性症状量表(PANSS)测查;并与122名性别、年龄和文化程度与患者组相匹配的社区正常人(对照组)进行比较.结果 (1)MCCB重测相关系数为0.88,P<0.001;(2)评定者间组内相关系数为0.97,P<0.001;(3)MCCB的A、B版本间的复本相关系数为0.64～0.74,P<0.001;A、B版本间的差异无统计学意义(P>0.05);(4)患者组各个分测验得分均低于对照组(P<0.001);逻辑回归分析,用MCCB区分精神分裂症患者与正常人,符合率达到84.8%(P<0.001),敏感性83.6%,特异性86.1%;(5)关联效度:MCCB与WCST、RAVEN和Stroop呈显著性相关(r=0.54～0.55),P<0.001;(6)结构效度:验证性因素分析证明中文版MCCB与英文版7个维度结构模型拟合良好;(7)MCCB平均完成时间为(58±10)min,耐受性和操作性达到中等偏上水平.结论 中文版MCCB的重测信度、评定者间信度、同质性信度、复本信度、关联效度、结构效度和效标效度等指标满足心理测量学要求,MCCB作为精神分裂症患者认知功能疗效评估的新标准,值得进一步修订和完善.     

Recovering the Self in Schizophrenia: An Integrative Review of Qualitative Studies

In this paper we review qualitative research on recovery from schizophrenia and summarize how persons' daily activities and experiences reflect mechanisms of recovery of the self. We begin by describing examples of persons' daily activities, suggesting that they have in common a stance labeled by E. Corin (1990) as positive withdrawal, representing negotiation of distance from the social milieu. We note that positive withdrawal may foster the creation of larger life frames, representing broad mechanisms through which to reconsider and ultimately recover a durable sense of self. We suggest that these mechanisms are not specific to people with schizophrenia, and briefly discuss implications of these ideas for models of outpatient treatment.     

Measurement and Treatment Research to Improve Cognition in Schizophrenia: NIMH MATRICS initiative to support the development of agents for improving cognition in schizophrenia

The impairments in social and vocational outcome that are common in schizophrenia are strongly related to the severity of impaired neurocognition. This observation led to the initiation of The NIMH's Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative, which supports the development of pharmacological agents to improve cognition in schizophrenia. MATRICS addresses barriers to drug development through a number of activities, including the development of a consensus battery for measuring cognition in schizophrenia; the development of a consensus regarding the most promising molecular targets that should be the focus of drug development; the use of a joint meeting with representatives from the industry, academia, NIMH, and the U.S. Food and Drug Administration (FDA) to clarify guidelines for the design of clinical trials for cognition enhancing agents; and finally, to assist NIMH in developing its research agenda in this area.     

Bridging the Gap in Neurotherapeutic Discovery and Development: The Role of the National Institute of Neurological Disorders and Stroke in Translational Neuroscience

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. NINDS supports early- and late-stage therapy development funding programs to accelerate preclinical discovery and the development of new therapeutic interventions for neurological disorders. The NINDS Office of Translational Research facilitates and funds the movement of discoveries from the laboratory to patients. Its grantees include academics, often with partnerships with the private sector, as well as small businesses, which, by Congressional mandate, receive > 3 % of the NINDS budget for small business innovation research. This article provides an overview of NINDS-funded therapy development programs offered by the NINDS Office of Translational Research.

Electronic supplementary material

The online version of this article (doi:10.1007/s13311-015-0366-6) contains supplementary material, which is available to authorized users.     

The Role of Rodent Models in The Discovery of New Treatments for Schizophrenia: Updating Our Strategy

The strategies used in preclinical research in schizophrenia have evolved from experiments focused on the pharmacology of existing antipsychotic or psychotomimetic drugs to the broader study of pharmacological modulation of the neurobehavioral systems affected in schizophrenia. As an additional approach, neurodevelopmental, including genetic, manipulations have become increasingly used to model disease risk factors or to induce schizophrenia-relevant neuropathology. In the vast majority of these models, behavioral testing paradigms are used to test the effects of the drugs or developmental manipulations on psychomotor, cognitive and affective processes hypothesized to be affected in schizophrenia. The term “animal model of schizophrenia” is now applied to any combination of these strategies. The expansion in animal modeling strategies has led to significant innovation in identifying novel neural mechanisms that may contribute not only to psychosis but also to the cognitive and negative symptoms of schizophrenia. Yet one cost of innovation in the discovery of truly novel treatment targets is a higher risk for false positives—drugs that have shown promise in animal models but not in clinical trials. The goals of this commentary are to first provide a brief history and conceptualization of rodent models in preclinical research and then examine the issues to be addressed in order to increase the predictive power of animal models in the identification of new treatment targets and, ultimately, new effective treatments for schizophrenia.     

