REPYFLEC cognitive remediation group training in schizophrenia: Looking for an integrative approach.

BACKGROUND: Overall results from Cognitive Remediation (CR) indicate robust and long-lasting effects with medium effect size on global cognition and functioning, and a small ES on symptoms present at post-treatment but not at follow-up. However, results are not the same in all CR therapies and in some cases no efficacy results are achieved. AIMS: To develop an integrative intervention taking into account previous efficacious therapies. To evaluate the efficacy of our cognitive remediation group training: Problem Solving and Cognitive Flexibility training (REPYFLEC), with the aim of improving cognition and functioning in schizophrenia patients. METHOD: Participants with a diagnosis of schizophrenia or schizoaffective disorder (n=62) were randomized to 32 group sessions of REPYFLEC CR, or to 32 group sessions of activities without specific objectives and focused on leisure. In both groups the sessions were conducted twice a week. Functioning and psychiatric symptoms were measured at baseline (week 0) and thereafter at 8, 16 and 40 weeks. Cognition was measured at weeks 0, 16 and 40. Mixed Models were used to estimate statistical differences. RESULTS: Patients in the cognitive remediation group demonstrated significant improvements in executive function, negative symptoms and functioning at post-treatment compared with patients in the control group. At 6-month follow-up, significant improvements in executive function and functioning remained. CONCLUSION: These results apparently show that REPYFLEC works as cognitive remediation training, improving executive thinking and functioning outcomes compared with a control group.

Individual differences in sequence learning and auditory pattern sensitivity as revealed with evoked potentials.

Research on motor sequence acquisition has shown significant differences between learners. Learners who develop explicit knowledge respond faster than non-explicit ones and they show larger amplitude in event-related brain potentials to sequence deviants. There is evidence that memory span correlates with the amount of sequence learned, but the specific mechanisms subserving such differences are still unknown. Recently, it has been observed that performance of explicit learners, but not of non-explicit ones, improves when presented with auditory action effects. Accordingly, differences between learners might be related to differences in auditory rhythm perception. To test this hypothesis, the mismatch negativity (MMN)-evoked potential elicited to stimuli violating stimulus alternation (i.e. low pitch, high pitch) was recorded in explicit and non-explicit sequence learners. Results confirmed our prediction: explicit learners showed larger amplitude of the MMN to the violation of the auditory rhythm, suggesting new theoretical implications to account for individual differences in sequential action control.

A kind of auditory 'primitive intelligence' already present at birth.

'Primitive intelligence' in audition refers to the capacity of the auditory system to adaptatively model the acoustic regularity and react neurophysiologically to violations of such regularity, thus supporting the ability to predict future auditory events. In the present study, event-related brain potentials to pairs of tones were recorded in 11 human newborns to determine the infants' ability to extract an abstract acoustic rule, the direction of a frequency change. Most of the pairs (standard, P = 0.875) were of ascending frequency (i.e. the second tone higher than the first), while the remaining pairs (deviant, P = 0.125) were of descending frequency (the second tone being lower). Their frequencies varied among seven levels to prevent discrimination between standard and deviant pairs on the basis of absolute frequencies. We found that event-related brain potentials to deviant pairs differed in amplitude from those to standard pairs at 50-450 ms from the onset of the second tone of a pair, indicating the infants' ability to represent the abstract rule. This finding suggests the early ontogenetic origin of 'primitive intelligence' in audition that eventually may form a prerequisite for later language acquisition.

Auditory event-related potentials as a function of abstract change magnitude.

Event-related potentials were recorded in healthy volunteers to test the accuracy of the human brain to extract, preattentively, auditory abstract rules. The abstract rule was determined by the frequency relationship between two pure tones forming a pair. The standard pairs had identical tone frequency, whereas the deviant pairs had the second tone two, four, six or eight musical steps higher or lower in frequency than the first one. All abstract changes elicited mismatch negativity, which was not affected by the magnitude of change. However, the subsequent P3a increased as a function of the magnitude of the abstract change. These results suggest that mismatch negativity detects violations of abstract rules, and the amount of violation is analyzed in subsequent stages of auditory processing.