The effects of the combination of cognitive training and supported employment on improving clinical and working outcomes for people with schizophrenia in Japan.

BACKGROUND: In Japan, Job assistance for SMI have been not active. Compared with mental retardation, employment rate of SMI was low. The needs of the effective job assistance for SMI are growing. The purpose of this study was to determine the effectiveness of the combination approach of Cognitive Remediation (CR) and Supported Employment (SE) in clinical outcomes, including cognitive functioning and psychiatric symptoms besides vocational outcomes. METHODS: The participants diagnosed with schizophrenia or schizoaffective disorder were assigned to CR+SE group (n=52) and SE group (n=57). CR comprised computer based trainings using COGPACK and group works. SE was individualized vocational support provided by employment specialists. Outcome measures included cognitive functioning, psychiatric symptoms, social functioning, performance of tasks as clinical outcomes, employment rate, duration of employment, and earned wage as vocational outcome. RESULTS: CR+SE group displayed significantly better psychiatric symptoms (F=3.490, p<.10), interpersonal relations (F=11.695, p<.01), and social and cognitive functioning including verbal memory (F=9.439, p<.01), digit sequencing (F=5.544, p<.05), token motor tasks (F=6.685, p<.05), and overall cognitive functioning (F=8.136, p<.01). We did not find any significant difference between two groups in terms of employment rate and earned wage. DISCUSSIONS: This is the first controlled study to determine the effectiveness of CR on vocational outcomes in Japan. The results showed that CR and SE programs were feasible in Japan and that CR using COGPACK had favorable effects on cognitive functioning, psychiatric symptoms, and social functioning, which is consistent with previous researches.

Reduced planum temporale volume and delusional behaviour in patients with schizophrenia.

The structural abnormality of planum temporale (PT), a part of the superior temporal heteromodal association cortex involved in auditory and language processing, has been implicated in the pathophysiology of schizophrenia. However, its relationship to clinical manifestations remains unclear. Magnetic resonance images were obtained from 17 right-handed Japanese men with schizophrenia and from 22 age-, handedness-, and parental socioeconomic-status-matched healthy Japanese men in order to manually evaluate grey matter volumes of Heschl's gyrus (HG) and PT. Psychiatric symptoms were assessed using positive and negative syndrome scale among the patients. Compared with healthy participants, patients with schizophrenia were associated with a statistically significant PT grey matter volume reduction without left or right lateralization, whereas HG volume was preserved. Smaller right PT volume was significantly correlated with more severe delusional behaviour in the patients. Previous investigations have focused on smaller-than-normal left PT in the pathophysiology of schizophrenia; however, the present results suggest a possible role of the right PT, which is involved in social cognition such as understanding the intentions of others, in the production of psychotic experiences in patients with schizophrenia.

P300 amplitude over temporal regions in schizophrenia.

To examine the left temporal scalp area reductions of P300 amplitude, event-related potentials (ERPs) during a standard oddball task were recorded in 57 schizophrenic patients and 33 normal controls. The P300 amplitude at T3 was not significantly smaller than that at T4 in schizophrenic patients. In the ANOVA analysis of the P300 peak amplitude and PCA factor scores, significant lateral topographical differences in P300 were not present between patients and controls. However, in schizophrenia, patients in the low T3 P300 group were older and consuming higher doses of antipsychotic medicine than those in the high T3 P300 group, and they had relatively low P300 amplitudes and significantly delayed P300 latency, compared with those in the high T3 P300 group. These findings suggested that although the reduction in the left temporal P300 amplitude did not necessarily exist in schizophrenic patients, it may be associated with the severity of the disease process and/or impairment of cognitive function.