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From Theory to PrACTice: A Cognitive Remediation Program Based on a Neuropsychological Model of Schizophrenia.

Fabre D, Vehier A, Chesnoy-Servanin G, Gouiller N, D'Amato T, Saoud M - Front Psychiatry (2015)

Bottom Line: However, moderate improvement for patients who benefit from these therapies has been observed as described in Wykes et al. review (3).Interestingly, available cognitive remediation programs have not been influenced by these models.We describe the PrACTice program that is in the process of being validated.

View Article: PubMed Central - PubMed

Affiliation: EA 4615, Centre Hospitalier le Vinatier, Université de Lyon , Bron , France.

ABSTRACT
Cognitive dysfunction is one of the hallmark deficits of schizophrenia. A wide range of studies illustrate how it is strongly interconnected to clinical presentation and daily life functioning [see Ref. (1, 2)]. Hence, cognition is an important treatment target in schizophrenia. To address the challenge of cognitive enhancement in schizophrenia, a large number of cognitive remediation programs have been developed and evaluated over the past several decades. First, an overview of these programs is presented highlighting their specificity to cognitive deficit in schizophrenia using an integrated method. In this case, cognitive training focuses on enhancing several elementary cognitive functions considered as a prerequisite to social skills or vocational training modules. These programs are based on the neurodevelopmental hypothesis of schizophrenia. However, moderate improvement for patients who benefit from these therapies has been observed as described in Wykes et al. review (3). Next, neuropsychological models of schizophrenia are then presented. They highlight the critical role of the internally generated intentions in appropriate willful actions. The cognitive control mechanism deals with this ability. Interestingly, available cognitive remediation programs have not been influenced by these models. Hence, we propose another alternative to set up a specific cognitive remediation program for schizophrenia patients by targeting the cognitive control mechanism. We describe the PrACTice program that is in the process of being validated.

No MeSH data available.


Related in: MedlinePlus

Brain circuits for voluntary action. Taken from Haggard (30).
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Figure 1: Brain circuits for voluntary action. Taken from Haggard (30).

Mentions: As explained beforehand, most cognitive training programs that are available have been conceptualized within the hypothesis that individuals with schizophrenia suffer from a global cognitive deficit. It is suggested by the neurodevelopmental model of schizophrenia (see above). The cognitive heterogeneity characterizing schizophrenia (20) also contributes to target multiple elementary cognitive domains, in particular, attention, memory, executive functions, and social cognition deficits in a cognitive training program. Nevertheless, contemporary cognitive neuroscience provides a unifying theory for the cognitive and neural abnormalities underlying higher cognitive dysfunctions (21, 22). In this theory, an impaired cognitive control process would be expected to lead to a range of cognitive deficits across a broad range of “domains” of higher cognition. According to Lesh et al. (21), “A piecemeal approach to cognition in schizophrenia may obscure the fact that the failure of a singular overarching cognitive domain could yield a substantial proportion of the varied pattern of cognitive deficits that are observed in the disorder.” The cognitive control mechanism would be that mechanism dysfunctioning in schizophrenia (23). This mechanism allows guiding thought and action in accord with internal intentions and with stimulus relevant for the intended behavior [i.e., context representation in Ref. (24, 25)]. That is, it deals with neuroscience of willful action. Several neuropsychological models of willful actions in schizophrenia have been described (26–29) without influencing cognitive training program for individuals with schizophrenia. For instance, the Frith’s model states that symptoms of schizophrenia as negative and disorganized symptoms arise from diminished capacity to regulate willed (or goal directed) and stimulus-driven action systems. Indeed, from a cognitive view, the willed action pathway implies the transfer of internally generated goals and intentions into a reliable action response. By contrast, the stimulus-driven action pathway mediates actions that are triggered by stimulus environment. As actions driven by the current stimulus environment may be incompatible with an individual’s goals, the regulation or control of these distinct action pathways is necessary to act in a goal-directed manner. From a neuronal view, two distinct action pathways are well known. The specific brain circuits for voluntary action are of particular interest in Frith’s model. It implies the primary motor cortex (M1), which receives information from the supplementary motor area (SMA) and the presupplementary motor area (preSMA), which in turn receives inputs from the basal ganglia and the prefrontal cortex. Hence, the brain activity preceding a voluntary action of the right-hand proceeds as follows: the frontopolar cortex (shown in green) forms and deliberates long-range plans and intentions. The preSMA (shown in red) begins the preparation of the action; together with other premotor areas, it generates the readiness potentials (RPs) (red trace) that can be recorded from the scalp. Immediately before the action takes place, M1 (shown in blue) becomes active (Figure 1).


