December 2024
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1 Read
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December 2024
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1 Read
February 2021
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163 Reads
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14 Citations
Schizophrenia Research
Background While Cognitive Remediation (CR) is effective in reducing cognitive and functioning difficulties in people with schizophrenia, there is variability in treatment response. Previous research suggested that participants' age may be a significant moderator of CR response. Aim To examine the impact of participants' age on CR outcomes. Method Individual participant data were accessed from fourteen CR randomised controlled trials. We tested the moderating effect of participants' age on cognitive and functioning outcomes using multivariate linear models. Results Data from 1084 people with a diagnosis of schizophrenia were considered. Participants had a mean age of 36.6 years (SD 11), with 11.6 years of education (SD 2.8), and an average duration of illness of 13.5 years (SD 10.7). Multivariate models showed that participants' age, when considered as a continuous variable, was not a significant moderator of treatment effect for cognitive and functioning outcomes. However, when participants were split by median age, younger participants showed higher gains in executive functions following CR compared to older participants (p=0.02). Conclusion These results suggest that participants' age does not moderate most CR outcomes. However, larger age differences may influence the effect of CR on executive function. This may suggest some adaptation of CR practice according to participants' age. These findings inform the CR personalisation agenda.
May 2020
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80 Reads
Schizophrenia Bulletin
Background Today, some evidence-based group therapy approaches focusing different treatment goals are available for the treatment of schizophrenia patients, e.g. psychoeducation, social skills training, CBTp or cognitive remediation. However, only few if any data are available regarding the impact of the group factor as an unspecific mechanism of change regarding outcome in schizophrenia patients. Does the participation in goal-oriented groups per se affect therapy outcome? Methods To bridge this gap, a cognitive remediation group approach (Integrated Neurocognitive Therapy, INT) developed in our lab has been compared with control patients not participating in therapy groups (Treatment as Usual, TAU). A total of 127 schizophrenia outpatients has been randomly assigned to INT (N=65) or TAU (n=62). INT was conducted twice a week over 15 weeks therapy duration. A comprehensive test battery was assessed before and after therapy as well as at 1-year follow up in both comparison groups. The group factor was assessed by the newly developed questionnaire “Experience and Behavior in Therapy groups EBIT”, a brief questionnaire including 13 items. Results The therapy group showed significantly better effects in EBIT outcome compared to controls regarding the global score (mean of all EBIT items) (GLM: F=4.23, p=.02) as well as regarding empirical 2-factor solution using factor analysis: factor 1 (affect and communication skills) (GLM: F=3.70; p=.03) and factor 2 (eye contact during communication) (F=3.35, p=.04). Additionally, EBIT scores are significantly associated with improvement in cognition and negative symptoms after treatment but not with positive symptoms. Discussion First of all, the group factor can be identified and measured using a brief questionnaire. Additionally, the group factor has a supplement positive effect on cognition and negative symptoms.
May 2020
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37 Reads
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1 Citation
Psychotherapie
Die Mehrheit schizophren Erkrankter leidet in erheblichem Masse an stark ausgeprägten kognitiven Defiziten. Diese sind vor allem deshalb bedeutsam, da ihnen für den Krankheitsverlauf, die Behandlung und die soziale (Re-)Integration eine zentrale Rolle zukommen dürfte. Insgesamt 11 für die Behandlung dieser Patientengruppe relevante neuround sozialkognitive Funktionsdomänen wurden von der MATRICS Initiative (Measurement and Treatment Research to Improve Cognition in Schizophrenia) als relevant definiert. Diese Initiative wurde vom National Institute of Mental Health (NIMH) in den USA unterstützt. Für die 11 Funktionsdomänen liegen heute wenige kognitive Remediations-Ansätze (KR) vor. Die Integrierte Neurokognitive Therapie (INT) ist ein KR-Gruppenansatz und wurde für die Behandlung ambulanter und tagesstationärer schizophren Erkrankter entwickelt. Die INT integriert als erster KR-Ansatz Interventionen zu allen 11 MATRICSDomänen in ein einheitliches Therapiekonzept. Jede kognitive Domäne wird nach dem gleichen didaktischen Vorgehen behandelt: Auf eine Einführung mit edukativen Elementen zur Förderung einer realistischen Selbstwahrnehmung im Zielbereich folgt die INT einem Kompensationsansatz (Strategielernen) und Restitutionsansatz (wiederholtes Üben). Dabei werden individuelle Copingstrategien mit anschliessendem Transfer der erlernten Strategien in den Alltag erarbeitet und wiederholt eingeübt. Die INT wurde in randomisierten Studien untersucht. Nebst den zu erwartenden unmittelbaren Verbesserungen in den kognitiven Domänen, zeigte die INT auch Generalisierungseffekte auf das soziale Funktionsniveau und die Negativsymptomatik, welche beide nicht als unmittelbares Interventionsziel definiert sind. Diese Effekte konnten i. d. R. auch über eine Katamnese von einem Jahr aufrechterhalten werden. Geringe Abbruchraten und hohe Teilnahmefrequenzen an den INT-Sitzungen weisen auf eine hohe Akzeptanz seitens der Teilnehmenden hin. Eine Ausweitung dieser Intervention auf andere Verlaufsstadien der Störung mit unterschiedlichen Behandlungssettings ist derzeit noch ausstehend, wie auch die Überprüfung einer potentiellen Rezidivprophylaxe durch die INT.
