HKA Mental Health Activities: Sep 05

Computer assisted cognitive remediation - a trial of a new treatment.

Dr Anthony Harris. Senior Lecturer, Discipline of Psychological Medicine, University of Sydney and Staff Specialist Sydney West Area Health Service.

Over the past 18 months a number of people with schizophrenia at the Cottage in the Park have been involved in a study seeing if the cognitive deficits associated with schizophrenia can be treated using simple computer games and educational software. These cognitive deficits, or thinking skills such as attention, memory, concentration and problems solving, are very important in recovery from psychosis. If you can't concentrate or remember things it becomes difficult to do every day activities - remember what to buy at the shop, remember an appointment or read a bus timetable. The newer medications such as clozapine (Clozaril or Clopine), olanzapine (Zyprexa) or risperidone (Risperdal) are known to have some beneficial effect on these thinking problems but are not the whole answer.

Some years ago when our research group identified the severity of these difficulties in young people with schizophrenia who had taken part in other research that we were conducting, our group heard of the treatment programs of Professor Alice Medalia from New York. Professor Medalia used computer game software to help people get over the concentration and problem solving difficulties that are common to many psychiatric conditions. This struck us as an interesting and engaging way of going about the problem. People generally want to learn how to use a computer. They are seen as "high status" skills. The educational and game software are designed to get people in, are usually carefully graded so that people can do higher degrees of difficulty slowly and have many aides built in to assist in errorless learning. For many they are fun which is a big improvement on most psychiatric treatments. There are also a large and growing number of such programs so the approach can be refreshed as new software is selected.

As with all treatments there is a trick, and the one for this treatment is that an individual's cognitive weaknesses need to be described and the software which may address different thinking skills, needs to be matched to the deficit. This means that all people need a detailed assessment of their cognitive deficits by a psychologist prior to beginning the treatment. Deficits are identified and a suite of software is chosen that will focus on and help remediate the deficits.

As with all new treatments, cognitive remediation needed to be test run in our community. We had to prove to ourselves and to the mental health teams that we worked with that the approach worked. To that end a group of us in Sydney West and Northern Area Health Services established a research group to test how well the approach worked. Recruiting from all over those two areas and from Cumberland and Macquarie Hospitals clinicians have been testing to see if the approach works. The trial tests people before and after they have had the treatment and again after 4 months, the later testing period is to see if the improvements last. The treatment involves working through a series of games and computer scenarios twice a week for at least 20 sessions. People who have little familiarity with computers were given up to 5 "warm up" sessions to help train themselves on the computers. All computers were ordinary (very ordinary in some cases) Health department computers. The trial was funded by an Eli Lilly "Answers that Matter" grant, the Research Trust Fund of the Schizophrenia Fellowship of New South Wales and the Perpetual Philanthropic Foundations (J. Love Foundation).

We have finished gathering all the data from the baseline and post-treatment testing. We are still gathering in the data for the 4 month follow-up. Initial results indicate that the approach is working well improving people's attention, concentration, problem solving skills and their speed of processing problems. Also people in the main found the approach very enjoyable. Cognitive remediation does not seem to have improved the way people remember words or other verbal material. Overall the results are very encouraging and will be feed back into the selection of games to improve the method. But if you know of any great verbal memory games please get back to me. They would be very useful.

New treatments are always difficult to establish and we all need to be skeptical of the claims too often made on their behalf. But this new treatment does appear to help a facet of the illness that is very difficult to treat and one that it is essential to improve if people with schizophrenia are to get back into normal life. I will write again for the newsletter when the final test results are in.

Dr. Anthony Harris   29 Sept 2005