From Theory to PrACTice: A Cognitive Remediation Program Based on a Neuropsychological Model of Schizophrenia.

Fabre D, Vehier A, Chesnoy-Servanin G, Gouiller N, D'Amato T, Saoud M - Front Psychiatry (2015)

Brain circuits for voluntary action. Taken from Haggard (30).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664640&req=5

Figure 1: Brain circuits for voluntary action. Taken from Haggard (30).
Mentions: As explained beforehand, most cognitive training programs that are available have been conceptualized within the hypothesis that individuals with schizophrenia suffer from a global cognitive deficit. It is suggested by the neurodevelopmental model of schizophrenia (see above). The cognitive heterogeneity characterizing schizophrenia (20) also contributes to target multiple elementary cognitive domains, in particular, attention, memory, executive functions, and social cognition deficits in a cognitive training program. Nevertheless, contemporary cognitive neuroscience provides a unifying theory for the cognitive and neural abnormalities underlying higher cognitive dysfunctions (21, 22). In this theory, an impaired cognitive control process would be expected to lead to a range of cognitive deficits across a broad range of “domains” of higher cognition. According to Lesh et al. (21), “A piecemeal approach to cognition in schizophrenia may obscure the fact that the failure of a singular overarching cognitive domain could yield a substantial proportion of the varied pattern of cognitive deficits that are observed in the disorder.” The cognitive control mechanism would be that mechanism dysfunctioning in schizophrenia (23). This mechanism allows guiding thought and action in accord with internal intentions and with stimulus relevant for the intended behavior [i.e., context representation in Ref. (24, 25)]. That is, it deals with neuroscience of willful action. Several neuropsychological models of willful actions in schizophrenia have been described (26–29) without influencing cognitive training program for individuals with schizophrenia. For instance, the Frith’s model states that symptoms of schizophrenia as negative and disorganized symptoms arise from diminished capacity to regulate willed (or goal directed) and stimulus-driven action systems. Indeed, from a cognitive view, the willed action pathway implies the transfer of internally generated goals and intentions into a reliable action response. By contrast, the stimulus-driven action pathway mediates actions that are triggered by stimulus environment. As actions driven by the current stimulus environment may be incompatible with an individual’s goals, the regulation or control of these distinct action pathways is necessary to act in a goal-directed manner. From a neuronal view, two distinct action pathways are well known. The specific brain circuits for voluntary action are of particular interest in Frith’s model. It implies the primary motor cortex (M1), which receives information from the supplementary motor area (SMA) and the presupplementary motor area (preSMA), which in turn receives inputs from the basal ganglia and the prefrontal cortex. Hence, the brain activity preceding a voluntary action of the right-hand proceeds as follows: the frontopolar cortex (shown in green) forms and deliberates long-range plans and intentions. The preSMA (shown in red) begins the preparation of the action; together with other premotor areas, it generates the readiness potentials (RPs) (red trace) that can be recorded from the scalp. Immediately before the action takes place, M1 (shown in blue) becomes active (Figure 1).

Bottom Line: However, moderate improvement for patients who benefit from these therapies has been observed as described in Wykes et al. review (3).Interestingly, available cognitive remediation programs have not been influenced by these models.We describe the PrACTice program that is in the process of being validated.

View Article: PubMed Central - PubMed

Affiliation: EA 4615, Centre Hospitalier le Vinatier, Université de Lyon , Bron , France.

ABSTRACT
Cognitive dysfunction is one of the hallmark deficits of schizophrenia. A wide range of studies illustrate how it is strongly interconnected to clinical presentation and daily life functioning [see Ref. (1, 2)]. Hence, cognition is an important treatment target in schizophrenia. To address the challenge of cognitive enhancement in schizophrenia, a large number of cognitive remediation programs have been developed and evaluated over the past several decades. First, an overview of these programs is presented highlighting their specificity to cognitive deficit in schizophrenia using an integrated method. In this case, cognitive training focuses on enhancing several elementary cognitive functions considered as a prerequisite to social skills or vocational training modules. These programs are based on the neurodevelopmental hypothesis of schizophrenia. However, moderate improvement for patients who benefit from these therapies has been observed as described in Wykes et al. review (3). Next, neuropsychological models of schizophrenia are then presented. They highlight the critical role of the internally generated intentions in appropriate willful actions. The cognitive control mechanism deals with this ability. Interestingly, available cognitive remediation programs have not been influenced by these models. Hence, we propose another alternative to set up a specific cognitive remediation program for schizophrenia patients by targeting the cognitive control mechanism. We describe the PrACTice program that is in the process of being validated.

No MeSH data available.


Related in: MedlinePlus