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Biomedical subjects

Robert S Kern

Publications and source records attributed to Robert S Kern.

11 recordsLinked to original sources
PubMed2006

The neurocognitive effects of aripiprazole: an open-label comparison with olanzapine.

RATIONALE: Cognitive deficits are a core feature of schizophrenia. As a target of intervention, improvements in cognition may lead to improvements in functional outcome. OBJECTIVES: The present paper is the first report, to our knowledge, on the neurocognitive effects of aripiprazole. Unlike other second-generation antipsychotics, aripiprazole is a D(2) and D(3) receptor partial agonist. It is unknown what effects this unusual pharmacological profile may yield on neurocognition. MATERIALS AND METHODS: The present open-label study included data on 169 patients with schizophrenia or schizoaffective disorder who were randomly treated with aripiprazole or olanzapine. Subjects received a neurocognitive battery at baseline, week 8, and 26. RESULTS: The aripiprazole group had a significantly greater dropout rate than the olanzapine group. Neurocognitive data were reduced through a principal components analysis that yielded a three-factor solution. The factors were general cognitive functioning, executive functioning, and verbal learning. For general cognitive functioning, both groups improved from baseline and the effects were relatively stable over the 26-week protocol. There were no differential treatment effects. For executive functioning, neither group improved significantly from baseline. For verbal learning, the aripiprazole group improved significantly from baseline to the 8th and 26th week of assessment, and there was a between-group effect favoring aripiprazole over olanzapine that was largely attributable to the differences in performance within the 8th week. Separate analyses were conducted for a measure of sustained attention (Continuous Performance Test-Identical Pairs). There were no differential treatment effects on this measure. CONCLUSIONS: The findings from this open-label study suggest that the neurocognitive effects of aripiprazole are at least as good as those of olanzapine.

Adult↗
PubMed2006

Cognitive rehabilitation for schizophrenia and the putative role of motivation and expectancies.

Cognitive rehabilitation (CR) approaches seek to enhance cognitive processes or to circumvent cognitive impairments in schizophrenia in an effort to improve functional outcome. In this review we examine the research findings on the 8 evidence-based approaches to cognitive remediation listed in the 2005 Training Grid Outlining Best Practices for Recovery and Improved Outcomes for People With Serious Mental Illness, developed by the American Psychological Association Committee for the Advancement of Professional Practice. Though the approaches vary widely in theoretical orientation and methods of intervention, the results are, for the most part, encouraging. Improvements in attention, memory, and executive functioning have been reported. However, many persons with schizophrenia are more impaired in real-world functioning than one would expect given the magnitude of their cognitive deficits. We may need to look beyond cognition to other targets such as motivation to identify the reasons that many persons with schizophrenia demonstrate such marked levels of disability. Although a number of current CR approaches address motivation to varying degrees, treating motivation as a primary target may be needed to maximize CR outcomes.

Adaptation, Psychological↗
PubMed2006

An "errorful" learning deficit in schizophrenia?

Disturbances in learning are prominent in schizophrenia. The present study examined the effect of committing mistakes (errors) on learning in schizophrenia. Subjects included schizophrenia and schizoaffective disorder patients (n = 36) and healthy adults (n = 22) who were administered a word-stem completion task under "errorfree" (no guessing) and "errorful" (guessing) conditions. The data were analyzed using a 2 (group) x 2 (order) x 2 (condition) repeated-measures ANOVA and by comparing standard residualized scores between patients and controls. The results from the ANOVA revealed a significant group x condition interaction with patients showing greater impairment relative to controls on the errorful versus errorfree condition. Similarly, contrasts of standard residualized scores revealed patients' scores on the errorful condition to be deviant from that of healthy adults. The findings implicate problems in the ability to self-correct and suggest that rehabilitation efforts incorporating errorless learning methods may benefit persons with schizophrenia.

Adult↗
PubMed2005

Learning potential and the prediction of work skill acquisition in schizophrenia.

