Computer Training May Improve Severe Schizophrenia

Fran Lowry

June 05, 2018

MIAMI — Use of an auditory-based computerized cognitive training program for severely ill patients with schizophrenia can improve their auditory discrimination, cognitive functioning, and positive symptoms, new research shows.

Dr Yash Joshi

In addition, such training may also protect patients from the anticholinergic burden that often impairs their overall ability to function.

"The medications that patients with schizophrenia are on affect the degree to which cognitive or brain-training games can improve functional outcomes in terms of cognition symptoms," lead investigator Yash Joshi, MD, PhD, from the University of California, San Diego, told Medscape Medical News.

The hope is that cognitive training may attenuate this burden, he said.

The findings were presented here at the American Society of Clinical Psychopharmacology (ASCP) 2018 annual meeting.

"Sickest of the Sick"

Impairments in early auditory information processing contribute to cognitive deficits in schizophrenia. Targeted cognitive training (TCT) is an emerging computerized intervention for remediating these deficits, said Joshi.

"Preliminary evidence from other trials has shown that improvement in auditory tasks improves cognitive functioning and positive symptoms, but these trials were done in less sick patients. We wanted to see if we could show similar improvements in sicker patients, those in residential care," he said.

"We were looking at the sickest of the sick — patients with schizophrenia who were in locked residential care. The average length of stay was about 6 months," he said.

"The type of intervention that we tested is called auditory-targeted cognitive training. This uses auditory activities to help patients with schizophrenia train and learn how to distinguish sounds better," Joshi said.

"For example, when I whistle, is the sound going up in tone or down in tone? We wanted to see if this intervention could achieve similar improvements in sicker patients, such as those in inpatient settings or residential care," he said.

The training was given for a total of 30 hours and was delivered three to five times per week in 1-hour sessions.

TCT produced improvements in cognition in terms of verbal learning and memory and reduced the severity of positive symptoms, such as auditory hallucinations and delusions, Joshi said.

Outcome Effect Size (Fisher's d)
Auditory discriminability 0.63
Verbal learning and memory 0.82
Positive Symptoms 0.62


Joshi said he hopes that more attention will be paid to this type of cognitive intervention and its role in rehabilitating patients with schizophrenia.

"From a research and clinical intervention perspective, it would be very useful for the field to develop augmenting strategies, medications or otherwise, to help people benefit to a greater degree from these types of brain-training games," he said.

"Despite all that is being presented here at this meeting, I'm not necessarily sure schizophrenia is one disease and that one drug will help all of our patients. But I am more inspired by what we can do to rehabilitate folks so they can get a job, so they can function better."

Promising Data

These preliminary data suggest a promising new lead for new nonpharmacologic interventions that, when coupled with traditional medications, may treat the enduring cognitive deficits in schizophrenia, commented Dean Salisbury, PhD, professor of psychiatry, Center for Neuroscience, University of Pittsburgh, Pennsylvania.

Dr Dean Salisbury

"Schizophrenia is a debilitating, lifelong illness where more than half of afflicted individuals cannot work even part time. Although intellectual and thinking deficits are striking, recent work suggests basic sensory processing abnormalities contribute to some of these cognitive problems," Salisbury told Medscape Medical News.

"Joshi and colleagues showed that basic sensory training, aimed at improving auditory perception in long-term schizophrenia, improved not only hearing function but also verbal learning and memory performance, and also led to a decrease in some symptoms," he said.

Dr Michael Thase

"This is an important study for two reasons," added Michael Thase, MD, professor, University of Pennsylvania, Philadelphia, and ASCP president.

"First, the results clearly support the use of a computer-administered cognitive training program to improve the cognitive performance of individuals with schizophrenia. Second, the 'load' — the composite effect of all medications of anticholinergic effect — gets in the way of training," Thase told Medscape Medical News.

"As clinicians, we will want to facilitate access to cognitive training programs. We will also be obliged to ensure that our patients are being treated with as low an exposure as possible to anticholinergic medications," he said.

Philip Gerretsen, MD, PhD, from the Center for Addiction and Mental Health, Toronto, Canada, said that future cognitive intervention studies of patients with schizophrenia should take into account the effects of anticholinergic burden on outcomes.

"Yoshi et al present fascinating pilot data from a study using targeted cognitive training, or TCT, to improve auditory discriminability, cognition, and symptom scores in patients with schizophrenia," Gerretsen told Medscape Medical News.

"Interestingly, TCT was better than treatment as usual in these domains, but also seemed to counter the negative effects of anticholinergic burden on auditory discriminability and cognition," he said.

The study was funded by a grant to Dr Joshi from the National Institutes of Health. Dr Joshi, Dr Salisbury, Dr Thase, and Dr Gerretsen have disclosed no relevant financial relationships.

American Society of Clinical Psychopharmacology (ASCP) 2018. Abstract T43, presented May 31, 2018.

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