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Background: In schizophrenia (SZ), social cognition mediates the relationship between neurocognition and social functioning. Although people with major depressive disorder (MDD) also exhibit cognitive impairments, which are often prolonged, little is known about the role of social cognition in MDD. Methods: Using data obtained through an internet survey, 210 patients with SZ or MDD were selected using propensity score matching based on their demographic information and illness duration. Social cognition, neurocognition, and social functioning were evaluated using the Self-Assessment of Social Cognition Impairments, Perceived Deficits Questionnaire, and Social Functioning Scale, respectively. The mediation effects of social cognition on the relationship between neurocognition and social functioning were examined in each disease group. Invariances of the mediation model across the two groups were then analyzed. Results: The SZ and MDD groups had mean ages of 44.49 and 45.35 years, contained 42.0% and 42.8% women, and had mean illness durations of 10.76 and 10.45 years, respectively. In both groups, social cognition had significant mediation effects. Configural, measurement, and structural invariances across the groups were established. Conclusion: The role of social cognition in patients with chronic depression was similar to that in schizophrenia. Social cognition could be a common endophenotype for various psychiatric disorders.

Background Recent studies indicate an urgent need to take action against mental health issues during the COVID-19 pandemic. However, the association between larger-scale environmental factors such as living conditions and mental health problems during the pandemic is currently unknown. Methods A nationwide, cross-sectional internet survey was conducted in Japan between August and September 2020 to examine the association between urbanization level and neighborhood deprivation as living conditions and COVID-19 case numbers by prefecture. Prevalence ratios (PRs) for severe psychological distress, suicidal ideation, and new-onset suicidal ideation during the pandemic were adjusted for potential confounders. Results Among 24,819 responses analyzed, the prevalence of mental health problems was 9.2% for severe psychological distress and 3.6% for new-onset suicidal ideation. PRs for severe psychological distress were significantly associated with higher urbanization level (highest PR = 1.30, 95% CI = 1.08-1.56). PRs for new-onset suicidal ideation were significantly associated with higher urbanization level (highest PR = 1.83, 95% CI = 1.37-2.45) and greater neighborhood deprivation (highest PR = 1.35, 95% CI = 1.06-1.72). Severe psychological distress and new-onset suicidal ideation were significantly more prevalent when there was higher urbanization plus lower neighborhood deprivation (PR = 1.34 [1.15-1.56], and 1.57 [1.22-2.03], respectively). Conclusion These findings suggest that it is not the number of COVID-19 cases by residence area but higher urbanization level and greater neighborhood deprivation (lower neighborhood-level socioeconomic status) that are associated with severe psychological distress and new-onset suicidal ideation during the pandemic. These findings differ in part from evidence obtained before the pandemic.

Background: In schizophrenia spectrum disorders (SSD), social cognition mediates the relationship between neurocognition and social functioning. Although people with major depressive disorder (MDD) also exhibit cognitive impairments, which are often prolonged, little is known about the role of social cognition in MDD. Methods: Using data obtained through an internet survey, 210 patients with SSD or MDD were selected using propensity score matching based on their demographics and illness duration. Social cognition, neurocognition, and social functioning were evaluated using the Self-Assessment of Social Cognition Impairments, Perceived Deficits Questionnaire, and Social Functioning Scale, respectively. The mediation effects of social cognition on the relationship between neurocognition and social functioning were examined in each group. Invariances of the mediation model across the two groups were then analyzed. Results: The SSD and MDD groups had mean ages of 44.49 and 45.35 years, contained 42.0% and 42.8% women, and had mean illness durations of 10.76 and 10.45 years, respectively. In both groups, social cognition had significant mediation effects. Configural, measurement, and structural invariances across the groups were established. Conclusion: The role of social cognition in patients with MDD was similar to that in SSD. Social cognition could be a common endophenotype for various psychiatric disorders.