This study examined whether a measure of learning potential could predict work skill acquisition in schizophrenia beyond the prediction offered by a single administration assessment. Fifty-seven outpatients with schizophrenia or schizoaffective disorder completed a test-train-test version of the Wisconsin Card Sorting Test as a measure of their learning potential. The outpatients were randomly assigned to training by errorless learning or conventional instruction on two work skills (index card filing and toilet tank assembly). Work skills were assessed both immediately and 3 months after training. Generally, patients with high learning potential performed better on the work skill tasks. Learning potential explained an additional 15 percent of variance beyond single administration assessment in participants' accuracy immediately after work skill training and an additional 13 percent of variance in participants' accuracy 3 months after training. These findings indicate that measures of learning potential contribute to the prediction of work skill acquisition, going beyond the predictive power of single administration assessments.

Adult↗
PubMed2005

Extensions of errorless learning for social problem-solving deficits in schizophrenia.

OBJECTIVE: There is a clear need to develop psychosocial rehabilitation methods that compensate for neurocognitive deficits common to persons with severe and persistent mental illness. Errorless learning, a compensatory training intervention, has been successful in teaching entry-level job tasks. However, errorless learning's applicability to broader, more complex functions is unknown. The present study tested the extension of errorless learning for deficits in social problem-solving skills in patients with schizophrenia. METHOD: Sixty clinically stable outpatients with schizophrenia or schizoaffective disorder were stratified by gender and level of memory impairment before being randomly assigned to one of two training programs: errorless learning or symptom management. Groups were matched for training time, format and structure of training, and types of teaching aids used. Social problem-solving ability, measured by the Assessment of Interpersonal Problem-Solving Skills, was assessed at baseline, within 2 days of training completion, and after 3 months. Dependent measures were the scores for the receiving, processing, and sending skills areas from the Assessment of Interpersonal Problem-Solving Skills. RESULTS: A repeated-measures analysis of covariance was conducted for each dependent measure with baseline Assessment of Interpersonal Problem-Solving Skills score entered as a covariate. For all three skills, there was a significant training group effect favoring errorless learning. Durability of errorless learning training effects extended to the 3-month follow-up assessment for processing and sending skills but not receiving skills. CONCLUSIONS: Results support the extension of errorless learning to complex functions such as social problem-solving skills in the rehabilitation of persons with schizophrenia.

Adult↗
PubMed2004

NIMH-MATRICS survey on assessment of neurocognition in schizophrenia.

The NIMH-Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative requires, among other things, the establishment of a reliable, valid, and consensus-derived method of assessing cognition. The derived battery will provide a standardized way to assess the effects of cognition-enhancing agents across clinical trials. To this end, the first of six consensus-oriented conferences was held April 2003. The goals were twofold: (a) To select which cognitive constructs to measure in a consensus battery, and (b) to select which criteria to use in evaluating tests for inclusion in the battery. Based on consultation with experts on the RAND Panel Method, 74 experts were invited to participate in a pre-meeting survey to provide information relevant to decisions on the cognitive battery. The survey included sections on reliability, validity, test administration, norms and interpretation of tests, cognitive domains and their integration, battery duration, and overall importance of test qualities. For selection of cognitive targets, the results showed that experts ranked executive functions, attention/vigilance, memory processes, and problem-solving ability highest. For test qualities, the experts ranked test-retest reliability, good coverage of key individual cognitive constructs, and comparable alternate forms highest. This article presents the results of the pre-conference survey that was the first step in the RAND process towards development of the NIMH-MATRICS consensus battery to assess cognition in schizophrenia.

Attention↗
PubMed2004

Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS.