February 2020
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24 Reads
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7 Citations
The Journal of nervous and mental disease
International guidelines define relapse prevention for schizophrenia patients as a key therapeutic aim. However, approximately 80% to 90% of schizophrenia patients experience further symptom exacerbation after the first episode. The purpose of this study was to investigate whether group integrated neurocognitive therapy (INT), a cognitive remediation approach, reduces relapse rates in schizophrenia outpatients. INT was compared with treatment as usual (TAU) in a randomized controlled trial. Fifty-eight stabilized outpatients participated in the study with 32 allocated to the INT group and 26 to the TAU group. A test battery was used at baseline, posttreatment at 15 weeks, and a 1-year follow-up. Relapse rates were significantly lower in the INT condition compared with TAU during therapy as well as at follow-up. The relapse rate after therapy was associated with significant reductions in negative and general symptoms, improvements in functional outcome, and overall cognition. Out of these variables, negative symptoms were identified to show the strongest association with relapses after therapy. The primary outcome of this study suggests that INT can prevent relapses in schizophrenia outpatients.
April 2018
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65 Reads
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1 Citation
Schizophrenia Bulletin
Background Relapse prevention is a major aim of any treatment for schizophrenia patients. In general, recent meta-analyses showed that one third of schizophrenia patients relapse in the first year after treatment, which corresponds with rehospitalization. Since years, study data support evidence for successful relapse prevention of psycho-educative and family therapy approaches in combination with pharmacological treatment. So far little is known about the impact of Cognitive Remediation Therapy (CRT) on relapse prevention. Methods The purpose of this RCT was to investigate whether additional CRT could prevent relapses compared to treatment as usual (TAU) defined as pharmacological and other psychosocial treatments. The CRT approach of choice was the Integrated Neurocognitive Therapy (INT) developed in our lab. INT is a group approach consisting of 4 modules including interventions on all the neuro- and social cognitive domains, defined by the MATRICS initiative, as well as educational, emotion regulation and stress reduction tasks. In this international multicenter study, a total of 156 stabilized schizophrenia outpatients, diagnosed with DSM-IV, participated. From this sample, 71 participants of two out of eight centers could be observed during a follow-up of 1, 5 and 8 years, regarding number of relapses and days of rehospitalization. Relapses were defined as increased symptoms followed by rehospitalization. Results One year after therapy, no marked differences between INT and TAU groups in relapse rates were evident. But during 5- and 8-year follow-up, 78% and 83% of TAU patients relapsed compared to 48% and 52% of INT patients suggesting a significant benefit of INT. TAU patients suffered from more than 2 relapses after 5 years and 2.5 relapses after 8 years. In comparison, INT patients showed 0.9 relapses after 5 and 1.4 relapses after 8 years. After the 5 years follow-up there was a highly significant difference between INT and TAU, and after the 8-years a statistical tendency favoring INT could be found. Regarding the days of hospitalization, TAU patients presented a mean value of 8 days during 1 year after treatment, 90 days after 5 years and 105 days after 8 years compared to INT patients with 1.2 days after 1 year, 19 days after 5 years and 35 days after 8 years. The comparison after 1 year was close to significant, the other ones were clearly significant favoring again the INT intervention. Discussion These data on INT intervention support evidence for an impact of CRT on relapse prevention in a 1, 5 and 8 years follow-up. However, the identification of mechanisms of change within INT treatment needs further research.
