Working memory training in patients with chronic schizophrenia: a pilot study.

Background. There is evidence that patients with schizophrenia suffer from decline in working memory performance with consequences for psychosocial outcome. Objective. To evaluate the efficacy of a computerized working memory training program (BrainStim) in patients with chronic schizophrenia. Methods. Twenty-nine inpatients with chronic schizophrenia were assigned to either the intervention group receiving working memory training (N = 15) or the control group without intervention (N = 14). Training was performed four times a week for 45 minutes during four weeks under neuropsychological supervision. At baseline and followup all participants underwent neuropsychological testing. Results. Pre-post comparisons of neuropsychological measures showed improvements in visual and verbal working memories and visual short-term memory with small and large effect sizes in the intervention group. In contrast, the control group showed decreased performance in verbal working memory and only slight changes in visual working memory and visual and verbal short-term memories after 4 weeks. Analyses of training profiles during application of BrainStim revealed increased performance over the 4-week training period. Conclusions. The applied training tool BrainStim improved working memory and short-term memory in patients with chronic schizophrenia. The present study implies that chronic schizophrenic patients can benefit from computerized cognitive remediation training of working memory in a clinical setting.

Selective optimization with compensation (SOC) competencies in depression.

BACKGROUND: The metamodel of selective optimization with compensation (SOC) aims to integrate scientific knowledge about the nature of development and aging with a focus on successful adaptation. For the first time the present study examines how SOC competencies and depressive symptoms are associated. In particular, potential state or trait effects of SOC competencies are considered. METHODS: Fifty-three patients (31 women and 22 men), aged 21 to 73 years, suffering from depression, were interviewed twice during inpatient treatment, first on admission to hospital and later during remission or on discharge, to assess the severity of depression and differences in the SOC competencies using standardized scales. For comparison purpose, data from a population based survey in Germany were used. RESULTS: The SOC scores in the first interview were significantly lower than those of the comparison collective (p<0.0001), but in remission there was no significant difference left. Younger and older patients showed no significant difference in their SOC competencies, neither regarding the severity of depressive symptoms on admission to the hospital, nor during remission. CONCLUSIONS: These findings support the hypothesis that the SOC ability is dynamic and mood dependent (state effect). Otherwise, there is no hint of life-long reduced SOC competencies or a trait effect which would be associated with an increased vulnerability to the development of a depressive disorder. Regarding the high prevalence of depression especially in the elderly and physically ill patients, (gerontological) studies on SOC competencies should take depression into account.

A clinical lesson: glioblastoma multiforme masquerading as depression in a chronic alcoholic.

AIMS: To highlight the need to consider other medical conditions when the presentation initially appears to be alcohol-related. METHOD: We report the case of a 34-year-old male alcoholic, who presented with clinical depression and later a delirious state, and was subsequently diagnosed to have a right frontal glioblastoma multiforme. CONCLUSIONS: Psychiatric patients, especially alcoholics, may present with physical and neurological symptoms in the emergency department, which are linked by the examiner to the toxic effects of alcohol. However, consideration should be given to the possibility that the symptoms are due to other severe medical conditions.