Anterior cingulate cortex activation is related to learning potential on the WCST in schizophrenia patients.

The remediation of executive function in patients with schizophrenia is important in rehabilitation because these skills affect the patient's capacity to function in the community. There is evidence that instructional techniques can improve deficits in the Wisconsin Card Sorting Test (WCST) in some schizophrenia patients. We used a standard test/training phase/standard test format of the WCST to classify 36 schizophrenia patients as high-achievers, learners or non-retainers. All healthy controls performed as high-achievers. An event-related fMRI design assessed neural activation patterns during post-training WCST performance. Patients showed a linear trend between set-shifting related activation in the anterior cingulate cortex and learning potential, i.e. increased activation in high-achievers, a trend for increased activation in learners, and no activation in non-retainers compared to controls. In addition, activation in the temporoparietal cortex was highest in patients classified as learners, whereas in non-retainers activation was increased in the inferior frontal gyrus compared to controls and high-achieving patients. These results emphasize the relevance of the ACC's neural integrity in learning set-shifting strategies for patients with schizophrenia. Also, our results support the hypothesis that compensatory neural activation in patients with schizophrenia helps them to catch up with healthy controls on cognitive tasks.

Learning potential on the WCST in schizophrenia is related to the neuronal integrity of the anterior cingulate cortex as measured by proton magnetic resonance spectroscopy.

BACKGROUND: In recent years, schizophrenia has increasingly been recognized as a neurocognitive disorder, which has led to a growing literature on cognitive rehabilitation, and suggested several potential enhancements to cognitive function. For instance, it has been shown that executive functioning deficits as measured by the Wisconsin Card Sorting Test (WCST) can be modified in a subgroup of schizophrenic patients. The neurobiological basis of cognitive remediation has not been elucidated so far, although structural, functional and metabolic abnormalities of the prefrontal cortex have been associated with cognitive impairment. METHODS: In this study, learning potential was investigated in 43 schizophrenic patients and 37 age- and education-matched healthy controls, using a dynamic version of the WCST, which integrates instructions and feedback into the testing procedure. Performance was related to cerebral metabolism, assessed by single-voxel proton magnetic resonance spectroscopy of the dorsolateral prefrontal cortex (DLPFC) and the anterior cingulate cortex (ACC). RESULTS: N-acetylaspartate (NAA), a marker of neuronal integrity, was significantly reduced in the DLPFC of schizophrenic patients as compared to the healthy control group. The level of NAA in the DLPFC positively correlated with performance in the dynamic WCST in healthy subjects, whereas in schizophrenic patients a significant correlation was observed between NAA and glutamate/glutamine in the ACC and learning potential. CONCLUSION: These data imply a relationship between neuronal plasticity as assessed by learning potential and NAA levels of the prefrontal cortex in schizophrenic patients and healthy subjects, and suggest the involvement of differential neuronal networks in learning for schizophrenic patients compared to healthy controls.

A longitudinal study of learning potential and rehabilitation outcome in schizophrenia.

OBJECTIVE: The study examined whether a measure of learning potential is prospectively related to the success of a vocational rehabilitation program for patients with severe mental illness in Germany. METHODS: At rehabilitation intake (November 2002 to January 2004), 41 persons with schizophrenia or schizoaffective disorders completed a test-train-test version of the Wisconsin Card Sorting Test as a measure of learning potential. Research participants were classified as high scorers, learners, or nonlearners. Rehabilitation outcome was assessed with measures of work capability during the rehabilitation program, level of functioning during rehabilitation and at three-month follow-up, and level of vocational integration at three-month follow-up. RESULTS: Individual learning potential was associated with the improvement of work-related learning ability during rehabilitation and with the level of functioning and the level of vocational integration at three-month follow-up (about 15 months after the initial testing). Generally, high scorers had better rehabilitation outcome at all assessment points regarding all outcome measures. Even though learners and nonlearners started at comparable levels at the beginning of the rehabilitation, learners benefited more from the program, whereas nonlearners showed a rather unfavorable rehabilitation outcome. CONCLUSIONS: Findings supported the assumption that learning potential is an informative predictor of rehabilitation outcome and may add information beyond static cognitive measures. Learning potential should be considered in the further development of vocational rehabilitation programs.

Dynamic testing in schizophrenia: does training change the construct validity of a test?

Dynamic testing typically involves specific interventions for a test to assess the extent to which test performance can be modified, beyond level of baseline (static) performance. This study used a dynamic version of the Wisconsin Card Sorting Test (WCST) that is based on cognitive remediation techniques within a test-training-test procedure. From results of previous studies with schizophrenia patients, we concluded that the dynamic and static versions of the WCST should have different construct validity. This hypothesis was tested by examining the patterns of correlations with measures of executive functioning, secondary verbal memory, and verbal intelligence. Results demonstrated a specific construct validity of WCST dynamic (i.e., posttest) scores as an index of problem solving (Tower of Hanoi) and secondary verbal memory and learning (Auditory Verbal Learning Test), whereas the impact of general verbal capacity and selective attention (Verbal IQ, Stroop Test) was reduced. It is concluded that the construct validity of the test changes with dynamic administration and that this difference helps to explain why the dynamic version of the WCST predicts functional outcome better than the static version.

