Effects of cognitive remediation on cognitive and social functions in individuals with schizophrenia.

Individuals with schizophrenia exhibit cognitive impairments, which are related to impairments in social functions. This study investigated the effects of cognitive remediation on cognitive, social, and daily living impairment. Participants were individuals with schizophrenia between 20 and 60 years old (N = 44). Participants were randomly assigned to two groups: a cognitive remediation intervention group and a non-intervention control group. The control group was provided with conventional drug therapy and either day care or occupational therapy. The intervention group was provided with the "neuropsychological educational approach to cognitive remediation" developed by Medalia and co-workers. We assessed cognitive functions using the brief assessment of cognition in schizophrenia (BACS), and evaluated social and daily living functions using the global assessment of functioning (GAF) scale. Significant group by time interaction effects indicated that verbal memory, working memory, attention, and executive function showed significantly greater improvement at post-intervention for the intervention group than the control group. Social and daily living function also improved in the intervention group and improvements were maintained one year after intervention. These preliminary findings indicate that the combination of cognitive remediation and psychiatric rehabilitation is effective for facilitating improvements in cognitive function and social and daily living functions in individuals with schizophrenia.

Computer-assisted cognitive remediation therapy increases hippocampal volume in patients with schizophrenia: a randomized controlled trial.

BACKGROUND: Cognitive remediation therapy (CRT) effectively reduces neurocognitive impairment in patients with schizophrenia, but few studies have used structural neuroimaging methods to assess its neuroanatomical effects. We investigated these effects, as well as the association between changes in cortical volume and neurocognitive performance. METHOD: Between August 2013 and September 2016, we performed a randomized controlled study comprising a CRT group (16 individuals) and a treatment-as-usual (TAU) group (15 individuals) of patients with schizophrenia. CRT participants engaged in twice-weekly computer-assisted CRT sessions and weekly group meetings for 12 weeks. T1-weighted magnetic resonance imaging was performed before and after the intervention period, and whole-brain voxel-based morphometric analysis was used to detect significant cortical gray matter volume changes. We also assessed the correlation between cortical volume changes and CRT-derived neurocognitive improvements. RESULTS: The CRT group exhibited significantly greater improvements than the TAU group in verbal fluency (P = 0.012) and global cognitive scores (P = 0.049). The CRT group also exhibited significantly greater increases in right hippocampal volume than the TAU group (P < 0.001). Changes in verbal fluency scores and right hippocampal volumes were positively correlated (r = 0.53, P = 0.001). CONCLUSION: We found that CRT significantly increased right hippocampal volumes and that these enhancements were positively correlated with changes in verbal fluency scores. Our results indicate that CRT induces cognitive improvement through hippocampal plasticity. TRIAL REGISTRATION: Registration number: UMIN000026146 , 2017/02/15, retrospectively registered.

Feasibility and effectiveness of a cognitive remediation programme with original computerised cognitive training and group intervention for schizophrenia: a multicentre randomised trial.

Devising new methods to improve neurocognitive impairment through cognitive remediation is an important research goal. We developed an original computer programme termed the Japanese Cognitive Rehabilitation Programme for Schizophrenia (JCORES) that provides cognitive practice across a broad range of abilities. The current study examined for the first time whether a cognitive remediation programme, including both computerised cognitive training using JCORES and group intervention such as enhancing meta-cognition and teaching strategies, is more effective than treatment as usual for improving neurocognitive and social functioning. Sixty-two outpatients with schizophrenia were randomised to either a cognitive remediation group or a control group. Participants engaged in two computerised cognitive training sessions and one group meeting per week for 12 weeks. The average number of total sessions attended (computerised cognitive practice + group intervention) was 32.3 (89.7%). The cognitive remediation group showed significantly more improvements in verbal memory, composite score of the Brief Assessment of Cognition in Schizophrenia, Japanese version (BACS-J), and general psychopathology on the Positive and Negative Syndrome Scale (PANSS) than the control group. These findings demonstrate that a cognitive remediation programme is feasible in Japan and is a more effective way to improve neurocognitive functioning and psychiatric symptoms.

Does improvement of cognitive functioning by cognitive remediation therapy effect work outcomes in severe mental illness? A secondary analysis of a randomized controlled trial.