IntroductionCognitive impairment is a major determinant of poor functional outcome in schizophrenia and there are currently no available pharmacotherapies. Deficits in glutamatergic signaling play a key role in the neuropathology of cognitive symptoms. Iclepertin (BI 425809), an inhibitor of glycine transporter-1, enhances glutamatergic signaling by increasing synaptic levels of the N-methyl-D-aspartate receptor co-agonist, glycine. A 12-week, Phase II trial (NCT02832037) in 509 patients with schizophrenia demonstrated that iclepertin was well tolerated and significantly improved cognition. The Phase III CONNEX program aims to confirm the efficacy, safety, and tolerability of iclepertin in improving cognition and functioning in a larger cohort of patients.MethodsCONNEX consists of three replicate randomized, double-blind, placebo-controlled parallel-group trials in patients with schizophrenia (NCT04846868, NCT04846881, NCT04860830) currently stable on antipsychotic treatment. Each trial aims to recruit ~586 patients, 18–50 years old, treated with 1–2 antipsychotic medications (≥12 weeks on current drug; ≥35 days on current dose prior to treatment), who have functional impairment in day-to-day activities, and interact ≥1 hour per week with a designated study partner. Patients with cognitive impairment due to developmental, neurological, or other disorders, or receiving cognitive remediation therapy within 12 weeks prior to screening, will be excluded. Patients will be recruited from multiple centers across 32 countries in Asia, North and South America, and Europe, and randomized 1:1 to receive either oral iclepertin 10 mg (n=293), or placebo (n=293) once daily over 26 weeks. The primary efficacy endpoint is change from baseline (CfB) in the MATRICS Consensus Cognitive Battery overall composite T-score. Key secondary efficacy endpoints are CfB in Schizophrenia Cognition Rating Scale total score and CfB in the adjusted total time in the Virtual Reality Functional Capacity Assessment Tool. Long-term safety and tolerability data will be collected in an open-label safety extension study (CONNEX-X).ResultsThe studies are currently recruiting (first patients enrolled Aug–Sept 2021), with completion expected in Q2 2024. Here we present an overview of the current study status, including any information relating to screening failures, and the experience of collecting these data as part of a large multi-country, multi-center study.ConclusionTo date, most large, industry-sponsored studies testing various compounds to address cognitive function have failed to show proof-of-clinical concept. Demonstration of efficacy of iclepertin in improving cognition in this Phase III program would provide important insight into the role of glutamate in cognitive symptoms that may also have relevance for other cognitive disorders. Iclepertin may represent the first efficacious medication for cognitive impairment associated with schizophrenia.FundingBoehringer Ingelheim International GmbH (1346-0011, NCT04846868; 1346-0012, NCT04846881; 1346-0013, NCT04860830)

In schizophrenia, social cognitive impairment is considered one of the greatest obstacles to social participation. Although numerous measures have been developed to assess social cognition, only a limited number of them have become available in Japan. We are therefore planning this evaluation study for social cognition measures in Japan (ESCoM) to confirm their psychometric characteristics and to promote research focused on social cognition. Participants in the cross-sectional observational study will be 140 patients with schizophrenia recruited from three Japanese facilities and 70 healthy individuals. In our primary analysis, we will calculate several psychometric indicators with a focus on whether they can independently predict social functioning. In secondary analyses, we will assess the reliability and validity of the Japanese translations of each measure and conduct an exploratory investigation of patient background, psychiatric symptoms, defeatist performance belief, and gut microbiota as determinants of social cognition. The protocol for this study is registered in UMIN-CTR, unique ID UMIN000043777.

The fear of cancer recurrence (FCR) is the most common and most severe unmet need among cancer survivors. Safe treatments for the FCR that are easily disseminated are greatly needed. Our primary aim is a preliminary evaluation of the efficacy and effect size of perilla oil, which is rich in omega-3 fatty acids, and Bifidobacterium, a probiotic, on FCR in breast cancer survivors after the completion of chemotherapy. This study has been planned as an exploratory clinical study (phase II) and will be conducted as a three-arm, 12-week parallel group, masked-rater randomized controlled trial. Fifteen participants will be randomized with 1:1:1 allocation to receive Bifidobacterium plus perilla oil, Bifidobacterium alone, or no intervention (control). Interventions will end within 12 weeks after the random allocation of each participant. The participants will be outpatients with invasive breast cancer aged 20 years or older whose chemotherapy was completed at least 6 months before registration; hormone therapy may be ongoing. The primary outcome will be severity of FCR at 12 weeks assessed by masked raters using the 4-item Concerns about Recurrence Scale concerning overall fear of recurrence. The study protocol for the current study is registered in the Japan Registry of Clinical Trials (jRCTs031200029).

