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Objective: Cognitive impairments are a frequent and difficult to treat symptom in patients with schizophrenia and the strongest predictor for a successful reintegration in occupational and everyday life. Recent research suggests transcranial direct current stimulation (tDCS) to enhance cognition in this patient group. However, the question regarding its acute effectiveness on executive functions remains largely unanswered. Here, we examined in a randomized, double blind, sham-controlled repeated-measures design the impact of tDCS on performance in several executive functions in patients with schizophrenia, schizoaffective disorder or acute transient psychotic disorder. Methods: Patients (N = 48) were tested twice using standardized, well-constructed and clinically validated neuropsychological tests assessing verbal working memory, response inhibition, mental flexibility and problem solving. In session 1 they solely underwent the neuropsychological assessment, whereas in session 2 they additionally received 2 mA of anodal tDCS stimulation over the left dorsolateral prefrontal cortex (DLPFC), cathode right supraorbital ridge, or sham stimulation for 20 minutes. Results: Patients of both groups were not able to correctly discriminate the type of stimulation received confirming the success of the blinding procedure. However, analyzing the whole sample the change in performance from session 1 to session 2 was the same in the verum as in the sham condition (all p >.5). Moreover, a subsequent exploratory analysis showed that performance in the response inhibition task was worse for patients that engaged in the task within 20 minutes after the end of the verum stimulation. Conclusion: Hence, 2 mA of anodal tDCS applied over the left DLPFC did not acutely enhance executive functions in patients with schizophrenia or related disorders but impaired performance in the response inhibition task shortly after. Future studies should continue to seek for effective stimulation configurations for this patient group. Clinical trial registration: The study is registered in the "Deutsches Register Klinischer Studien DRKS", German Clinical Trial Register and has been allocated the following number: DRKS00022126. [ABSTRACT FROM AUTHOR]

This review presents the current state of research on neurocognitive symptoms in depression and offers an adaption of the psychotherapeutic procedure derived from it. Cognitive symptoms appear in many patients with depression and persist after remission of the acute psychopathology. The cognitive symptoms greatly influence the psychosocial level of functioning and the outcome of psychotherapeutic interventions. These symptoms also function as predictors for the recurrence of the disease. Against this background, the authors suggest a concept for adapting psychotherapeutic procedures, comprising (1) diagnostics and identification, (2) structuring, (3) compensation, (4) experience focus, (5) activating stimulation, and (6) restitutive training. [ABSTRACT FROM AUTHOR]

Computer-assisted cognitive remediation (CACR) is an economical, adjustable, and effective treatment for individuals with schizophrenia. The current randomized controlled study examined whether an individualized or generic exercise plan in CACR is superior in patients with multiple cognitive deficits compared to treatment-as-usual (TAU). Fifty-nine inpatients diagnosed with schizophrenia were randomly assigned to 1) TAU, 2) TAU plus an individualized exercise plan in CACR, or 3) TAU plus a generic exercise plan in CACR. Neuropsychological performance, psychopathology, and functional outcome were assessed at baseline and post-treatment. The results show a medium to large training effect for all neuropsychological performance measures. Contrary to our expectations the neuropsychological improvement over time did not differ between groups. Self-reported depression, global level of functioning, and activity and participation functioning showed a significant improvement from baseline to post-treatment. However no further group, time, or interaction effects for other psychopathology and functional outcome could be demonstrated. Possible implications for clinical use of CACR and future studies are discussed. [ABSTRACT FROM AUTHOR]

The concept of information processing speed is one of the oldest research topics in experimental psychology. Tests for assessing the construct are widely used in clinical practice and among the world's most extensively used neuropsychological assessment instruments. The methods currently used were mainly developed in the middle of the last century. This raises the question of whether the construct and the method for use in clinical practice are still valid and whether the popularity is justified. In the present article we firstly discuss the limitation of the construct, followed by a review of typical test procedure and everyday relevance as well as the clinical significance of the construct. Finally, the treatment of information processing speed deficits is discussed. [ABSTRACT FROM AUTHOR]

The Eriksen Flanker task is a classic paradigm for investigating interference at the level of response compatibility. Several previous studies analyzed the ability of young children (starting at the age of four years) to ignore flanking distractors in children-specific variants of the task. However, in all published studies the interference took place at the perceptual level as well as on the level of response compatibility because the ‘compatible condition’ involved stimulus congruency as well as response compatibility. By confounding stimulus congruency and response compatibility, interference at the level of response programming and priming at the perceptual level cannot be distinguished: the observed flanker effects might not be the result of successfully ignoring but instead might just be explained due to priming. We tested 57 children aged between 7 and 12 years in a flanker variant in which all trials were perceptually incongruent but different at the level of response compatibility (compatible versus incompatible). Children showed a flanker effect (faster reaction times in response compatible trials) that was, however, in terms of the effect size, smaller than flanker effects reported in previous studies. [ABSTRACT FROM PUBLISHER]

