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EFFECTS OF TRANSCRANIAL DIRECT CURRENT STIMULATION ON PROBABILISTIC FEEDBACK LEARNING IN PEOPLE WITH SCHIZOPHRENIA
Abstracts
with alarms, signs and checklists established in the home environment to bypass cognitive deficits in patients who have difficulty following a medication regimen. Methods: In study I, 95 outpatients with schizophrenia were randomly assigned to 1) Full-CAT (CAT focused on many aspects of community adaptation), 2) Pharm-CAT (CAT focused only on medication and appointment adherence) or 3) treatment as usual (TAU). Treatment lasted for 9 months, and patients were followed for 6 months after the withdrawal of home visits. In Study II, a translation study, CAT treatment was delivered by case managers in a community mental health center to 124 consumers for a 9 month period. In study III, in a sample of 92, we compared TAU, to PharmCAT, to a group using smart pill containers that download adherence data to a secure website that can be checked by case management staff. Results: Study I: Results of mixed effects regression models indicated that both CAT and PharmCAT treatments were superior to TAU for improving adherence to prescribed medication. These differences remained significant when home visits were withdrawn. Survival time to relapse or significant exacerbation was significantly longer in both CAT and PharmCAT in comparison to TAU Study II: Adherence improved significantly in the treatment group compared to a group of control individuals in the same clinic. Issues in the implementation of CAT by community agencies were identified and addressed. Assessments were simplified and visit frequency adjusted to fit state mandated guidelines that would allow reimbursement. Adequate reimbursement for time spent in supervision and preparation for visits was also problematic. Study III: Individuals in both the PharmCAT group and the group who received smart pill containers improved with respect to medication adherence in comparison to treatment as usual after only 3 months. Discussion: Interventions using technology may be easier to use in over-burdened delivery systems. Novel treatments to improve adherence delivered in standard community settings may provide a foundation for the individual to more successfully pursue broader goals in their own process of recovery.
doi:10.1016/j.schres.2010.02.212
EFFECTS OF TRANSCRANIAL DIRECT CURRENT STIMULATION ON PROBABILISTIC FEEDBACK LEARNING IN PEOPLE WITH SCHIZOPHRENIA Jacqueline A. Rushby1,2,3, Colleen Loo1,4,5, Cynthia S. Weickert1,2,3,5, Thomas W. Weickert1,2,3,5 1 School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; 2Prince of Wales Medical Research Institute Sydney, New South Wales, Australia; 3Schizophrenia Research Institute Sydney, New South Wales, Australia; 4Black Dog Institute Sydney, New South Wales, Australia; 5Brain Sciences UNSW Sydney, New South Wales, Australia Background: Probabilistic feedback learning relies on frontalstriatal activation in healthy adults and generally elicits a deficit associated with prefrontal cortex dysfunction in people with schizophrenia (Poldrack et al. 1999 Neuropsychology 13, 564-74; Weickert et al. 2009 Journal of Neuroscience 29, 1244-54). Anodal transcranial Direct Current Stimulation (tDCS) of the left dorsolateral prefrontal cortex was shown to improve probabilistic feedback learning in healthy adults (Kincses et al. 2003 Neuropsychologia 42, 113-7). The aim of the current study was to evaluate the ability of weak anodal tDCS of the left dorsolateral prefrontal cortex
177
to reverse probabilistic feedback learning deficits in people with schizophrenia. Methods: Following a baseline session without stimulation 19 people with schizophrenia entered the single-blind, randomized, counter-balanced, cross-over, with-in subjects study in which sham stimulation or anodal tDCS at an intensity of 2.0 mA was administered continuously for 20 minutes to the left dorsolateral prefrontal cortex during probabilistic feedback learning. People with schizophrenia were classified as good or poor learners on the basis of their ability to show sustained improvement over time during the baseline assessment. Results: Of the 19 participants, 11 people with schizophrenia were classified as good learners and 8 people with schizophrenia were classified as poor learners at baseline. An ANOVA of those people with schizophrenia classified as good learners at baseline revealed a significant condition (active versus sham) X trial interaction, F(149, 2980) = 1.37, p = .002. Post hoc LSD test revealed significant improvement in performance in active tDCS relative to sham conditions within the first 12 trials in those people with schizophrenia classified as good learners at baseline (all p's < .02). There was no significant condition X trial interaction in those people with schizophrenia classified as poor learners at baseline, F(149, 2086) = 1.16, p = .10. Discussion: These results suggest that acute tDCS may have an immediate beneficial effect to improve cognitive function in some people with schizophrenia. Further studies are needed to test the effects of repeated tDCS treatment to sustain the potential therapeutic benefit.
