Efficacy and specificity of computer-assisted cognitive remediation in schizophrenia: a meta-analytical study.

BACKGROUND: Cognitive remediation is frequently based on computerized training methods that target different cognitive deficits. The aim of this article was to assess the efficacy of computer-assisted cognitive remediation (CACR) in schizophrenia and to determine whether CACR enables selective treatment of specific cognitive domains. METHOD: A meta-analysis was performed on 16 randomized controlled trials evaluating CACR. The effect sizes of differences between CACR and control groups were computed and classified according to the cognitive domain assessed. The possible influences of four potential moderator variables were examined: participants' age, treatment duration, weekly frequency, and control condition type. To test the domain-specific effect, the intended goal of each study was determined and the effect sizes were sorted accordingly. The effect sizes of the cognitive domains explicitly targeted by the interventions were then compared with those that were not. RESULTS: CACR enhanced general cognition with a mean effect size of 0.38 [confidence interval (CI) 0.20-0.55]. A significant medium effect size of 0.64 (CI 0.29-0.99) was found for Social Cognition. Improvements were also significant in Verbal Memory, Working Memory, Attention/Vigilance and Speed of Processing with small effect sizes. Cognitive domains that were specifically targeted by the interventions did not yield higher effects than those that were not. CONCLUSIONS: The results lend support to the efficacy of CACR with particular emphasis on Social Cognition. The difficulty in targeting specific domains suggests a 'non-specific' effect of CACR. These results are discussed in the light of the possible bias in remediation tasks due to computer interface design paradigms.

Frontal reactivity and sensation seeking an ERP study in skydivers.

1. In the line of Zuckerman's studies on sensation seeking and optimal level of arousal, the authors hypothesized that high sensation seeking might be used to compensate for anhedonia due to basal arousal deficit. A population of interest was found with parachutists practicing skydiving, generally described as very high sensation seekers. 2. After clinical assessment of emotional and affective components, amplitudes of the frontal P3 of the ERP were used as indices of arousal. 3. Skydivers presented more negative symptoms (anhedonia and blunted-affect) than controls. This was observed in isolation from any depressive episode, which would suggest the presence of emotional deficit as a trait. As expected, skydivers presented more sensation seeking than controls. These two results taken together could indicate that sensation seeking is an adaptive reaction to anhedonia. 4. ERP results showed that frontal P3 amplitudes were larger in skydivers than in controls, whereas in a previous study we showed the opposite in depressed patients with a similar emotional deficit. This could indicate that the frontal P3 amplitude does not reflect the emotional deficit per se. We suggest that it rather reflects the capacity to use some behaviors which improve automatic attentional processes in order to obtain arousing stimulation that could counterbalance the emotional deficit. Depressions with emotional deficit might be due to the lack of such a capacity.

[Psychopathology and cognitive neurosciences: theoretical conflicts and experimental paradigms]. / Psychopathologie et neurosciences cognitives: conflits théoriques et paradigmes expérimentaux.

Clinical research may be seen in the context of the more general problem of an exchange of knowledge between psychopathology and neurosciences. While this interaction is not contested by the specialists in either field, we cannot, nonetheless, ignore the question of their various levels of congruence. More generally, we are increasingly aware of a need for enhanced formalization of the models derived from the two disciplines with a view to setting up transpositions or even cross fertilizations. The two communities, that of psychiatrists and that of neurobiologists, while they fascinate each other, have rarely been able to produce joint findings. The psychopathologist expects a positive validation of his clinical concepts from the neurobiologist, while the neurobiologist, who has frequently not resisted the etiological temptation, wants the clinician to give him pointers to enable him to refine his own experimental models. What is required, however, is that both the psychopathologist and the neurobiologist reduce their expectations and agree to move outside of their respective disciplinary autarkies. This would avoid two traps: that of the homological temptation which leads both to graft an experimental model onto clinical entities without checking the levels of congruence or non-congruence, making do with a simple behavioral similarity; the second error consists in using the complexity of the clinical picture as an unavoidable obstacle to any coming-together of the two disciplines. These two traps have not always been avoided, in particular in the context of the use of cognitive paradigms in nosographic clinical models.