Social cognition is strongly linked to social functioning outcomes, making it a promising treatment target. Because social cognition measures tend to be sensitive to linguistic and cultural differences, existing measures should be evaluated based on their relevance for Japanese populations. We aimed to establish an expert consensus on the use of social cognition measures in Japanese populations to provide grounds for clinical use and future treatment development. We assembled a panel of experts in the fields of schizophrenia, social psychology, social neuroscience, and developmental disorders. The panel engaged in a modified Delphi process to (1) affirm expert consensus on the definition of social cognition and its constituent domains, (2) determine criteria to evaluate measures, and (3) identify measures appropriate for Japanese patients with a view toward future quantitative research. Through two online voting rounds and two online video conferences, the panel agreed upon a definition and four-domain framework for social cognition consistent with recent literature. Evaluation criteria for measures included feasibility and tolerability, reliability, clinical effectiveness, validity, and international comparability. The panel finally identified nine promising measures, including one task originally developed in Japan. In conclusion, we established an expert consensus on key discussion points in social cognition and arrived at an expert-selected set of measures. We hope that this work facilitates the use of these measures in Japanese clinical scenarios. We plan to further examine these measures in a psychometric evaluation study.

We present a case of schizophrenia comorbid for tetralogy of Fallot, without chromosome 22q.11.2 deletion or duplication, treated successfully with a combination of clozapine and antiepileptic drugs. Although clozapine by itself initially triggered convulsive seizures, we continued it with co-administration of valproate and topiramate. This combined treatment did not affect cardiac function of the patient, who experienced a favorable clinical course in terms of symptomatology and functional outcomes. To our knowledge, we provide the first report on a patient with tetralogy of Fallot, in whom 22q.11.2 was not deleted and clozapine-induced seizures were observed.

Aim Low motivation is a core symptom of schizophrenia which significantly impacts successful engagement in and benefit from psychosocial treatments. Therefore, it is important for clinicians to design psychosocial treatments to effectively motivate and engage patients during the treatment. The MUSIC® Model of Academic Motivation Inventory (MMI) is an 18-item instrument with five scales that assess students' motivation during academic tasks. The objective of the current study was to validate the MMI for use with schizophrenia-spectrum patients undergoing cognitive training. Methods Participants included 181 people with schizophrenia spectrum disorders enrolled in cognitive training in four countries. A confirmatory factor analysis (CFA) assessed construct validity. Quality of fit was determined using the Comparative Fit Index (CFI), the Standardized Root Mean Square Residual (SRMR), and the Root Mean Square Error of Approximation (RMSEA). Pearson's correlation coefficients assessed construct validity and Cronbach's alphas assessed reliability. Furthermore, we examined factor loadings for each inventory item and assessed predictive validity by analyzing MMI scales with attendance outcomes. Results Consistent with the original MMI validation studies used in academic settings, we found CFI values indicated a good fit, as did the SRMR and RMSEA values. The scales were correlated yet distinct. Cronbach's alpha values ranged from good to excellent and factor loadings showed that all items loaded very well onto their intended factors. The MMI had a positive relationship to treatment intensity. Conclusion The MMI is a valid and reliable tool to use with individuals with schizophrenia spectrum disorders undergoing a cognitive training intervention.