AIM: The aim of this study was to clarify whether improvement of cognitive functioning by cognitive remediation therapy can improve work outcome in schizophrenia and other severe mental illnesses when combined with supported employment. METHODS: The subjects of this study were persons with severe mental illness diagnosed with schizophrenia, major depression, or bipolar disorder (ICD-10) and cognitive dysfunction who participated in both cognitive remediation using the Thinking Skills for Work program and a supported employment program in a multisite, randomized controlled study. Logistic and multiple linear regression analyses were performed to clarify the influence of cognitive functioning on vocational outcomes, adjusting for demographic and clinical variables. RESULTS: Improvement of cognitive functioning with cognitive remediation significantly contributed to the total days employed and total earnings of competitive employment in supported employment service during the study period. Any baseline demographic and clinical variables did not significantly contribute to the work-related outcomes. CONCLUSION: A cognitive remediation program transferring learning skills into the real world is useful to increase the quality of working life in supported employment services for persons with severe mental illness and cognitive dysfunction who want to work competitively.

[The Role of Psychiatrists as Personal Support Specialists].

Robert P. Liberman introduced "Personal Support Specialists" as a role of psychiatrists who support patients' lives and help them discover the meaning of life, as well as helping with daily activities and personal difficulties. They need to have multiple perspectives on medical, subjective, social, and life recoveries. Important areas to help patients practically are job-assis- tance, supporting love and marriage, and independent living in the community. I usually use Seikatsu-Rinsho (The way of Living Learning), cognitive behavioral therapy, and Seikatsu-ryouhou (Life-centered Therapy) by Hiroshi Utena as basic principles in my practice. Recently, I shed light on an -individual value system to evolve these principles. Reflecting on two recovery stories I co-encountered, contents of psychiatric interviews and roles of psychiatrists are discussed. There remain many difficulties which modern psychiatry has not resolved, such as negative symptoms and marked disabilities in social life. We as psy- chiatrists should know how to evolve and maintain hope and intrinsic motivation to support a patient's life.

Facial expression perception correlates with verbal working memory function in schizophrenia.

AIMS: Facial emotion perception is considered to provide a measure of social cognition. Numerous studies have examined the perception of emotion in patients with schizophrenia, and the majority has reported impaired ability to recognize facial emotion perception. We aimed to investigate the correlation between facial expression recognition and other domains of social cognition and neurocognition in Japanese patients with schizophrenia. METHODS: Participants were 52 patients with schizophrenia and 53 normal controls with no history of psychiatric diseases. All participants completed the Hinting Task and the Social Cognition Screening Questionnaire. The Brief Assessment of Cognition in Schizophrenia was administered only to the patients. Facial emotion perception measured by the Facial Emotion Selection Test (FEST) was compared between the patients and normal controls. RESULTS: Patients performed significantly worse on the FEST compared to normal control subjects. The FEST total score was significantly positively correlated with scores of the Brief Assessment of Cognition in Schizophrenia attention subscale, Hinting Task, Social Cognition Screening Questionnaire Verbal Working Memory and Metacognition subscales. Stepwise multiple regression analysis revealed that verbal working memory function was positively related to the facial emotion perception ability in patients with schizophrenia. CONCLUSIONS: These results point to the concept that facial emotion perception and some types of working memory use common cognitive resources. Our findings may provide implications for cognitive rehabilitation and related interventions in schizophrenia.

[Supporting the Love, Marriage, and Child-Rearing of Persons with Schizophrenia].

Persons with schizophrenia and their families have strong interests and hopes for love, marriage, pregnancy, and child-rearing. These experiences often lead to recovery from schizophrenia. There are many partners with schizophrenia who enjoy fruitful lives even with their disability. However, only some persons can enter into such lives in the real world in Japan and other countries. This leads persons with schizophrenia to develop a discouraged and disappointed attitude, and also causes professionals of mental health to develop indifference or pessimism about these issues. Schizophrenics are thought to have interests in love and sexual behavior just as strong as the general population. I discuss with my patients about these issues and working life early in the course of treatment. Because they lose their chance to learn adult behavior in social lives with peers due to the beginning of schizophrenia, they need an opportunity to participate in a social situation to learn knowledge and skills of dating and related behaviors, and systematic education such as psycho-education and social skills training should be provided. Continuing married life and child-rearing require more support from experts with rich experience and knowledge. Psychiatrists are required to participate in shared decision-making about medication during pregnancy and breast-feeding, as well as provide knowledge on the benefits and risks of antipsychotics. Net-working with the family, professionals of child welfare, and the community is necessary to support child-rearing. Urakawa Bethel's House was introduced as a pioneering concept to support love, marriage, and child-rearing. Finally, professionals' negative or indifferent attitudes toward these issues are discussed in the setting of treatment. I hope that professionals of mental health will think about these issues from the standpoints of persons with schizophrenia and their families.

