Schizophrenia Care Enters Cyberspace

It looks as though computers can help schizophrenia patients improve some areas of cognition in which they are deficient. So reported three groups of researchers at the Ninth International Congress on Schizophrenia Research, held in Colorado Springs, Colo.

Three Yale University scientists—Gary Bryson, Ph.D., Morris Bell, Ph.D., and Bruce Wexler, M.D.—randomly assigned 30 schizophrenia subjects to either a therapist-based program or a computer-based program to improve their skills in cognitive areas such as attention, memory, and executive function. Both programs essentially consisted of simplifying tasks and having subjects rehearse them. In both programs, subjects trained up to five hours a week for a 15-week period.

Bryson and his colleagues then compared the cognitive outcomes of the 30 subjects with the cognition of 45 schizophrenia patients who were comparably ill and who had received no cognitive remediation. Both the subjects who had gotten the personal therapist remediation and the subjects who had gotten computer-based remediation did significantly better than the control group.

A computer-based cognitive remediation program for schizophrenia patients is also available in Germany. It is called COGPACK. Stefan Bender, M.D., head of the Biological Psychiatry Research Group at the University of Essen, and colleagues tested the value of the program on 80 schizophrenia patients.

The researchers found that the subjects’ performances in all of the neuropsychological domains that COGPACK attempted to remedy—attention, memory, executive function, visuomotor function, and calculation—improved significantly after using the program, although the least so in the memory domain. What’s more, subjects reported increased self-esteem and progress in using computers as a result of the COGPACK exercises.

Thus, COGPACK is “an efficacious treatment for cognitive dysfunction in patients with schizophrenia,” Bender and his team concluded. They will now be seeing whether the use of various atypical antipsychotics might influence schizophrenia subjects’ COGPACK outcomes.

In another study, James Gold, Ph.D., an associate professor of psychiatry at the University of Maryland, and colleagues have been exploring in 25 schizophrenia subjects, during the past six months, the potential of a computer cognitive remediation program that engages users in several types of cognition at once. The exercises are highly animated and visually appealing.

The researchers reported at the congress that their preliminary results with the program look promising. Also, they said, schizophrenia subjects enjoyed engaging in the computer tasks and were willing to come to their clinic several times a week to undertake them. The researchers will now be comparing the value of the program to a control condition. ▪