Empathy is crucial for maintaining effective social interactions. Research has identified both an early-emotional sharing and a late-cognitive component of empathy. Although considered a functionally vital social cognition process, empathy has scarcely been studied in schizophrenia (SZ). We used event-related potentials (ERPs) to study the temporal dynamics of empathic response in 19 patients with SZ and 18 matched healthy controls (HC) using an empathy for physical pain paradigm. Participants responded to pictures of hands in neutral and painful situations in an active empathic condition and one manipulated by task demands. Additionally, subjective ratings of the stimuli and empathic self-reports were collected. People with SZ had (1) decreased early-emotional ERP responses to pictures of others in pain; (2) decreased modulation by attention of late-cognitive ERP responses; (3) lower ratings of perspective taking and higher ratings of personal distress which were both related to decreased modulation of late-cognitive empathic responses; (4) a significant relationship between high affective overlap between somebody else's pain and their own pain and decreased modulation of late-cognitive empathic responses; (5) a distinct relationship between regulatory deficits in late-cognitive empathy and functioning. Patients had present but reduced early and late empathy-related ERPs. Patients also reported increased personal distress when faced with distress in others. The late ERP responses are thought to be associated with self-regulation and response modulation. The magnitude of these late responses was inversely associated with reported levels of personal distress in both patients and controls. Additionally, regulatory deficits in cognitive empathy were highly related with deficits in functioning. Decreased ability to regulate one's own emotional engagement and response to emotions of others may be an important source of distress and dysfunction in social situations for patients with schizophrenia.

article i nfo Article history: This study determined whether increasing stimulus duration for patients with schizophrenia normalized late Event Related Potentials (ERPs) associated with modulation of response to emotion-evoking stimuli. These ERPs are decreased in patients versus healthy controls when both view stimuli of the same duration. Subjects viewed pictures of hands and judged whether the events depicted were painful or non-painful. Pictures were presentedto patientsfor 500or 800 msandto healthycontrolsfor 200or 500 ms.Participants were 19adultout- patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder and 18 healthy controls, as assessed by the Structured Clinical Interview. ERPs to neutral stimuli during a 350-900 ms window following stimulus onset were subtracted from ERPs during this same response window to pain stimuli. The area under this difference wave reflected the degree of pain-related positivity and was the dependent measure for analysis. Patient late-positive ERP responsesfollowing 500 and 800 msstimuli were highly similar to responses in healthy controls following 200 and 500 ms stimuli respectively. Patients and controls differed significantly when responses to 500 ms stimuli were compared. People with schizophrenia are known to process information moreslowlythanhealthypeople.Ourresultsindicate thatslowedearlyprocessing ofsensoryinputmaylimiten- gagement of higher cognitive and regulatory processes in patients with schizophrenia. This may be one reason that self-regulation is compromised in patients, and may help explain why measures of slowed information processing account for so much variance in other cognitive deficits in schizophrenia.

The regional neuronal changes taking place between before and after cognitive rehabilitation are still not characterized in schizophrenia patients. In addition, it is not known whether these regional changes are predictive or correlated with treatment response. We conducted a preliminary quasi-experimental study to investigate the effects of a Neuropsychological Educational Approach to Cognitive Remediation (NEAR), one of the cognitive remediation therapies, on neurocognitive functioning assessed by the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J), and on prefrontal and temporal hemodynamic responses during working memory (WM) task (2-back, letter version) using 52-channel near-infrared spectroscopy (NIRS). We assessed 19 patients with schizophrenia or schizoaffective disorder twice with an interval of 6 months. Moreover, taking into consideration the possible practice effect, we assessed 12 control patients twice with an interval of 6 months. The NEAR group, in comparison with the control group, showed significant improvement in two subcomponents of BACS-J, that is, motor speed and executive function along with the composite scores. The NEAR group also showed a significant increase in brain activation in the bilateral cortical regions associated with WM, and in comparison with the control group the between-group differences were restricted to the right frontopolar area. In addition, the amount of enhancement in some cognitive subcomponents was positively correlated with the magnitude of an increase in hemodynamic response during WM task predominantly in the right hemispheres. These findings suggest that neurocognitive deficits in schizophrenia and their neural dysfunction may be improved by NEAR, and NIRS may be a useful tool to assess the changes of the neural activity underlying the improvement of neurocognitive functioning elicited by neurocognitive rehabilitation.

