Cognitive Interventions for Schizophrenia: Compensatory and Restorative Approaches - PowerPoint PPT Presentation

Loading...

PPT – Cognitive Interventions for Schizophrenia: Compensatory and Restorative Approaches PowerPoint presentation | free to download - id: 6c3461-YzY3Y



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Cognitive Interventions for Schizophrenia: Compensatory and Restorative Approaches

Description:

Cognitive Interventions for Schizophrenia: Compensatory and Restorative Approaches Sean Kidd, Ph.D. CAMH Schizophrenia Division University of Toronto Department of ... – PowerPoint PPT presentation

Number of Views:10
Avg rating:3.0/5.0
Date added: 23 August 2019
Slides: 31
Provided by: robinr157
Learn more at: http://psyc.info.yorku.ca
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Cognitive Interventions for Schizophrenia: Compensatory and Restorative Approaches


1
Cognitive Interventions for Schizophrenia
Compensatory and Restorative Approaches
  • Sean Kidd, Ph.D.
  • CAMH Schizophrenia Division
  • University of Toronto Department of Psychiatry
  • December 1st, 2014

2
Funders and Collaborators
  • Dawn Velligan and Natalie Maples University of
    Texas at San Antonio
  • Jaswant Kaur George Brown College
  • Rohan Ganguli, Tony George, Yarissa Herman, Kwame
    McKenzie, Gursharan Virdee
  • There are no competing interests in the work
    presented

3
presentation overview a tale of two approaches
  • What is promising
  • What is problematic
  • What is next

4
some general background
  • Tools are available for addressing positive
    symptoms (delusions, hallucinations).
  • But, we have little to offer for cognitive
    impacts and negative symptoms

5
cognitive impacts
  • Attention
  • Memory
  • Problem Solving
  • Social Cognition

6
what to do about it?
7
1. enhance
  • Practice cognitive tasks
  • A variable literature (types of tasks, adjunct
    intervention)
  • Linking to real world contexts and challenges
    important

8
people working in CR research
  • Susan McGurk Boston U
  • Til Wykes London Institute of Psychiatry
  • Matthew Kurtz - Yale
  • Bruce Wexler Yale
  • Chris Bowie Queens U
  • Alice Medalia - Columbia

9
cognitive remediation the evidence
  • Psychosis symptoms (highly variable, .28 avg)
  • Neurocognition (.41)
  • Psychosocial functioning (.35)
  • Gains are sustained
  • Benefit over comparable tasks
  • Little link between outcome and intervention
    duration

10
an example George Brown College
  • Built into academic curriculum
  • Group and individual computer exercises

11
matching with McGurk
12
(No Transcript)
13
the pilot summer 2010
  • People like it!
  • Turned up and stayed
  • Improved

Kidd, S.A., Kaur Bajwa, J., Haji-Khamneh, B.,
McKenzie, K., Ganguli, R. (2012). Cognitive
Remediation for Individuals with Psychosis in a
Supported Education Setting A Pilot Study.
Journal of Rehabilitation Research and Practice,
2012, 1-5.
14
the rct
  • Same intervention model
  • Randomized in term 1
  • 19 to CRSE, 18 to SE
  • Cognitive battery, PANSS, Self Esteem, academic
    functioning
  • Baseline, term 1 end, term 2 end follow up

15
rct findings
  • Again people liked it, only 1 person dropped out
  • Cognition improved for both groups, but no
    improvement for CR
  • PANSS no change for either group
  • Self Esteem (.44) sustained at f/u
  • Academic More term 1 completers (.74), at f/u
    better contributions, attitude etc. (.64-.75)

16
challenges and what comes next
  • Bang for the buck and seeing evidence through the
    hype
  • Dismantling
  • Better screening
  • Better bridging and focus
  • Considering setting

17
Compensatory Approaches
18
Compensatory Approaches
  • Some overlap, but emphasize
  • Compensatory strategy rather than improving
    function
  • Home and non-treatment/education contexts

19
cognitive adaptation training (CAT) - described
  • Focus primarily on medication taking and basic
    functional domains
  • Builds from assessment
  • Intensive typically 9 months

20
2. adapt - cognitive adaptation training
21
(No Transcript)
22
cat the evidence
  • Compared to control conditions, clients receiving
    CAT
  • Psychosis Symptoms (mostly ns)
  • Lower relapse rates (65 versus 19 over 19
    months)
  • Higher levels of adaptive functioning (1.00)
  • Most consistently, better medication adherence
    (approx 1.00)
  • Not for everyone

23
(No Transcript)
24
the revision
  • 9 months
  • Intensive CAT 4 months, with 5 months case
    manager follow up
  • Eval baseline, 4 months, 9 months
  • Symptoms (BPRS, NSA), functioning MCAS, SOFAS,
    GAS
  • N 23

25
the outcomes
  • It worked, people liked it
  • Symptoms BPRS .41 - .24 NSA .33 - .33
  • Functioning

26
the challenges
  • Bedbugs
  • Time and travel

27
next steps
  • Family CAT
  • Inpatient CAT

28
where do we go from here?
29
considering...
  • Sequencing/staging in care pathways approaches
  • Better screening and providing individualized
    care
  • Linkages CBT, CBSST, MBCT/SR, Supported Voc and
    Ed, family intervention, concurrent disorders tx
  • The tool is as only good as the person using it
    common factors and fidelity

30
a decent summary paper
  • McGurk, S.R., Mueser, K.T., Covell, N.H.,
    Cicerone, K.D., Drake, R.E., Silverstein, S.M.,
    Medalia, A., Myers, R., Bellack, A.S., Bell,
    M.D., Essock, S. M., 2013. Mental health system
    funding of cognitive enhancement interventions
    for schizophrenia Summary and update of the New
    York Office of Mental Health Expert Panel and
    Stakeholder Meeting. Psychiat Rehab J. 36
    133-145.
About PowerShow.com