August 2017
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36 Reads
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5 Citations
Verhaltenstherapie
Untersuchungen zu kognitiven Funktionsdefiziten zeigen, dass diese bei schizophren Erkrankten weit verbreitet und häufig stark ausgeprägt sind. Sie erscheinen vor allem deshalb bedeutsam, da ihnen für den Verlauf und die soziale (Re-)Integration eine zentrale Rolle zukommen dürfte. Verschiedene für die Behandlung dieser Patientengruppe relevante neuro- und sozialkognitive Funktionsbereiche wurden einheitlich definiert. Für die Verbesserung verschiedener kognitiver Funktionsdefizite liegen heute zahlreiche kognitive Remediationstherapie(KRT)-Ansätze vor, die sich hinsichtlich ihres Interventionsziels wie folgt kategorisieren lassen: Einige dieser KRT-Ansätze sind PC-gestützte Trainings zur Verbesserung von Neurokognitionen, die einem Restitutionsansatz folgend Effekte durch wiederholtes Üben der Patienten anstreben. KRT zur Verbesserung von sozialen Kognitionen verfolgen dagegen eher einen Kompensationsansatz und versuchen, mit den Patienten individualisierte Bewältigungsstrategien zu entwickeln. Diese sollen dann im Alltag zur Kompensation kognitiver Defizite anwendet werden. Weiter liegt auch eine Reihe von integrierten Therapieansätzen vor, die meist auf Gruppen ausgerichtet sind und sowohl auf Restitution als auch auf Kompensation basieren. Integrierte Ansätze kombinieren Neurokognitionen mit andern Funktionen oder der Symptomatik als Interventionsziel. Zahlreiche Studien von hoher wissenschaftlicher Qualität, die in verschiedenen Meta-Analysen quantifiziert wurden, liefern empirische Evidenz für die Verbesserung verschiedener kognitiver Funktionen durch KRT bei schizophren Erkrankten. Generalisierungseffekte auf andere Funktionsbereiche und das Aufrechterhalten der Effekte nach Ende der Therapie konnten in stärkerem Maße für integrierte Ansätze nachgewiesen werden. Die vorliegende Datenlage zu KRT steht jedoch im Widerspruch zu den für den deutschen Sprachraum zentralen S3-Praxisleitlinien der Deutschen Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde, die KRT «nicht für die breite klinische Praxis» empfehlen. Die vorliegende Übersichtsarbeit zu KRT soll auch diesem Umstand Rechnung tragen.
March 2017
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59 Reads
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3 Citations
Schizophrenia Bulletin
Background: Relapses do not only add psychological burden to the individuals, their friends and families, but also are costly to the government and the health-care system. Thus, relapse prevention is a major concern and goes along with the primary goal of any treatment: remission of positive and also negative symptoms within functional recovery. The Remission in Schizophrenia Working Group (RSWG) defines remission as mild or less severe symptoms for a period of at least 6 months. Besides medication, relapse prevention became an important treatment goal for psychosocial intervention. Since years, study data support evidence for successful relapse prevention of psycho-educative and family therapy approaches, but little is known about any impact Cognitive Remediation Therapy (CRT) has. Methods: The purpose of this study was to investigate whether additional CRT could prevent relapses compared to treatment as usual (TAU). The CRT approach of choice was the Integrated Neurocognitive Therapy (INT) developed in our lab. INT is a group approach consisting of 4 modules including intervention on all neuro- and social cognitive domains defined by the MATRICS initiative as well as educational and stress reduction tasks. A total of 56 stabilized schizophrenia outpatients according to DSM-IV participated in the study and were randomly allocated to INT or TAU. Patients showed mild or no symptoms according to RSWG criteria in PANSS at study intake. A relapse was defined as an increase of symptoms in any of the RSGW areas for remission to a level of moderate or higher symptom severity. Assessments including e.g. PANSS, GAF and cognitive tests was administered before and after therapy (30 biweekly sessions) and at a 1-year follow-up. Results: Highly significant results support evidence for relapse prevention of INT compared to TAU during therapy. This effect could be maintained during the 1-year follow-up period: 76% of the patients in the INT group and 46% in the TAU group did not relapse. This primary outcome was in line with significant improvements in negative symptoms, psychosocial functioning (GAF) and in the cognitive domains of speed, executive functioning and emotion processing at the follow-up favoring INT compared to TAU. Conclusion: These data on INT intervention support evidence for an impact of CRT in relapse prevention. The further outcome results seem to be in accordance with empirical integrated models suggesting a mediation role of social cognition and negative symptoms between neurocognition and functional outcome. The successful INT intervention in negative symptoms and social cognition may help to improve the functional outcome and to prevent relapse.