Social cognitive impairments are core features of schizophrenia and are closely associated with poor functional outcome. This study sought to identify specific aspects of social cognition and their relationships to measures of social function, quality of life, and neurocognition. Principal component analysis was performed using social cognitive measures in patients with schizophrenia and healthy matched controls and revealed three factors: Interpersonal Discomfort, Basic Social Cognition, and Empathy. Patients had higher scores on Interpersonal Discomfort and lower scores on Basic Social Cognition than controls, but the two groups were the same on Empathy. Lower social performance was significantly correlated with poor Basic Social Cognition in patients and with high Interpersonal Discomfort in controls. While neurocognition was significantly associated with Basic Social Cognition in both groups, it was not associated with Empathy. Social cognitive interventions should emphasize improving basic social cognitive processing deficits, managing Interpersonal Discomfort, and utilizing preserved capacity for empathy as a potential strength in social interactions.

Objective With the aim of investigating gender differences in the functional lateralization subserving preattentive processing of language stimuli, we compared auditory mismatch negativities (MMNs) using dichotic listening tasks. Methods Forty-four healthy volunteers, including 23 males and 21 females, participated in the study. MMNs generated by pure-tone and phonetic stimuli were compared, to check for the existence of language-specific gender differences in lateralization. Both EEG amplitude and scalp current density (SCD) data were analyzed. Results With phonetic MMNs, EEG findings revealed significantly larger amplitude in females than males, especially in the right hemisphere, while SCD findings revealed left hemisphere dominance and contralateral dominance in males alone. With pure-tone MMNs, no significant gender differences in hemispheric lateralization appeared in either EEG or SCD findings. Conclusion While males exhibited left-lateralized activation with phonetic MMNs, females exhibited more bilateral activity. Further, the contralateral dominance of the SCD distribution associated with the ear receiving deviant stimuli in males indicated that ipsilateral input as well as interhemispheric transfer across the corpus callosum to the ipsilateral side was more suppressed in males than in females. Significance The findings of the present study suggest that functional lateralization subserving preattentive detection of phonetic change differs between the genders. These results underscore the significance of considering the gender differences in the study of MMN, especially when phonetic stimulus is adopted. Moreover, they support the view of Voyer and Flight [Voyer, D., Flight, J., 2001. Gender differences in laterality on a dichotic task: the influence of report strategies. Cortex 37, 345–362.] in that the gender difference in hemispheric lateralization of language function is observed in a well-managed-attention condition, which fits the condition adopted in the MMN measurement; subjects are required to focus attention to a distraction task and thereby ignore the phonetic stimuli that elicit MMN.

It is now widely accepted that cognitive deficits, beyond other psychiatric symptoms (e.g., delusion, hallucination, emotional flattening, social withdrawal and apathy), is far most relevant to social functional outcome in schizophrenia. Accordingly, the treatment target has been shifted to the area, developing new drugs that facilitate cognitive function and building up new psychosocial rehabilitation programs that directly approach the cognitive deficits. Despite the desirability to target these deficits, no standard neuropsychological test batteries exist for assessing the level of cognitive function. Mismatch negativity (MMN), an auditory event-related potential component, is a measure of preattentive information processing and its amplitude has repeatedly been demonstrated to be reduced in schizophrenia. MMN deficits are a robust feature in chronic schizophrenia and indicate abnormalities in automatic context-dependent auditory information processing and auditory sensory memory in schizophrenia. Moreover, the deficits have been related to poor social functioning level and social skills acquisition, hypofunction of NMDA system, and illness duration, which indicate the validity of accepting MMN as a biomarker of the disease. In this article, we present a summary of the discussions about the plausibility of MMN to be used as a neurobiological index for assessing the cognitive function and also its predictability of social functional outcome in schizophrenia.

Background The relationship between violence and neurocognitive function in schizophrenia is unclear. We examined the backgrounds and neurocognitive functions of violent and nonviolent patients with schizophrenia to identify factors associated with serious violence. Methods Thirty male patients with schizophrenia who were hospitalized after committing serious violent acts were compared with 24 hospitalized male patients with schizophrenia and no history of violence. We evaluated psychiatric symptoms using the Positive and Negative Syndrome Scale (PANSS) and neurocognitive functions using the Brief Assessment of Cognition in Schizophrenia (BACS)-Japanese version. Results Repeated-measures analyses of variance on BACS subcomponents z-scores showed that the violent and control groups had different neuropsychological profiles at trend level (p = 0.095). Post hoc analyses of variance indicated that the violent group had significantly better working memory and executive function than the control group. In post hoc ANOVAs also controlling for the effect of the presence of substance abuse on cognitive function, violent or nonviolent group had a significant main effect on executive function but not on working memory. Conclusions Patient with violent or non-violent schizophrenia have distinct neuropsychological profiles. These results may help develop improved psychosocial treatments.