[Validation of the French version of the Snaith-Hamilton Pleasure Scale (SHAPS, Snaith et al. 1995). Determination of the statistical parameters in 208 normal subjects and 103 hospitalized patients presenting with depression or schizophrenia]. / Etude de validation de la version française de l'échelle de plaisir de Snaith et Hamilton (Snaith-Hamilton pleasure scale, SHAPS, Snaith et al. 1995). Détermination des paramètres métrologiques chez 208 sujets sains et chez 103 malades hospitalisés présentant une dépression ou une schizophrénie.

The aim of the study is to explore the validity and the reliability of the French version of the SHAPS in two groups of subjects. 208 healthy students and 103 inpatients meeting the RDC criteria for schizophrenia or depression filled out the French versions of the SHAPS and the revised Physical Anhedonia Scale of Chapman and Chapman. The internal consistency of the SHAPS was measured in each group using first the Kuder Richardson coefficient (point biserial) between the items and the total score. The concurrent validity was studied using the Pearson correlation coefficient between the SHAPS and the PAS in each group. The predictive validity was determined by the comparison of the SHAPS score between the two groups. The reliability was studied using a test-retest in a sub-group (n = 32) extracted of the control group. The values of the KR 20 in the healthy and psychiatric groups were respectively 0.47 and 0.80. The mean of the correlations between the items and the total score were respectively 0.35 and 0.52. The values of the correlations between the SHAPS and the PAS were respectively in the normal and psychiatric groups 0.39 (p < 0.001) and 0.34 (p < 0.001). Psychiatric subjects had a higher score (m = 2.33, sd = 2.68) on the SHAPS than the normals (m = 0.89, sd = 1.18) [F (1,303) = 12.26, p = 0.0005]. The test-retest showed a correlation of 0.56 (p < 0.01) between the two passations of the SHAPS. The metrological parameters of the SHAPS were discussed as well as the utility of that scale compared to the PAS.

Focused attention in anhedonia: a P3 study.

Attentional and information processing impairments have been evidenced in nonclinical anhedonic subjects. However, the extent of attentional deficit has not been determined. We studied focused attention, the ability to reject irrelevant or distracting messages, in anhedonic nonclinical subjects. The event-related potentials and behavioral performances of anhedonic subjects were compared with those of control subjects during the Eriksen focused attention task (C.W. Eriksen & B.A. Eriksen, 1974); the task combined one compatible and one incompatible condition, the latter causing an interference. Anhedonic subjects exhibited a smaller P300 and slower reaction times than control subjects. Varying task conditions had different effects on anhedonic subjects and controls, suggesting that anhedonic subjects may have developed a conservative response strategy. In view of previous works, these results suggest that attentional impairment is not ascribed to specific processes, but may involve a more global deficit, that is, a resource allocation deficit.

Psychometric normalization of a hyperacusis questionnaire.

Clinical hyperacusis consists of a marked intolerance to ordinary environmental sounds, while hearing thresholds are quite often normal. Hyperacusis appears to be a subjective phenomenon, which is not easily defined or quantified by objective measurements. In order to create a tool suitable to quantify and evaluate various hyperacusis symptoms, a questionnaire screening several aspects of auditory symptomatology has been constructed. Two hundred and one subjects (who were either hyperacusic or not), randomly selected from the general population, were tested. A principal component analysis performed on the correlation matrix of the 14 items of the questionnaire isolated three dimensions: attentional, social, and emotional. The three dimensions had satisfactory internal consistency reliability. The mean +/- SD total score was 15 +/- 6.7 out of 42 (maximum of hyperacusis) and a score greater than 28 seems to represent a strong auditory hypersensitivity. This new psychometric tool should further be tested on hyperacusic patients to verify its relevance in pathology and define the involvement of the three dimensions statistically obtained on the hyperacusis symptomatology.