LVR-Klinikum Düsseldorf Hospital of the Heinrich-Heine University ...

LVR-KLINIKUM DÜsseLDORF – hOsPITaL OF The heINRIch-heINe UNIVeRsITY DÜsseLDORF
Biological principles of relapse in schizophrenia
Participation in the homonymous multi-centre project
within the Competence Network on Schizophrenia (Principal
investigators: W. Gaebel and W. Wölwer)
W. Wölwer, M. Streit, J. Brinkmeyer, W. Gaebel
Project period: 2000–2006
Financing: FMER funding 01 GI 9932, 01 GI 0232
Using the vulnerability-stress-coping model of schizophrenia
as a starting point, the three components of this model were
assessed in 125 first-episode patients with schizophrenia
at the start and after the first and second year of longterm
treatment in order to investigate their contribution
to the risk of relapse as well as their relationship with the
occurrence of prodromal symptoms and severe clinical
deterioration.
The study showed that patients with later clinical
deterioration demonstrate stronger cognitive impairments in
executive functions before the start of long-term treatment
than patients with relatively stable clinical remission. Such
cognitive impairments prove to be significant predictors
of clinical development in regression analyses, even
exceeding in predictive validity clinical variables such as
the remaining positive symptoms at the start of long-term
treatment. However, they demonstrate only low sensitivity
(72%) and specificity (51%), which clearly restricts their use
for individual risk predictions. In this regard, combinations
of the neuropsychological (executive functions) and clinical
parameters (residual symptoms) taken from the start of
long-term treatment were superior, insofar as only the risk,
not the time of clinical deterioration was to be predicted.
To predict the time when such a deterioration could occur,
unspecific prodromal symptoms – assessed fortnightly
during the course of the long-term treatment – proved to be
the superior predictors.
24
22
20
18
16
14
76
Number of correct responses in a
standardised test of facial affect recognition
Training of affect decoding
Cognitive remediation training
No training
T 0 T1
Before training After training
Psychological intervention strategies in
cognitive and emotional disorders
W. Wölwer, N. Frommann, S. Halfmann, M. Streit in
cooperation with R. Vauth (University of Freiburg/Basel)
Project period: 2000–2003
Financing: FMER funding 01 GI 9932
Impairments in social-cognitive processes, such as facial
affect decoding, are well documented in people with
schizophrenia, are stable across the course of the disorder
and make a significant contribution to the often poor
social functioning of people with schizophrenia. Since the
impairments remain largely uninfluenced by the usual
treatment strategies, the search remains for alternative
treatment approaches. For this reason, the Training of
Affect Recognition (TAR) was newly developed in the
Experimental Psychopathology Research Laboratory. The
TAR was first evaluated with regard to potential increases
in performance in facial affect recognition in a randomised
pre-post control group design in comparison with an active
control condition (basic-cognitive remediation training [CRT]
for the improvement of neurocognitive basic functions) and
compared with usual treatment (Treatment as Usual [TAU])
without any additional cognitive training (Figure 10). At the
same time, such “molecular” training approaches focusing
on circumscribed cognitive functions were compared with
broader “molar” training strategies addressing a number of
cognitive and behaviour-related functions. Altogether, the
results produced a picture of a double dissociation, in which
social-cognitive training strategies improve facial affect
decoding, but do not improve memory performance, whereas
basic-cognitive training improves memory, but not affect
decoding. Both effects were achieved almost independently
of the type of training strategy (molar vs. molecular) that was
used for the respective area. Correspondingly, impairments
of facial affect decoding in people with schizophrenia can
in general be treated if training strategies that specifically
address social-cognitive functions are used.
Figure 10: Improved performance in facial affect recognition after training
in patients with schizophrenia. A specifically devised training programme to
improve facial affect recognition resulted in a clear improvement, whereas
a training programme oriented more to the general improvement of
cognitive performance (“cognitive remediation training”) had no effects on
facial affect decoding (modified after Wölwer W., Frommann N., Halfmann
S., Piaszek A., Streit M., Gaebel W. Remediation of impairments in facial
affect recognition in schizophrenia: Efficacy and specificity of a new training
program Schizophr Res. (2005) 80; 295-303.)