SCHIZOPHRENIA CASE STUDY

Schizophrenia Case Study

Schizophrenia Case Study

Introduction

Schizophrenia is a severe, chronic mental disorder characterized by various behavioral, emotional, and cognitive disturbances. Although the phenomenology of the disorder is highly heterogeneous, common characteristics of the illness can generally be classified into four domains: positive symptoms, negative symptoms, cognitive impairment, and social dysfunction. Positive symptoms include hallucinations, delusions, and disorganization of thinking, speech, and behavior that schizophrenia patients experience.

Negative symptoms consist of deficiencies compared with nonpatients, such as a reduced range of emotional experience and expression, social withdrawal, and diminution in goal-directed behavior. In addition to positive and negative symptoms, schizophrenia is associated with diminished life satisfaction, poor social and occupational functioning, neurocognitive impairments, and profound deficits in social competence. Cognitive impairment is now recognized as a key characteristic of schizophrenia that has a significant (negative) impact on functioning. Finally, social dysfunction is a defining feature of schizophrenia that is stable over time and predictive of the course and outcome of the illness. Cognitive and social deficits are relatively independent of positive and negative symptoms and are not responsive to medication.

Cognitive Remediation Model (CR Model)

Description of the Strategy

Cognitive impairment is now widely considered to be a central feature of schizophrenia. The vast majority of patients with the illness demonstrate clear deficits relative to healthy controls, most often reported in domains of processing speed, attention, working memory, new learning, and executive/reasoning abilities. Importantly, from the perspective of rehabilitation, (a) a growing body of literature has demonstrated that neuropsychological performance has a significant impact on community functioning, including social competence, independent living, and vocational performance, and (b) optimal pharmacological treatment offers limited cognitive benefit and does little to relieve the profound functional disability experienced by patients. These factors have fostered an upsurge of interest over the past decade in the possibility of cognitive remediation in schizophrenia.

The targets of training in cognitive remediation have included verbal memory, problem solving, and executive functions, attention, social perception, and work performance. Some programs have focused narrowly on single domains, while others have targeted a range of functions. Training strategies have been quite diverse, including self-guided practice on computer tasks, self-guided exposure to commercially produced educational software, intensive individual training using paper-and-pencil neurocognitive test materials, and small-group discussions and naturalistic rehearsal of social cognition exercises. Training durations have ranged from 5 weeks to 6 months, usually with multiple training sessions per week. Three prototypical approaches illustrate the similarities and differences among cognitive remediation programs currently described in the literature.

Wykes and colleagues developed cognitive remediation therapy (CRT), an intervention that focuses on executive functioning (e.g., cognitive flexibility, working memory, and planning). The approach employs a sophisticated training model based on principles of errorless learning, targeted reinforcement, and guided practice on cognitive tasks administered in one-onone therapy sessions. Training media consist of a variety of paper-and-pencil games and neurocognitive tests. An alternative approach introduced by Bell and Wexler capitalizes on the ease of standardization and flexibility provided by computer software. This approach emphasizes repetitive practice of elementary neurocognitive skills ...