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PAMELA SCOTT |
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Institute of Psychiatry, London |
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Defining �Information Processing� |
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Prevalence and Measurement of Information
Processing Abilities |
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Impact on Social Functioning |
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Pharmacological Interventions |
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Psychosocial Interventions |
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Conclusion |
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Future Research |
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1950�s�
Positive Symptoms
���������������� Hallucinations,
Delusions |
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1980�s�
Negative Symptoms
���������������� Lack of
Motivation/Affect |
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1990�s�
Information Processing
���������������� Memory, Attention,
Executive
���������� Function |
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Also called �Cognition� or �Neurocognition |
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Ability to recognise and process information in
order to carry out complex tasks adequately |
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Broad Term- Encompassing memory, attention,
sequencing/planning, General Intelligence, visuo-motor skills |
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Brain Structures mainly involved -frontal,
temporal, basal ganglia |
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94% of individuals have some form of information
processing deficit |
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May be very mild (unnoticeable) or severe |
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Central feature of the illness |
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Independent of Positive and Negative Symptoms |
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Neuropsychological Test Batteries and fMRI gold
standard measurements of Info Processing abilities |
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GLOBAL DEFICITS |
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General Intelligence |
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Individuals with Schizophrenia perform at lower
levels than volunteers |
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Measured by IQ Tests-IQ does not decline with
age |
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Leads to Global Assumptions |
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Deficit fails to prevent the individuals ability
to acquire, retain or relearn new skills |
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MEMORY |
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Short Term/Working Memory |
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�������
Verbal- Acquisition of verbal material |
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Visual- same for visual material |
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Poorer verbal and spatial memory |
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Frontal lobes main modulator of WM-may be� related to reduced blood flow to this
area |
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Ability to hold information over longer time
period-hrs,days,years |
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Problems seen specifically with recalling
previous events |
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Memory deficits present in first episode and un
medicated individuals |
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Ability to plan and carry out goal directed
behaviour |
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Solving puzzles main neuropsychological
assessment tool |
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Performance does not improve after explicit
instructions |
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One of the oldest documented problems dating
back to Kraeplin 1919 |
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Often difficulties remaining vigilant and not
getting distracted |
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Information Processing deficits impact on the
daily lives of individuals with schizophrenia |
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Social functioning divided into 3 key areas- |
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Skills Acquisition |
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Social Problem Solving |
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Community Functioning |
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In summary- |
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Verbal memory was related to all 3 types of
functioning |
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Vigilance (attention) predicts skills
acquisition, social problem solving |
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Executive functioning predicts ability to
function in community |
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Pharmacological Remediation-Conventional
Antipsychotics |
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potent effects on +ve symptoms, little action on
cognitive abilities-may actually worsen |
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�Their lives are being ruined twice over-by the
illness and by the drugs to treat it� Cliff Prior Director of NSF on use of
Typical drugs 1999 |
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NSF survey (2000) 3 worst medicines were all
conventional antipsychotic- Haloperidol, Chlorpromazine, Stelazine |
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Appear to improve information processing
abilities |
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Data showing superiority of risperidone over
olanzapine but also vice versa |
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both decreased hospitalisation/relapse |
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NSF Survey 3 out of 4 best medicines were all
atypical |
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less side effect profile-reduces need for
anticholinergic may improve attitudes to medication esp in young
individuals |
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SKILLS TRAINING |
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Learning based theory |
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Individuals taught wide range of skills to
enhance independent living |
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As learning based may not be effective in those
with memory and attention problems |
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+ve effects on individuals perception, but
moderate success on relapse and
symptoms |
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Intensive Therapy that helps people with
schizophrenia cope better with everyday live |
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Works on the theory that changes in information
processing will lead to improvements in social functioning |
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Aims to improve ability to remember things,
concentration, making and carrying out plans |
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Individuals carry out graded tasks (easy to
difficult) that help them in 3 key areas: |
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Cognitive flexibility- change form one task to
another |
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Working Memory-thinking about one task while
doing another |
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Planning-learning to think ahead |
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Improvements in self esteem |
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Most studies show changes in information
processing and gradual beneficial trend in social functioning |
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Used in conjunction with atypical antipsychotics |
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May not benefit everyone |
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Information processing deficits are widespread
but may be un noticeable |
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Not confined to chronic illness |
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Strong relationship with social functioning and
therefore ability to live independently |
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Improving information processing can therefore
improve life quality |
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Atypical seems to have +ve effects as does CRT |
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Need to investigate CRT over a longer time scale |
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Examine the efficacy of atypical antipsychotics
against one another and also on skills acquisition |
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Develop better assessment tools to measure
skills - virtual reality would be the way forward |
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