Unmet Need for Mental Health Care in Schizophrenia: An Overview of Literature and New Data From a First-Admission Study

We present an overview of the literature on the patterns of mental health service use and the unmet need for care in individuals with schizophrenia with a focus on studies in the United States. We also present new data on the longitudinal course of treatments from a study of first-admission patients with schizophrenia. In epidemiological surveys, approximately 40% of the respondents with schizophrenia report that they have not received any mental health treatments in the preceding 6–12 months. Clinical epidemiological studies also find that many patients virtually drop out of treatment after their index contact with services and receive little mental health care in subsequent years. Clinical studies of patients in routine treatment settings indicate that the treatment patterns of these patients often fall short of the benchmarks set by evidence-based practice guidelines, while at least half of these patients continue to experience significant symptoms. The divergence from the guidelines is more pronounced with regard to psychosocial than medication treatments and in outpatient than in inpatient settings. The expansion of managed care has led to further reduction in the use of psychosocial treatments and, in some settings, continuity of care. In conclusion, we found a substantial level of unmet need for care among individuals with schizophrenia both at community level and in treatment settings. More than half of the individuals with this often chronic and disabling condition receive either no treatment or suboptimal treatment. Recovery in this patient population cannot be fully achieved without enhancing access to services and improving the quality of available services. The recent expansion of managed care has made this goal more difficult to achieve.     

Treatment Content in Child and Adolescent Mental Health Services: Development of the Treatment Recording Sheet

This paper presents a clinician self-report measure developed to record the specific components of treatment used with adolescents attending a Child and Adolescent Mental Health Service (CAMHS). Using action research methodology, 18 clinicians attended up to five facilitated discussion groups during 2006 to discuss the planned implementation of a clinical trial. The clinicians helped adapt a checklist for recording treatment strategies applied in CAMHS with adolescents. The sessions were audio-taped and transcribed for thematic analysis. The final treatment recording checklist is presented. The clinicians reported the instrument was helpful for recording the content of their interventions and understanding their colleagues practice.     

Social Disconnection in Late Life Suicide: An NIMH Workshop on State of the Research in Identifying Mechanisms,Treatment Targets,and Interventions

Both social disconnection and suicide are significant public health concerns among older adults, and social disconnection is associated with greater risk for suicide-related thoughts and behaviors in late life. We present a synthesis of research discussed during a workshop hosted by the National Institute of Mental Health on social disconnection and late-life suicide. Social disconnection is related to suicide risk in late life via a variety of mechanisms, including biological, behavioral, and psychological correlates. Researchers in several scientific fields have begun to establish these connections and identify targets for interventions to reduce risk in late life. While research has demonstrated that social connection is amenable to change, there is little research to date on the most evidence-based interventions to mitigate social disconnection or the related risks. However, there are several promising biological, behavioral, and psychological interventions that may target various mechanisms, as well as social disconnection itself. With a relative paucity of research in this area, these lines of study are ripe for innovative investigation. In order to most effectively advance the field, we must establish more consistent definitions of social connection and disconnection; more accurately measure and assess older adults’ social needs; examine the most effective approaches and modalities for assessment and intervention; take into account important contextual factors; and apply a translational, convergent scientific approach.     

Disengagement From Mental Health Treatment Among Individuals With Schizophrenia and Strategies for Facilitating Connections to Care: A Review of the Literature

Disengagement from mental health services can lead to devastating consequences for individuals with schizophrenia and other serious mental illnesses who require ongoing treatment. We review the extent and correlates of dropping out of mental health treatment for individuals with schizophrenia and suggest strategies for facilitating treatment engagement. Although rates vary across studies, reviews of the literature suggest that up to one-third of individuals with serious mental illnesses who have had some contact with the mental health service system disengage from care. Younger age, male gender, ethnic minority background, and low social functioning have been consistently associated with disengagement from mental health treatment. Individuals with co-occurring psychiatric and substance use disorders, as well as those with early-onset psychosis, are at particularly high risk of treatment dropout. Engagement strategies should specifically target these high-risk groups, as well as high-risk periods, including following an emergency room or hospital admission and the initial period of treatment. Interventions to enhance engagement in mental health treatment range from low-intensity interventions, such as appointment reminders, to high-intensity interventions, such as assertive community treatment. Disengagement from treatment may reflect the consumer''s perspective that treatment is not necessary, is not meeting their needs, or is not being provided in a collaborative manner. An emerging literature on patient-centered care and shared decision making in psychiatry provides suggestive evidence that efforts to enhance client-centered communication and promote individuals’ active involvement in mental health treatment decisions can also improve engagement in treatment.