Psychiatry - December 2008 - (Page 58)

[research to practice] being human. There are various brain regions involved in executive functions, but the prefrontal cortex is the most frequently engaged. In the clinic, executive function is tested in a number of ways and may involve problem solving (e.g., Wisconsin Card Sorting Test or maze tests), suppression of a salient response with development comparator in many of these studies was a large dose of one of the older drugs, usually haloperidol. Some of the benefit we were seeing with the newer antipsychotics was probably due to practice effects and placebo effects. There are currently a number of large efforts underway to find new medications that might CAN NEUROCOGNITIVE TESTING BE APPLIED IN CLINICAL PRACTICE WHERE TIME IS A FACTOR? Dr. Keefe: This is a very important question. Although formal cognitive testing is sensitive to the cognitive impairments found in schizophrenia, the resources required to complete full neuropsychological evaluations are often prohibitive. However, resource requirements have not kept cognitive impairment out of the diagnostic criteria for other disorders of cognition, such as Alzheimer’s dementia and attention deficit hyperactivity disorder (ADHD), which do not require formal cognitive testing. Brief assessment may help reduce the burden of collecting cognitive performance data, but psychiatrists frequently are pressed to find enough time even to complete standard clinical evaluations. The methods for establishing the presence of cognitive impairment in schizophrenia for diagnostic purposes will need to be established. A few possible methods are brief assessment, such as the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) or the Brief Assessment of Cognition for Schizophrenia (BACS), which was developed in our lab at Duke; interview-based assessments of cognition, such as the Schizophrenia Cognition Rating Scale (SCoRS) or the Cognitive Assessment Interview (CAI); and measures of functional capacity, such as the UCSD Performancebased Skills Assessment. Each of these measures can be completed in 30 to 45 minutes or less per assessment. It is of course also important to assess a patient’s longitudinal course of cognitive functioning in the context of his or Astute clinicians have begun to incorporate cognitive measures into their practices so that they can adjust doses of medications or refer patients for rehabilitation as necessary. If ongoing studies on new compounds to improve cognition are fruitful, clinicians will thus be in a good position to use these medications and assess their efficacy in the clinic. of an alternate response (e.g., Stroop test), or response conflict or task switching (e.g., Trailmaking B). Given the challenges associated with assessing executive function, some researchers and clinicians have recommended delineating specific component processes instead of treating it as a global domain. be added as “cotreatments” to antipsychotics in order to improve cognition. While nothing is on the market yet, clinicians should prepare themselves to begin assessing cognition so that they will be able to determine if a patient is benefitting. Besides, antipsychotic dose, adjunctive treatment, and other factors can have an impact on cognition, so clinicians really should be aware of cognitive changes in their patients. CAN THE IDENTIFIED COGNITIVE DEFICITS BE TREATED? Dr. Keefe: To date, treatment benefits appear to be minimal. Psychosocial, cognitive, and psychotropic treatments can have some impact on cognition, but almost all of the measurable cognitive impairment remains in most patients despite these treatments. Regarding psychotropics, we had some early hope that the newer antipsychotics improved cognition. But my interpretation of the recent studies is that the early optimism was largely due to the fact that the 58 Psychiatry 2008 [ V O L U M E 5, NUMBER CAN COGNITIVE THERAPY ABET THE COGNITIVE DEFICITS IN SCHIZOPHRENIA? Dr. Keefe: Some recent work on cognitive remediation suggests that some of these behavioral strategies can be very effective, especially if patients are motivated to get better because they want to work or improve in some other way. It is a fascinating area of research, but the results are still preliminary and require long-term studies to evaluate sustained benefits. 12, DECEMBER]

Table of Contents Feed for the Digital Edition of Psychiatry - December 2008

Psychiatry - December 2008 Editor’s Message Contents Editorial Advisory Board Antidepressant Prescribing by Specialty and Treatment of Premenstrual Dysmorphic Disorder Pain, Pain, Go Away: Antidepressants and Pain Management Why Psychotherapy Helps the Patient in Chronic Pain General Medical Drugs Associated with Depression Katatonia: A New Conceptual Understanding of Catatonia and a New Rating Scale Thermoregulation and the Role of Calcium Signalling in Neurotransmission Cognition and Schizophrenia: Is There a Role for Cognitive Assessments in Diagnosis and Treatment? Journal Watch Information for Authors

Psychiatry - December 2008

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