[Negative Symptoms Revisited--Toward the Recovery of Persons with Schizophrenia].

The negative symptoms of schizophrenia are usually treatment-refractory, and considered to be a major cause of a poor outcome. Recently, it has become an important issue to elucidate the etiology of and develop treatment for negative symptoms in order to improve the outcome of schizophrenia patients. Firstly, the history of negative symptoms was reviewed. Several lines of factor-analysis studies have suggested that negative symptoms are independent from other symptoms of schizophrenia, and consist of two factors, the poverty of expression and avolition, while the results depend upon the assessment scale employed in each analysis. Anhedonia, a part of avolition, may be considered as the impairment of pleasure-seeking behavior, the impairment of remembering non-current feelings, and a person's belief that he/she cannot experience pleasure, rather than the loss of pleasure itself. As neurological bases for avolition, decreases in reward expectancy, value representation, and the behavior to seek uncertain reward were observed, which resulted in poor social functioning due to the difficulties of initiating adaptive behaviors for the future. These impairments are the bases of decreased intrinsic motivation. The negative symptoms were considered to result in poor social functioning mediated by neuro-and social cognitive dysfunction and dysfunctional cognition, such as low self-efficacy and self-stigma. Pharmacotherapy for negative symptoms remains to be established due to a lack of evidence. Several psycho-social interventions in self-efficacy, self-stigma, intrinsic motivation, and environmental contexts are now being developed, while their effects are rather limited. The principles of psychiatric rehabilitation, i.e., respecting one's own value system and preference, self-determination, and motivation, are worth revisiting from the viewpoint of neuro-cognitive science. Furthermore, a hope-oriented approach, the presence of peers, and reconstructing social values as barrier-free may be considered to be of marked help not only for treating negative symptoms through re-establishing self-esteem, but also to aid the general population.

Effects of risperidone and aripiprazole on neurocognitive rehabilitation for schizophrenia.

AIM: Methods to improve neurocognitive impairments are of important research interest. This study sought to examine the synergistic effects of neurocognitive rehabilitation and antipsychotics for schizophrenia. METHODS: Subjects were 43 patients diagnosed with schizophrenia or schizoaffective disorder in a randomized trial of the effects of neurocognitive rehabilitation or a quasi-randomized experimental trial of supported employment with neurocognitive rehabilitation. We compared the effects of risperidone and aripiprazole in neurocognitive rehabilitation for schizophrenia. Subjects were divided into the following groups: (i) the control-risperidone group (CR group) (n = 13); (ii) the rehabilitation-risperidone group (RR group) (n = 9); (iii) the control-aripiprazole group (CA group) (n = 10); and (iv) the rehabilitation-aripiprazole group (RA group) (n = 11). Subjects in the rehabilitation group were engaged in computer-based cognitive exercises (24 sessions) with bridging group (12 sessions) over 12 weeks. Psychiatric symptoms, neurocognitive functioning and social functioning assessments were evaluated at baseline and at 12 weeks. RESULTS: A two-way anova with neurocognitive rehabilitation and antipsychotic medication as factors revealed a significant interaction effect on motor speed. Working memory and motor speed significantly improved in the RA group compared with the CA group. We found no significant improvements between the CR group and the RR group. CONCLUSION: A synergistic effect of neurocognitive rehabilitation and aripiprazole was observed as improvement of motor speed. In patients treated with aripiprazole, neurocognitive rehabilitation appeared to improve working memory and motor speed. Further studies of synergistic effects of neurocognitive rehabilitation and antipsychotic medication are necessary to verify these findings.

New instrument for measuring multiple domains of social cognition: construct validity of the Social Cognition Screening Questionnaire (Japanese version).