doi:10.1016/j.schres.2010.02.213
A BOTTOM-UP BIOFEEDBACK REMEDIATION IMPROVES EMOTION RECOGNITION IN SCHIZOPHRENIA: EVIDENCE FROM A VISUAL SCAN PATH PILOT STUDY Kathryn L. McCabe1,2, Carmel M. Loughland1,2, Mick Hunter1,2, Terry Lewin1,3, Vaughan J. Carr1,4 1 Schizophrenia Research Institute (SRI) Sydney, NSW, Australia; 2 University of Newcastle Newcastle, NSW, Australia; 3Hunter New England Health Newcastle, NSW, Australia; 4University of New South Wales Sydney, NSW, Australia Background: Cognitive deficits in schizophrenia are now widely accepted as both a core feature of schizophrenia and an area lacking effective treatment regimes. Their resistance to the effects of antipsychotic mediations, association with functioning and apparent separateness from positive symptoms demonstrates the need for efficacious treatments targeting cognition. To date, remediation strategies have adopted a largely top-down remediation approach. This is despite extensive evidence for bottom-up sensory training resulting in downstream, higher order improvements. However, this has largely been ignored in the schizophrenia remediation literature. The rationale for the present study was that in order for the brain to assign meaning to face emotion stimuli it must first generate reliable neurological responses relating to the location and sampling of sensory information. Utilizing a novel remediation strategy derived from the neurosciences, we predicted that visual scanpath performance would be altered (with patients recording a less restricted viewing strategy and increased fixations) with a downstream improvement in emotion recognition. Methods: Twenty five participants with schizophrenia were randomly allocated to a emotion recognition treatment program (METT/SETT) or a biofeedback based treatment. Participants completed training weekly for 6 weeks. At baseline, post treatment
with alarms, signs and checklists established in the home environment to bypass cognitive deficits in patients who have difficulty following a medication regimen. Methods: In study I, 95 outpatients with schizophrenia were randomly assigned to 1) Full-CAT (CAT focused on many aspects of community adaptation), 2) Pharm-CAT (CAT focused only on medication and appointment adherence) or 3) treatment as usual (TAU). Treatment lasted for 9 months, and patients were followed for 6 months after the withdrawal of home visits. In Study II, a translation study, CAT treatment was delivered by case managers in a community mental health center to 124 consumers for a 9 month period. In study III, in a sample of 92, we compared TAU, to PharmCAT, to a group using smart pill containers that download adherence data to a secure website that can be checked by case management staff. Results: Study I: Results of mixed effects regression models indicated that both CAT and PharmCAT treatments were superior to TAU for improving adherence to prescribed medication. These differences remained significant when home visits were withdrawn. Survival time to relapse or significant exacerbation was significantly longer in both CAT and PharmCAT in comparison to TAU Study II: Adherence improved significantly in the treatment group compared to a group of control individuals in the same clinic. Issues in the implementation of CAT by community agencies were identified and addressed. Assessments were simplified and visit frequency adjusted to fit state mandated guidelines that would allow reimbursement. Adequate reimbursement for time spent in supervision and preparation for visits was also problematic. Study III: Individuals in both the PharmCAT group and the group who received smart pill containers improved with respect to medication adherence in comparison to treatment as usual after only 3 months. Discussion: Interventions using technology may be easier to use in over-burdened delivery systems. Novel treatments to improve adherence delivered in standard community settings may provide a foundation for the individual to more successfully pursue broader goals in their own process of recovery.
