Cognitive help for schizophrenics.

Training that improves attention, memory and basic reasoning skills may play a key role in treating many cases of schizophrenia, according to Swiss researchers. Their findings, and comments on their work by several other researchers, appear in the current SCHIZOPHRENIA BULLETIN.

Schiziphrenia consists of recurrent psychotic symptoms, such as hallucinations and delusions, and persistent deficit symptoms, such as emotional unresponsiveness and apathy (SN: 3/21/91, p.181). Studies suggest that schizophrenia also interferes with the ability to concentrate on and think about incoming information, but no consensus exists on the exact nature of this problem.

The Swiss approach of "cognitive rehabilitation" for schizophrenics differs from more typical programs, which focus on teaching social skills. In the last decade, psychiatrist Hans D. Brenner of the University of Bern and his colleagues have conducted several studies of hospitalized schizophrenics who completed a three-month program that first addresses simple thinking abilities. For instances, the researchers give patients a stack of cards, each of which displays a number of geometric form, a color patch and a day of the week. Patients learn to sort the cards by one or more attributes. Training then advances to word problems and games modeled after "20 questions." Next, patients learn to interpret the meaning of social interactions shown on slides, practice listening to and conversing with others and learn more complex social skills.

As many as 18 months after completing the program, participants show substantial improvement on tests measuring attention and in overall mental condition, Brenner's group reports. But complex thought and social skills needed for independent living still elude most program graduates.

The Swiss findings offer reason for cautions optimism, but rehabilitation programs may need to target different "cognitive styles," contend social worker Gerard E. Hogarty and psychologist Samuel Flesher, both of the University of Pittsburg. Some schizophrenic patients take an extraordinary long time to make sense of simple bits of information because they have difficulty organizing information into relevant categories, an ability that clinicians can teach and reinforce, Hogarty and Flesher maintain. Other patients get easily distracted and must learn to remind themselves verbally of the task at hand. Still others need instruction in escaping from rigid, often paranoid views of the world, the Pittsburgh researchers add.

Long-term evidence that any form of cognitive rehabilitation fosters major improvements in schizophrenics remains scarce and uncertain, assets psychologist Alan S. Bellack of the Medical College of Pennsylvania in Philadelphia.