AIM: The present study aimed to test the construct validity and internal consistency of the Social Cognition Screening Questionnaire (SCSQ) (Japanese version). METHODS: We first tested whether the subscale scores and the total score of the SCSQ could discriminate patients with schizophrenia from normal controls. Next, we tested the internal consistency. Finally, we investigated the relation between the subscale scores and other measures of social cognition and social functioning that were presumed to correspond to the subscale's scores, including the Hinting Task, the Ambiguous Intentions Hostility Questionnaire (AIHQ), the Beck Cognitive Insight Scale and the Social Functioning Scale. RESULTS: The subscale scores and the total score appeared to show more robust between-group differences than other measures of social cognition, such as the AIHQ and the Hinting Task. The total score distinguished the patients from normal controls with an area under the receiver-operator curve of 0.84, which indicated a high level of discrimination. The Cronbach's alpha for the four subscales was 0.72, which was considered acceptable. In terms of criterion-related validity, theory of mind, metacognition and hostility bias subscale scores showed significant correlations with the Hinting Task, Beck Cognitive Insight Scale and AIHQ, respectively. Moreover, the theory of mind subscale score showed a significant correlation with four domain scores of the Social Functioning Scale. The present results indicated good construct validity and internal consistency of the SCSQ. CONCLUSIONS: Although this is an interim report with a small sample size, the SCSQ holds promise as an efficient measure for social cognition.

Neurocognitive functioning in patients with first-episode schizophrenia 1 year from onset in comparison with patients 5 years from onset.

OBJECTIVE: The course of neurocognitive deficits in schizophrenia has not yet been established. Therefore, we followed patients with first-episode schizophrenia to verify the course of these deficits. METHODS: In Study 1, tests of neurocognitive functioning were administered to patients with first-episode schizophrenia (FE group) every 6 months. Of the 26 patients who completed the baseline assessment, 19 completed a 6-month follow-up, and 13 completed a 1-year follow-up. In Study 2, 19 patients in FE group at 6-months when the neuropsychological measures was less influenced by psychotic symptoms and other patients who experienced schizophrenia 5-years earlier (5-year group) were compared. RESULTS: In Study 1, verbal memory, motor speed, and executive functions significantly improved at the 1-year follow-up. In Study 2, patients in 5-year group performed worse in verbal memory and executive functions than patients in FE at 6-month group, but marginally but significantly better in verbal fluency. CONCLUSIONS: Verbal memory, executive functions, and verbal fluency were significantly different between 5-year group and FE at 6-month group, and may indicate progression of schizophrenia. Executive functions may reflect the state of psychosis. Working memory and processing speed which did not change significantly from onset are needed to verify the course in further research.

Examining the content validity of the Comprehensive Assessment of Functioning for Mental Illness-Subjective Version (CAMI-S) with reference to the framework of the International Classification of Functioning, Disability, and Health (ICF).

Aim: To support the achievement of life goals and social participation of persons with mental illness, based on the World Health Organization's International Classification of Functioning, Disability, and Health (ICF), we generated items, identified domains, and examined the content validity of the Comprehensive Assessment of Functioning for Mental Illness-Subjective Version (CAMI-S). The purpose was to assess patients' strengths and weaknesses by incorporating the patient and public involvement perspective. Methods: Focus group interviews on the items to be included were conducted with Group A. A draft scale was constructed by extracting articles mentioning factors for social participation and recovery for each ICF component from PubMed. Group B participants rated themselves using the draft and highlighted items they considered inappropriate. Experts then rated the importance of the items through the Delphi method. Lastly, Group C participants evaluated whether the draft scale would help in understanding their strengths and weaknesses. Results: The interviews revealed subjective experience items. The draft scale had 81 items (physical and mental functions, 10; activities, 23; participation, 24; environment, 12; individuals, six; and subjective experience, six). Through the Delphi method, the number of items was reduced to 34 in six domains. Most participants (N = 50) indicated that it helped them ascertain patients' strengths and weaknesses (mean = 2.11 ± .714). Completion time for the scale was 56 min, including the 60-item face sheet (20-110 min). Conclusion: The CAMI-S helped participants ascertain patients' strengths and weaknesses. Its reliability and validity will be verified through a large-scale survey in the future.

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.

[How is social functioning of schizophrenics measured?].