It is generally accepted that cognitive deficits in schizophrenia are related to functional outcome. However, support for longitudinal relationships between cognition and functional outcome has not been as well documented. The current paper presents a review of 18 recently published longitudinal studies (minimum 6-month follow up) of the relationships between cognition and community outcome in schizophrenia. Results from these studies reveal considerable support for longitudinal associations between cognition and community outcome in schizophrenia. These studies demonstrate that cognitive assessment predict later functional outcome and provide a rationale for psychopharmacological interventions for cognitive deficits in schizophrenia. Although the relationships between cognition and community outcome are well-supported, it is clear that community functioning is also affected by a host of factors apart from cognition that are usually not considered in clinical trial studies (e.g., psychosocial rehabilitation and educational/vocational opportunities). In the second part of the paper, we consider intervening steps between cognitive performance measures and community outcome. These steps are apt to have important implications for clinical trials of cognition-enhancing agents in schizophrenia.

Antipsychotic Agents↗
PubMed2004

Approaching a consensus cognitive battery for clinical trials in schizophrenia: the NIMH-MATRICS conference to select cognitive domains and test criteria.

To stimulate the development of new drugs for the cognitive deficits of schizophrenia, the National Institute of Mental Health (NIMH) established the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative. This article presents an overview of decisions from the first MATRICS consensus conference. The goals of the meeting were to 1) identify the cognitive domains that should be represented in a consensus cognitive battery and 2) prioritize key criteria for selection of tests for the battery. Seven cognitive domains were selected based on a review of the literature and input from experts: working memory, attention/vigilance, verbal learning and memory, visual learning and memory, reasoning and problem solving, speed of processing, and social cognition. Based on discussions at this meeting, five criteria were considered essential for test selection: good test-retest reliability, high utility as a repeated measure, relationship to functional outcome, potential response to pharmacologic agents, and practicality/tolerability. The results from this meeting constitute the initial steps for reaching a consensus cognitive battery for clinical trials in schizophrenia.

Clinical Trials as Topic↗
PubMed2002

A controlled trial of cognitive remediation in schizophrenia.

A randomized, controlled trial of a 3-month cognitive remediation program was examined for its efficacy at ameliorating deficits in social and emotion perception in 42 hospitalized patients with schizophrenia. Generalization of training effects to attention, memory, and executive functioning was also examined. The program included an eclectic mix of self-instruction, memory enhancement, inductive reasoning, and compensatory training procedures, while the control condition included participation in a leisure group that was matched to the experimental group for staff involvement time. Patient care management, including type and dose of antipsychotic medication, remained constant throughout the study period. The results indicated that the cognitive training program improved emotion perception, with some evidence of generalization to measures of executive functioning; other areas of neurocognitive functioning were largely unaffected. While cognitive training programs may improve targeted areas of neurocognitive processing, broad generalization effects to domains outside those targeted for intervention are not likely concomitants.

Adult↗
PubMed2002

Applications of errorless learning for improving work performance in persons with schizophrenia.

OBJECTIVE: Until recently, few training methods used in the psychosocial rehabilitation of persons with schizophrenia have taken into account the neurocognitive deficits common to this illness. The present study tested a training method called errorless learning (which theoretically compensates for neurocognitive impairments) for efficacy at teaching entry-level job tasks to persons with serious and persistent mental illness. METHOD: Sixty-five unemployed, clinically stable outpatients with schizophrenia or schizoaffective disorder were randomly assigned to training by means of either errorless learning or conventional instruction for two entry-level job tasks (index card filing and toilet tank assembly). Training was conducted in small groups of four subjects for 90-120 minutes in a simulated workshop. Efficacy-as measured by accuracy, speed, and overall productivity-was assessed immediately after training and at a 3-month follow-up evaluation. RESULTS: Significant group differences in accuracy that favored errorless learning were found on both job tasks. In terms of productivity, the errorless learning group was superior to the conventional instruction group on the card filing task, and differences for the tank assembly task approached significance. There were no significant group differences in speed. Both groups showed significant drops in accuracy and productivity on the tank assembly task from immediately after training to the 3-month follow-up evaluation; performance levels were more stable for both groups on the card filing task. CONCLUSIONS: Errorless learning appears to be a useful training method for establishing introductory high levels of performance in the work rehabilitation of persons with schizophrenia. Future studies may wish to test its long-term durability by embedding it within supported employment programs.

Adult↗