[The Concordance of Rater- and Self-Administration of the Osnabrück Profile of Working Abilities (O-AFP)]. / Zur Konkordanz fremd- und selbsteingeschätzter Arbeitsfähigkeiten im Osnabrücker Arbeitsfähigkeitenprofil (O-AFP).

OBJECTIVES: The O-AFP can be used as a rater-administered inventory (RAI) and as a self-report scale (SRS). The study analyses the relations between these versions. METHODS: O-AFP-scales for working abilities and work complexity and SCL-90-R data of 88 vocational therapy patients (psychiatric clinic, PC; addiction clinic, AC). RESULTS: Only few significant correlations were found, with slightly higher scores in the AC patients. Also, AC patients rated themselves higher, whereas PC patients rated lower compared to the RAI ratings. The discrepancy between SRS and RAI scores decreased with rising work complexity and with a low symptom strain. With high GSI, SRS scores are clearly lower than RAI scores. CONCLUSIONS: The SRS-version of the O-AFP is not appropriate for economizing the assessment process. Rather, it is helpful in therapist-patient communication on issues of work rehabilitation. Correspondence between SRS and RAI ratings can be improved by increasing work requirements.

[Longer-term effects of inpatient vocational and ergotherapeutic measures on the vocational integration of patients with schizophrenia]. / Längerfristige auswirkungen stationärer arbeits--und ergotherapeutischer massnahmen auf die berufliche Integration schizophrener patienten.

OBJECTIVE: Unemployment rates are high in people with schizophrenia, so that considerable importance is attached to measures to improve their ability to work and their vocational integration. METHODS: In a study of the German Research Network on Schizophrenia the long-term effects of four-week vocational and ergotherapeutic measures on in-patients were investigated. The target criteria were the vocational integration, level of general functioning (Global Assessment of Functioning Scale) and psychopathology (Positive and Negative Syndrome Scale). 227 patients were randomized and assigned either to a work-oriented vocational therapy group, or to a creativity-oriented ergotherapy group; 163 patients completed the study. Data was available for 89 patients at the last catamnesis point after two years. RESULTS: No differences were seen between the effects of the two forms of therapy on the development of vocational integration or on general functioning level and psychopathology after two years. The number of patients in regular work declined over this period. CONCLUSIONS: It is assumed from this that short-lasting vocational and ergotherapeutic measures do not have any long-term influence on the vocational integration of patients with schizophrenia.

[Do the effects of inpatient vocational therapy and ergotherapy approaches differ in schizophrenic patients? Results of a controlled multicenter study of the german research network on schizophrenia]. / Unterscheiden sich die Effekte stationärer arbeits -- und ergotherapeutischer Massnahmen? Ergebnisse einer kontrollierten Multizenterstudie des Kompetenznetzes Schizophrenie.

For some decades, vocational therapy approaches have been an integral part of inpatient psychiatric treatment of patients with schizophrenia. Like most sociotherapeutic measures, they are largely hypothesis-based. So far, their effectiveness has been subjected to very little scientific scrutiny. The results of a multicenter study in which five vocational therapy models were compared with creativity-oriented ergotherapy in a prospective, randomized control group design are presented. Target criteria were job-relevant skills, psychopathology, general level of functioning, quality of life, self-efficacy, and speed of cognitive performance. 227 patients were enrolled in the study, which was carried out within the framework of the German Research Network on Schizophrenia funded by the German Federal Ministry for Education and Research (BMBF). Multicenter analyses in a pre-post comparison revealed only minimum differences between the experimental and the control group over a four-week intervention period. Job-oriented approaches cannot currently be assumed to be superior to creativity-oriented ergotherapy.

[The work personality profile: an instrument for the assessment of the work competence of psychiatric patients]. / Das Arbeitsfähigkeitenprofil (AFP): Ein Instrument zur Erfassung der Arbeitsfähigkeiten psychiatrischer Patienten.

The "Work Personality Profile", which assesses via supervisor ratings the basic work competences of psychiatric patients on eleven scales, was translated and adapted for use in German psychiatric institutions. Test analysis of data of 58 patients, most of whom were schizophrenic, yielded good statistical indicators for most of the scales. Factor analyses indicated a structure of two to three components: Learning ability, social and interactional competence, and social adaptation and motivation. Test analyses yielded good coefficience for most of the scales. Further clinical application of the instrument thus seems to be promising. Recommendations for use of a short version are given.