Previous meta-analytic studies conducted in Western countries have consistently revealed impairments in theory of mind (ToM) in schizophrenia. However, there is no systematic meta-analytic review of ToM deficits in individuals with schizophrenia in non-Western countries. In addition, ToM impairments in individuals with schizophrenia have not been investigated in the distinctive domains (i.e., verbal vs. visual, or affective vs. cognitive). The current meta-analytic study systematically synthesized 13 studies comparing ToM performance of adults with schizophrenia (n=377) and that of healthy controls (n=386) in Korea. The results indicate that Koreans with schizophrenia showed overall large ToM impairments (d=-1.273) but intact performance in control tasks that require a similar amount of cognitive demand as ToM tasks do. Large impairments in affective and cognitive ToM (d=-1.445 and -1.202, respectively) and verbal and visual ToM (d=-1.239 and -1.221, respectively) were found in Koreans with schizophrenia. There were no differences in magnitude between affective and cognitive ToM or between verbal and visual ToM. These results suggest that Koreans with schizophrenia experience substantial impairments in various ToM domains. Comprehensive multi-modality-based assessment targeting various ToM domains should be considered for treatment planning of individuals with schizophrenia.

Observation of others in pain induces positive elevation (pain effect) in late event-related potentials (ERP). This effect is associated with top-down attention regulating processes. It has previously been shown that stimulus exposure duration can affect top-down attentional modulation of response to threat-related stimuli. We investigated the effect of exposure duration on ERP response to others in pain. Two late ERP components, P3 and late positive potentials (LPP), from 18 healthy people were measured while they viewed pictures of hands in painful or neutral situations for either 200 or 500 ms, during two task conditions (pain judgment and counting hands). P3 and LPP pain effects during the pain judgment condition were significantly greater with 500 ms than 200 ms stimulus presentation. Ours is the first study to suggest that engagement of empathy-related self-regulatory processes reflected in late potentials requires longer exposure to the pain-related stimulus. Although this is important information about the relationship between early sensory and subsequent brain processing, and about engagement of self-regulatory processes, the neural basis of this time-dependence remains unclear. It might be important to investigate the relationship between stimulus duration and empathic response in clinical populations where issue so f self-regulation, empathic response and speed of information processing exist.

Skin conductance response (SCR) to emotion-evoking stimuli has in previous studies suggested the existence of two subgroups of schizophrenia patients. One is characterized by absent SCR and the other by heightened or non-habituating SCR. These subgroups have also been shown to differ in symptoms, prognosis and social integration. The present project compared social cognition in the two subgroups. SCR from 28 patients with schizophrenia and 24 matched healthy controls was measured while they watched emotion-evoking and neutral video tapes. Assessments of symptoms, neurocognition, social cognition, and social function were also performed. Event related potentials (ERP) were recorded in response to pictures of people experiencing pain or not. Subjects were divided into “SCR non-responder” and “SCR responder” groups based on SCR frequency. Schizophrenia SCR responders had significantly higher self-reported personal distress in response to others in distress and lower P300 ERP responses to others in pain than schizophrenia SCR non-responders and healthy controls. SCR responsiveness is a potential marker of subgroups of patients with schizophrenia that differ in pathophysiology, function and prognosis.