February 2017
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87 Reads
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25 Citations
Schizophrenia Research
Negative symptoms often inhibit the social integration of people suffering from schizophrenia. Reducing severe negative symptoms (SNS) in a clinically relevant way is a major unmet need. The aim of this study was to investigate whether Integrated Neurocognitive Therapy (INT), a group cognitive remediation therapy (CRT), reduces SNS in schizophrenia outpatients. INT was compared with Treatment As Usual (TAU) in a randomized-controlled trial (RCT). A total of 61 SNS outpatients participated in the study, 28 were allocated to the INT group and 33 to the TAU group. A test-battery was used at baseline, post-treatment at 15 weeks, and 1-year-follow-up. Remission rates of SNS after therapy were significantly higher for INT compared to TAU. A trend favoring INT was obtained at follow-up. Furthermore, INT showed significantly higher functional outcome during follow-up compared to TAU. Regarding cognition, the strongest significant effect was found in attention post-treatment. No effects between groups on more complex neurocognition and social cognition were evident. SNS outpatients seem to accept INT group intervention as suggested by the high attendance rate.
February 2015
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159 Reads
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77 Citations
Schizophrenia Bulletin
Objective: Cognitive remediation (CR) approaches have demonstrated to be effective in improving cognitive functions in schizophrenia. However, there is a lack of integrated CR approaches that target multiple neuro- and social-cognitive domains with a special focus on the generalization of therapy effects to functional outcome. Method: This 8-site randomized controlled trial evaluated the efficacy of a novel CR group therapy approach called integrated neurocognitive therapy (INT). INT includes well-defined exercises to improve all neuro- and social-cognitive domains as defined by the Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative by compensation and restitution. One hundred and fifty-six outpatients with a diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV-TR or ICD-10 were randomly assigned to receive 15 weeks of INT or treatment as usual (TAU). INT patients received 30 bi-weekly therapy sessions. Each session lasted 90min. Mixed models were applied to assess changes in neurocognition, social cognition, symptoms, and functional outcome at post-treatment and at 9-month follow-up. Results: In comparison to TAU, INT patients showed significant improvements in several neuro- and social-cognitive domains, negative symptoms, and functional outcome after therapy and at 9-month follow-up. Number-needed-to-treat analyses indicate that only 5 INT patients are necessary to produce durable and meaningful improvements in functional outcome. Conclusions: Integrated interventions on neurocognition and social cognition have the potential to improve not only cognitive performance but also functional outcome. These findings are important as treatment guidelines for schizophrenia have criticized CR for its poor generalization effects.
... The inconsistent effectiveness of interventions could also be due to differences in training regimens, measurement indices, and behavioral changes. For example, there are integrated neurocognitive therapy [26,27], cognitive remediation therapy [28], social cognitive training [29,30], combined computerized social cognitive training, neuroplasticity-based auditory training [31], and integrated psychological therapy [32,33]. ...
January 2013
... The presence of an active and trained therapist delivering the intervention, the structured repetition of exercises, the development of novel cognitive strategies, and the implementation of techniques to transfer cognitive gains into the real world all represent essential elements of the intervention [55,112]. Age of participants does not appear to represent a significant moderator of effects [55,113]. In this regard, CR can be offered and provide benefits in older participants, but also represents a valid strategy in a longitudinal perspective in the early-course of SSD individuals [114][115][116][117]. ...
February 2021
Schizophrenia Research
... We also observed a close relationship between the cognitive thought process and psychotic symptoms. Our results show the importance of a cognitive and valuative system for seeking and maintaining personal and social relationships; this requires mentalization, empathy, and self-confidence (Müller and Roder, 2020). ...
May 2020
Psychotherapie
... This analysis points out that the relapse rate after therapy was associated with significant reductions in negative and general symptoms, improvements in functional outcome and overall cognition. Authors underline that out of these variables, negative symptoms were identified to show the strongest association with relapses after therapy 160 . ...
