Neurocognitive rehabilitation for schizophrenia |
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Authors: | Matthew M Kurtz |
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Institution: | (1) Schizophrenia Rehabilitation Program, Institute of Living, 200 Retreat Avenue, 06106 Hartford, CT, USA |
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Abstract: | A critical review of randomized, controlled trials of extended programs of neurocognitive rehabilitation for the cognitive
deficits characteristic of schizophrenia conducted between the years 2000 to 2002 was completed. Over the past several years,
two models of cognitive rehabilitation have emerged. In one model, labeled “cognitive remediation,” cognitive deficits are
treated directly through repeated practice and acquisition of compensatory strategies on cognitive exercises designed to engage
underfunctioning brain systems. In a second model, labeled “cognitive adaptation,” neurocognitive deficits are addressed through
modification of the patients’ environment to allow patients to bypass their deficits. Results revealed that a range of cognitive
remediation strategies varying widely along dimensions of duration, intensity, method, target of behavioral intervention,
and clinical status of participants produced improvements on measures of working memory, emotion perception, and executive
function distinct from those trained during remediation. No effects were evident in secondary verbal or nonverbal memory.
Results of two pilot studies using functional magnetic resonance imaging to assess changes in task-evoked brain activation
have revealed that these interventions may produce changes in several functionally relevant neural systems in a subset of
patients. Results from studies of standardized cognitive adaptation interventions have indicated that these treatments can
produce improvements in symptoms, psychosocial status, and relapse rates. A variety of approaches for future research are
also discussed. |
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