The concept and assessment tools for social cognition of schizophrenia were reviewed in order to bridge the gap between brain cognitive science and psycho-social intervention. Social cognition as well as neuro-cognition strongly influences social functioning, and the impact of neuro-cognition is mediated by social cognition. Neuronal networks of personal identification, facial perception, emotional identification, eye contact, "theory of mind", mutual communication, and the decision-making process have been clarified recently. The results of face discrimination and emotion recognition tasks show impairment in persons with schizophrenia as compared with healthy controls, especially fear, dislike, and sad recognition tasks. It might be difficult for them to link ambiguous stimuli with specific emotions, and they have a tendency to recognize uncomfortable emotions easily. "Jumping to conclusions" tendency (JTC) was identified in previous research on delusion. JTC develops from information uptake bias and confidence bias, and they might be thought to be trait and state. Social problem-solving is the skill to use social cognition to comprehensively adjust to specific social situations, and processing skills of social problem-solving are related to divergent thinking. Rating scales and the results of previous studies on emotion recognition, social perception, attribution style, and "theory of mind" were summarized. Furthermore, psycho-social interventions to improve emotion recognition directly, JTC, and divergent thinking were reported. Interventions aiming at improving social cognition or meta-cognition directly have been recently developed, which might improve some components of social functioning that used to be difficult to improve. These concepts of social cognition and researches on brain science, assessment tools, and intervention methods would clarify the mechanisms of the effects of psycho-social interventions, improve their methodology, and help to develop new aspects of intervention.

Cognitive remediation purports to improve the cognitive dysfunction of schizophrenia, and has many forms. Eighty percent of people with schizophrenia suffer from cognitive dysfunction. The impact of cognitive dysfunction on everyday activity is widespread. Cognitive remediation as a non-pharmaceutical, psychosocial treatment modality for cognitive dysfunction has received attention as medical treatment has been able to make only limited gains. The ultimate goal of cognitive remediation is to improve the functional outcome. The increased interest in cognitive remediation resulted in numerous reports of outcome studies and meta-analysis. This paper reports different methods of cognitive remediation, evaluations of outcome studies, and various outcome indices. Cognitive remediation differs according to whether specific cognitions are targeted, and whether a method takes a compensatory or restorative approach. This paper briefly reviews methods of cognitive remediation which demonstrated their effect through RCT: IPT, NEAR, CET, and NET. Cognitive remediation often includes sessions that aim for transfer of the gained learning, such as verbal sessions or vocational skills training. Cognitive remediation is considered most effective when included as part of a comprehensive rehabilitation program. It is important to note that various studies report different outcome indices, control groups, and effect sizes in evaluating the effect of cognitive remediation.

The main aim of this study is to demonstrate the feasibility and efficacy of a Neuropsychological Educational Approach to Cognitive Remediation (NEAR) in Japan. This multi-site study used a quasi-experimental design. Fifty-one patients with schizophrenia or schizoaffective disorder participated. The NEAR program consisted of two 1-h computer sessions per week and an additional group meeting session lasting 30 to 60 min once a week. The subjects completed 6 months of NEAR sessions before being assessed. Moreover, taking into consideration the possible practice effect, we assessed 21 control patients twice with an interval of 6 months. We assessed cognitive function by using the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J). Consequently, the NEAR group showed significant improvement in overall cognitive function, and in comparison with the control group, these findings were generally similar except for motor speed. Although the present study has its limitations, it demonstrates that the NEAR is feasible in Japan as well as it is in Western countries.

Aim: Functional neuroimaging studies to date have indicated prefrontal dysfunction in late-onset major depression (LOD). The relationships between prefrontal dysfunction and clinical characteristics including social functioning, however, have been unclear. The objective of the present study was to evaluate prefrontal hemodynamic response related to an executive task in LOD and to assess the relationship between activation in the prefrontal regions and clinical characteristics including social functioning. Methods: Twenty-four subjects with LOD and 30 age- and gender-matched healthy subjects were recruited for the present study. Hemoglobin concentration changes in the prefrontal and superior temporal cortical surface area were measured during verbal fluency task (VFT) using 52-channel near-infrared spectroscopy (NIRS), which enables real-time monitoring of cerebral blood volume (CBV) in the cortical surface area. Results: The two groups had a distinct spatiotemporal pattern of oxy-hemoglobin concentration change; LOD patients had less activation in a broad area covering both prefrontal and superior temporal cortices than healthy controls. In addition, reduced activation of the frontopolar region had a significant positive correlation with lower self-assessment of social functioning scores in the patient group. Conclusion: Reduced frontopolar cortical activation was associated with social functioning impairment in patients with LOD, and NIRS may be an efficient clinical tool for monitoring these characteristics.