Negative symptoms in schizophrenia have been linked to selective reinforcement learning deficits in the context of gains combined with intact loss-avoidance learning. Fundamental mechanisms of reinforcement learning and choice are prediction error signaling and the precise representation of reward value for future decisions. It is unclear which of these mechanisms contribute to the impairments in learning from positive outcomes observed in schizophrenia. A recent study suggested that patients with severe apathy symptoms show deficits in the representation of expected value. Considering the fundamental relevance for the understanding of these symptoms, we aimed to assess the stability of these findings across studies. Sixty-four patients with schizophrenia and 19 healthy control participants performed a probabilistic reward learning task. They had to associate stimuli with gain or loss-avoidance. In a transfer phase participants indicated valuation of the previously learned stimuli by choosing among them. Patients demonstrated an overall impairment in learning compared to healthy controls. No effects of apathy symptoms on task indices were observed. However, patients with schizophrenia learned better in the context of loss-avoidance than in the context of gain. Earlier findings were thus partially replicated. Further studies are needed to clarify the mechanistic link between negative symptoms and reinforcement learning. [ABSTRACT FROM AUTHOR]

Kognitive Remediation ist eine wirksame Behandlung zur Verbesserung des Funktionsniveaus bei psychiatrischen Erkrankungen wie Schizophrenie oder Depression. Im klinischen Alltag ist der Therapieansatz jedoch noch nicht durchgängig etabliert. Dies geht unter anderem auf Zweifel in Bezug auf die Zumutbarkeit der Kognitiven Remediation für psychiatrische Patienten zurück. Die vorliegende Studie untersucht deshalb die Akzeptanz, die Motivation zu und die subjektive Belastung durch Kognitive Remediation für psychiatrische Patienten im Vergleich zu einem gängigen Behandlungsangebot. Material und Methode 21 psychiatrische Patienten, die zeitgleich an einer ergo-therapeutischen Basisgruppe und einer Kognitiven Remediation teilnahmen, beurteilten über 5 Wochen Motivation, Erschöpfung, Freude und Anstrengungsbereitschaft auf einer visuellen Analogskala (VAS) in Bezug auf die jeweilige Therapie. Ergebnisse Die Beurteilungen der Ergotherapie und der Kognitiven Remediation unterschieden sich nicht in Bezug auf Motivation, Erschöpfung und Freude. Die subjektive Anstrengung in der Kognitiven Remediation war größer als in der Ergotherapie. Diskussion Kognitive Remediation wird von psychiatrischen Patienten in Bezug auf Motivation, Freude und Erschöpfung vergleichbar zu einem allseits etablierten Therapieansatz bewertet. Zweifel in Bezug auf die Akzeptanz und Zumutbarkeit der Kognitiven Remediation konnten nicht bestätigt werden. In den klinischen Alltag sollte die Kognitive Remediation als effektiver und akzeptierter Therapieansatz für verschiedene Störungsbilder als Standardbehandlung integriert werden. [ABSTRACT FROM AUTHOR]

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Mental disorders are a frequent consequence of acquired central nervous damage. If not recognized and treated early, they have a negative impact on the course of neurological rehabilitation. This article deals with the diagnosis and treatment of mental disorders after acquired damage to the central nervous system., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar / geldwerten Vorteil für Referententätigkeit erhalten: ja, von einer anderen Institution (Pharma- oder Medizintechnikfirma usw.); Bezahlter Berater / interner Schulungsreferent / Gehaltsempfänger: ja, von einer anderen Institution (Pharma- oder Medizintechnikfirma usw.); Patent / Geschäftsanteile / Aktien (Autor / Partner, Ehepartner, Kinder) an Firma (Nicht-Sponsor der Veranstaltung): nein; Patent / Geschäftsanteile / Aktien (Autor / Partner, Ehepartner, Kinder) an Firma (Sponsor der Veranstaltung): ja. Erklärung zu nichtfinanziellen Interessen Die Autorinnen / Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Cognitive impairments are frequent in patients suffering from major depressive disorders. They are among the first symptoms, often persist independently of improvement even after remission of the affective symptoms and are an important predictor of psychosocial functioning. In the clinical practice it is mandatory to ask about subjective complaints of the patient as well as to assess the cognitive abilities with the help of a standardized neuropsychological test battery. Cognitive remediation, selective serotonin reuptake inhibitors (SSRI) and vortioxetine as well as repetitive transcranial magnetic stimulation have proven their effectiveness as treatment options.