Measuring social functioning of schizophrenics is becoming an important clinical issue in the era of community care, where persons with mental illness can live in the community. Neuro- and social-cognitive function studies on the outcome of schizophrenia focus on researching brain functioning, and social functioning is a co-primary outcome measure of intervention. In this review, the viewpoint of measuring social functioning is clarified, typical and recommended assessment scales are introduced, methods to be developed for measurement are discussed, and how to measure social functioning in clinical and research settings is summarized. The axes of classifying measures include functional capacity/real-world functioning, subjective/objective evaluation, and rating/observing behaviors. Six social functioning scales were chosen as recommended scales in the study of real-world functioning as a co-primary measure in NEMH-MATRICS. Almost all scales are objective rating with the interviewing of informants. The functional capacity or competence is evaluated in performance tasks. While the scale of processing tasks of everyday functioning (UPSA) was recommended in many studies, there is no standard for assessing social skills or social problem-solving skills, because these skills differ greatly depending on the sex, age, and culture. Intervening variables among neuro/social cognitive functioning, functional capacity, and real-world functioning are intrinsic motivation, meta-cognition, self-efficacy, expected support, and the environment and support which might decrease the association of basic cognition and the functional outcome. In a clinical setting, these intervening variables, hope and subjective evaluation of support needs, and life history regarding the previous capacity are needed as well as assessment scales to develop a plan for intervention. Objective assessment scales are useful for measuring the effects of intervention.

Characteristic association of symbol coding test score with occupational function in Japanese patients with schizophrenia.

AIM: Studies showed that cognitive function affects occupational function in patients with schizophrenia. This study aimed to determine the effects of cognitive function on occupational function in Japanese patients with schizophrenia using the Brief Assessment of Cognition in Schizophrenia (BACS). METHODS: Participants were 198 outpatients with schizophrenia or schizoaffective disorder (66 females; mean age 34.5 ± 6.8 years). Occupational function was assessed using the work subscale of the Life Assessment Scale for Mental Ill (LASMI-w). Multiple regression analysis was performed using the BACS as the independent variable and LASMI-w as the dependent variable. Furthermore, we divided the LASMI-w score into three groups, <11, 11-20, and >21, and performed a multinomial logistic regression analysis. RESULTS: Multiple regression analysis revealed that LASMI-w score was negatively associated with BACS composite score (ß = -0.20, p < 0.01). Among the sub-items of the BACS, only the symbol-coding score showed a significant negative association (ß = -0.19, p < 0.05). Multinomial logistic analysis showed that the better the composite and symbol coding scores, the smaller the impairment of the occupational function (composite score: ß = 2.39 between mild and moderate occupational impairments, p < 0.05; symbol coding score: ß = 2.44 between mild and severe impairments, p < 0.05). CONCLUSION: The occupational function of patients with schizophrenia was associated with overall cognitive function (composite score). In particular, the symbol coding score of the BACS was suggested to be related to work ability. These results might be useful in the assessment and training of cognitive rehabilitation aimed at employment support.

Effects of psychosocial program for preparing long-term hospitalized patients with schizophrenia for discharge from hospital: randomized controlled trial.

AIM: The aims of the present study were to revise the Community Re-entry Program-Japanese version and to review the effectiveness of the revised Program, named the Discharge Preparation Program. METHODS: This study was a randomized controlled trial. The Discharge Preparation Program (DPP) was the intervention condition (n = 26), and the usual rehabilitation program was the control condition (n = 23). Outcome indicators included factors that make patient discharge difficult (which nurses evaluated), psychiatric symptom, knowledge about the illness or medication, and the number of patients who were discharged within 6 months after the end of a program. RESULTS: Significant improvements were found in the score of the 'Issues on treatment compliance' factor and the score of the 'Autistic life' factor, which are subscales of the Discharge Difficulty Scale, for the DPP group, on two-way ANOVA ('Issues on treatment compliance': F = 3.818, P < 0.10; 'Autistic life': F = 4.155, P < 0.05) These factors affected discharge outcome. Thus, the program may be capable of promoting discharge of long-term hospitalized psychiatric patients. With regard to the number of patients discharged in 6 months after the end of a program, there was no significant difference between both groups. CONCLUSION: The present result is in agreement with past studies, and the DPP is useful in discharge support for patients with schizophrenia in Japan.

[The model program of psycho-social treatment and staff training].

The model program of psycho-social treatment and staff training were reported in this issue. The mission of model program is supporting recovery of persons with mental illness and their family as well as empowering their hope and sense of values. The personal support specialists belonging to multi-disciplinary team have responsibility to support life-long process of recovery across hospitalization, out-patients clinic, day treatment, and outreach service. The shared value of multi-disciplinary team (the community life supporting team) is recovery so that the team renders self directive life, various alternatives of their lives, and peer group with models of recovery to persons with mental illness. There should be several technologies which are used in the team such as engagement, psycho-education, cognitive-behavior therapy, care-management, cooperating with other resources. The responsibility, assessment and evaluation techniques, guarantee of opportunities for training, and auditing system of the team and process of treatment are important factors to educate team staff. Raising effective multi-disciplinary team requires existence of a mentor or good model near the team.