February 2020
The Journal of nervous and mental disease
... Niektoré v sebe majú aj komponent tréningu všeobecnej kognície. Medzi najčastejšie používané komplexné tréningy patrí Social Cognition and Interaction Training (Combs, Adams et al., 2007;Roberts & Penn, 2009), Integrated Neurocognitive therapy (modifikácia na Slovensku používaného Integrovaného psychologického liečebného programu) (Roder & Müller, 2015), prípadne aj Metakognitívny tréning (Moritz & Woodward, 2007). Tento tréningový program je voľne dostupný v slovenskej jazykovej verzii. ...
January 2015
... Bis vor etwa zwei Dekaden war das zentrale Element der Behandlung die medikamentöse Therapie [6]. Psychotherapie beschränkte sich lange auf die Psychoedukation und übende Verfahren zur Kompensation funktioneller Defizite [7]. Die Akzeptanz der Pharmakotherapie unter Patient*innen ist aufgrund von Nebenwirkungen jedoch häufig gering [8]. ...
January 2013
... In the past few decades, psychological interventions have been shown to be effective when used in conjunction with pharmacological treatment (10,11). Psychoeducation, assertiveness training, family therapy, cognitive behavioral therapy, and cognitive remediation treatment programs have been developed and systematically studied and further improved (10)(11)(12)(13)(14)(15). Current guidelines recognize their importance for treatment and outcome, correspondingly implementation early on in treatment is recommended, even in hospitalized patients (16)(17)(18)(19). ...
August 2017
Verhaltenstherapie
... Negli ultimi anni si sta sviluppando sempre più l'utilizzo dell'ortoterapia nel campo della salute mentale, in particolar modo per persone affette da schizofrenia e da disturbo depressivo (Chan, 2017), ma anche per soggetti con deficit cognitivi in assenza di psicosi (Makizako, 2015). Nel progetto che qui presentiamo il programma di orticoltura è stato proposto a pazienti con schizofrenia come programma riabilitativo alternativo o complementare a terapie più classiche, quali ad esempio la Terapia Neurocognitiva Integrata (Integrated Neurocognitive Therapy, INT), che consta di un trattamento riabilitativo integrato, cognitivo e psicosociale (Roder et al., 2015). Il percorso di orticoltura prevedeva attività strutturata di cura della terra e delle piante, nonché processamento e vendita di prodotti alimentari, allo scopo di promuovere benefici in termini di salute e inclusione sociale. ...
January 2015
... Reducing nonverbal social perception deficits is considered to be important to improve social and community functioning in schizophrenia (Walther et al., 2016;Pinkham et al., 2017). Recently, studies using cognitive social remediation therapy (Kurtz and Richardson, 2012;Muller et al., 2014;Mueller and Roder, 2017;Bin Kitoko et al., 2020;Vita et al., 2021), non-invasive brain stimulation (Mehta et al., 2014;Walther et al., 2020a), as well as, virtual reality (Rus-Calafell et al., 2014;Torregrossa et al., 2018;Pavlidou and Walther, 2021) all show promising results in alleviating some of the social deficits schizophrenia patients' experience. This holds true for the reduction of symptom severity and improvement of emotional processing, theory of mind, social functioning, as well as interpretation and use of nonverbal social cues (i.e., gesture performance). ...
March 2017
Schizophrenia Bulletin
... Conversely, 8 studies reported non-significant differences between interventions in terms of dropout/attrition rates (Mahncke et al. 48 : CR vs control, P = 0.12; Mueller et al. 54 : Integrated Neurocognitive Therapy vs treatment as usual (TAU), P = 0.46; Thomas et al. 45 : Targeted Cognitive Training vs TAU, P = 0.10; Jahshan et al. 55 : BrainFitness vs CogPack vs Sporcle control group, P = 0.31; Lim et al. 56 : Social Cognitive Skills Training + TAU vs TAU, P = 0.55) and/or average completed sessions/completion rates/weekly training time (D'Souza et al. 57 : CR alone vs CR + D-Serine vs D-Serine alone vs control video watching, P = 0.66; Jahshan et al. 55 : BrainFitness vs CogPack vs Sporcle control group, P = 0.22; Nahum et al. 58 : SocialVille vs control computer games, P = 0.34; Medalia et al. 59 : remote + on-site CR (hybrid CR) vs all on-site CR, P = 0.81). ...
February 2017
Schizophrenia Research