Computer Therapy for SchizophreniaThe results from a recent clinical trial may have long-term implications for improving life-skills among people with schizophrenia.

Researchers at the San Francisco VA Medical Center (SFVAMC) and the University of California, San Francisco (UCSF) used computer exercises to improve social skills among people with schizophrenia.

Investigators discovered schizophrenia patients who received 80 hours of computerized training over the course of 16 weeks became better at monitoring reality. This improvement coincided with increased activation in a key part of the brain: the medial prefrontal cortex.

“The medial prefrontal cortex is a critical higher-order brain region that supports successful reality-monitoring processes,” said Karuna Subramaniam, Ph.D., the study’s first author, who worked directly with the patients in the study and analyzed their data.

The training focused on lower-level perceptual process as a stepping stone to improving higher-order working-memory and social cognitive processes.

Experts say that schizophrenia strikes about 1 percent of all Americans and about 51 million people worldwide.

It is one of the most intractable and difficult to treat psychiatric illnesses, with the prognosis becoming progressively poorer the longer a patient has the disease, according to the study’s senior author, Sophia Vinogradov, M.D.

One of the core impairments of the disease is losing a grip on what is real, she said. “Reality-monitoring is the ability to separate the inner world from outer reality,” she explained. “It is a complex cognitive function that is impaired in schizophrenia.”

In the study, the brains of 31 patients with schizophrenia and 15 healthy people used for comparison were scanned using functional magnetic resonance imaging (fMRI) while they performed a reality-monitoring task.

Then, 16 of the 31 patients with schizophrenia were randomly assigned to complete 80 hours of computerized training composed of auditory, visual and social cognitive exercises that included programs designed by the Posit Science Corporation.

The other 15 patients with schizophrenia were assigned to play computer games for the same amount of time.

After 80 hours, all of the subjects repeated the original reality-monitoring task in the MRI scanner, to monitor brain activity associated with their ability to discern words they made up in their head from words the experimenter showed them.

Compared to their pre-training assessments, people who had received the computerized cognitive training were better able to distinguish between the words they had made up themselves and those that had been presented to them.

Furthermore, analyses of the MRI data revealed they also had increased activity in the part of the brain (the medial prefrontal cortex) that governs these decisions.

The study “sets the groundwork for what could be a new treatment approach in psychiatric illness – a new tool we could use in addition to medication, psychotherapeutic approaches or cognitive behavioral approaches,” she said.

The article, “Computerized Cognitive Training Restores Neural Activity within the Reality Monitoring Network in Schizophrenia” appears in the journal Neuron.

Source: University of California, San Francisco (UCSF)