[The intermediate and long-term supports for the suffered places of the Higashi-Nihon Huge earthquake. From the point of view of the community living and psychiatric rehabilitation].

The intermediate and long-term supports for suffered places of the Higashi-Nihon Huge Earthquake were discussed from the viewpoint of the community living and psychiatric rehabilitation. It might be useful to prevent from exacerbation of psychiatric disorders that gathering information, communication skills, relation with neighborhood, and joining training for disaster defense, and so on are acquired by persons with psychiatric disorders in the community living. If persons with psychiatric disorders are cared as disabled against disaster without empowering them with these skills, they cannot contribute to new society after disaster and worse estrangement from the society might appear. The Japanese Association of Psychiatric Rehabilitation proposed two models of one-stop service combining psychiatric service, mental health, and welfare from the viewpoint to support the community living; multi-disciplinary outreach team based temporary psychiatric clinic focusing psychiatric services, and comprehensive community living support center focusing mental health and welfare. It depends on demands of the suffered places which model is better adjusted, and hybrid model is possible. The important need to build long-term support system for people of supporting suffered persons from this huge earthquake was mentioned.

[Social cognition of schizophrenia: bridging gap between brain science and psychosocial intervention].

The concept and assessment tools for social cognition of schizophrenia were reviewed in order to bridge the gap between brain cognitive science and psycho-social intervention. Social cognition as well as neuro-cognition strongly influences social functioning, and the impact of neuro-cognition is mediated by social cognition. Neuronal networks of personal identification, facial perception, emotional identification, eye contact, "theory of mind", mutual communication, and the decision-making process have been clarified recently. The results of face discrimination and emotion recognition tasks show impairment in persons with schizophrenia as compared with healthy controls, especially fear, dislike, and sad recognition tasks. It might be difficult for them to link ambiguous stimuli with specific emotions, and they have a tendency to recognize uncomfortable emotions easily. "Jumping to conclusions" tendency (JTC) was identified in previous research on delusion. JTC develops from information uptake bias and confidence bias, and they might be thought to be trait and state. Social problem-solving is the skill to use social cognition to comprehensively adjust to specific social situations, and processing skills of social problem-solving are related to divergent thinking. Rating scales and the results of previous studies on emotion recognition, social perception, attribution style, and "theory of mind" were summarized. Furthermore, psycho-social interventions to improve emotion recognition directly, JTC, and divergent thinking were reported. Interventions aiming at improving social cognition or meta-cognition directly have been recently developed, which might improve some components of social functioning that used to be difficult to improve. These concepts of social cognition and researches on brain science, assessment tools, and intervention methods would clarify the mechanisms of the effects of psycho-social interventions, improve their methodology, and help to develop new aspects of intervention.

A preliminary study on predictors of treatment response to repetitive transcranial magnetic stimulation in patients with treatment-resistant depression in Japan.

BACKGROUND: Brain imaging studies have reported that the effect of repetitive transcranial magnetic stimulation (rTMS) is associated with the activities of the dorsolateral prefrontal cortex (DLPFC) and ventral medial prefrontal cortex (VMPFC). However, few studies have been conducted in Japanese patients. AIM: We aimed to identify brain regions associated with depressive symptom changes by measuring regional cerebral blood flow (rCBF) in the DLPFC and VMPFC before and after the high-frequency rTMS to the left DLPFC in Japanese patients with treatment-resistant depression. METHOD: Fourteen patients participated in the rTMS study and were assessed with the 17-item Hamilton depression rating scale (HAM-D17 ). Among them, 13 participants underwent magnetic resonance imaging scan of the brain using the arterial spin labeling method. The rCBF was calculated using the fine stereotactic region of interest template (FineSRT) program for automated analysis. We focused on eight regions reported in previous studies. RESULTS: Depression severity significantly decreased after 2 week (HAM-D17 :11.4 ± 2.8, P = 0.00027) and 4 week (HAM-D17 : 11.0 ± 3.7, P = 0.0023) of rTMS treatment. There was no significant change in rCBF at each region in the pre-post design. However, there was a significantly negative correlation between baseline rCBF in the right DLPFC and the improvement in HAM-D17 score (r = -0.559, P = 0.047). CONCLUSION: We obtained supportive evidence for the effectiveness of rTMS to the prefrontal cortex in treatment-resistant depression, which may be associated with reduced rCBF of the right DLPFC before initiation of rTMS.