doi:10.1016/j.schres.2010.02.212
EFFECTS OF TRANSCRANIAL DIRECT CURRENT STIMULATION ON PROBABILISTIC FEEDBACK LEARNING IN PEOPLE WITH SCHIZOPHRENIA Jacqueline A. Rushby1,2,3, Colleen Loo1,4,5, Cynthia S. Weickert1,2,3,5, Thomas W. Weickert1,2,3,5 1 School of Psychiatry, University of New South Wales Sydney, New South Wales, Australia; 2Prince of Wales Medical Research Institute Sydney, New South Wales, Australia; 3Schizophrenia Research Institute Sydney, New South Wales, Australia; 4Black Dog Institute Sydney, New South Wales, Australia; 5Brain Sciences UNSW Sydney, New South Wales, Australia Background: Probabilistic feedback learning relies on frontalstriatal activation in healthy adults and generally elicits a deficit associated with prefrontal cortex dysfunction in people with schizophrenia (Poldrack et al. 1999 Neuropsychology 13, 564-74; Weickert et al. 2009 Journal of Neuroscience 29, 1244-54). Anodal transcranial Direct Current Stimulation (tDCS) of the left dorsolateral prefrontal cortex was shown to improve probabilistic feedback learning in healthy adults (Kincses et al. 2003 Neuropsychologia 42, 113-7). The aim of the current study was to evaluate the ability of weak anodal tDCS of the left dorsolateral prefrontal cortex
177
to reverse probabilistic feedback learning deficits in people with schizophrenia. Methods: Following a baseline session without stimulation 19 people with schizophrenia entered the single-blind, randomized, counter-balanced, cross-over, with-in subjects study in which sham stimulation or anodal tDCS at an intensity of 2.0 mA was administered continuously for 20 minutes to the left dorsolateral prefrontal cortex during probabilistic feedback learning. People with schizophrenia were classified as good or poor learners on the basis of their ability to show sustained improvement over time during the baseline assessment. Results: Of the 19 participants, 11 people with schizophrenia were classified as good learners and 8 people with schizophrenia were classified as poor learners at baseline. An ANOVA of those people with schizophrenia classified as good learners at baseline revealed a significant condition (active versus sham) X trial interaction, F(149, 2980) = 1.37, p = .002. Post hoc LSD test revealed significant improvement in performance in active tDCS relative to sham conditions within the first 12 trials in those people with schizophrenia classified as good learners at baseline (all p's < .02). There was no significant condition X trial interaction in those people with schizophrenia classified as poor learners at baseline, F(149, 2086) = 1.16, p = .10. Discussion: These results suggest that acute tDCS may have an immediate beneficial effect to improve cognitive function in some people with schizophrenia. Further studies are needed to test the effects of repeated tDCS treatment to sustain the potential therapeutic benefit.
doi:10.1016/j.schres.2010.02.213
A BOTTOM-UP BIOFEEDBACK REMEDIATION IMPROVES EMOTION RECOGNITION IN SCHIZOPHRENIA: EVIDENCE FROM A VISUAL SCAN PATH PILOT STUDY Kathryn L. McCabe1,2, Carmel M. Loughland1,2, Mick Hunter1,2, Terry Lewin1,3, Vaughan J. Carr1,4 1 Schizophrenia Research Institute (SRI) Sydney, NSW, Australia; 2 University of Newcastle Newcastle, NSW, Australia; 3Hunter New England Health Newcastle, NSW, Australia; 4University of New South Wales Sydney, NSW, Australia Background: Cognitive deficits in schizophrenia are now widely accepted as both a core feature of schizophrenia and an area lacking effective treatment regimes. Their resistance to the effects of antipsychotic mediations, association with functioning and apparent separateness from positive symptoms demonstrates the need for efficacious treatments targeting cognition. To date, remediation strategies have adopted a largely top-down remediation approach. This is despite extensive evidence for bottom-up sensory training resulting in downstream, higher order improvements. However, this has largely been ignored in the schizophrenia remediation literature. The rationale for the present study was that in order for the brain to assign meaning to face emotion stimuli it must first generate reliable neurological responses relating to the location and sampling of sensory information. Utilizing a novel remediation strategy derived from the neurosciences, we predicted that visual scanpath performance would be altered (with patients recording a less restricted viewing strategy and increased fixations) with a downstream improvement in emotion recognition. Methods: Twenty five participants with schizophrenia were randomly allocated to a emotion recognition treatment program (METT/SETT) or a biofeedback based treatment. Participants completed training weekly for 6 weeks. At baseline, post treatment