1. Computerized drills to enhance basic ability to think
One of the issues with the illness is poor ‘reality monitoring’, which is the inability amongst patients to differentiate between the real and the imagined. A group of researchers at UCSF came up with a set of computerized drills to address the issue. They have named the training process ‘cognitive remediation’. The drills, containing video, audio and emotion identification modules, have been designed to improve basic attention, memory, social and executive cognitive processes in patients. 6 studies with more than 1,000 patients over 6 months to 2 years showed significant improvement in reality monitoring abilities.
The research was triggered by the hope that the process of neuron impairment in patients can be reversed. Researchers had wondered if the malfunctioning neurons that contribute to the illness would respond to intensive focused training. The study has found significant improvements in the activity of the medial prefrontal cortex in the patients, the ‘reality monitoring’ center of the brain. Post-training, subject patients showed improved social functioning and were living better qualities of lives.
There is no FDA-approved medication to address issues such as defective neurons. However, this new behavioral treatment is based on evidence from the studies, all of which show moderate results, especially when the drills are applied along with standard psychiatric rehabilitation. It is already in use in many support centers. However, further research is to be conducted. For instance, researchers are yet to identify exactly which aspects of the training influenced the improved brain activity. Further, generalizations must be removed and so it becomes easier to identify the patients that can be benefited from this treatment.
2. Paliperidone slow release tablets for greater tolerance
The paliperidone extended-release oral tablets were developed to help patients that are intolerant to prescribed anti-psychotic drugs. What elevates this drug, known as an atypical anti-psychotic, is its use of OROS technology, which is a mechanism of osmosis that slows down the release of the drug in the patient’s system to a steady rate, and increases the patient’s tolerance for it. Paliperidone controls the activity of dopamine, like other anti-psychotics. However, it is effective against both negative symptoms as well as positive symptoms in schizophrenic patients, whereas traditional anti-psychotics only address the negative symptoms.
The FDA has already approved the manufacture of the drug for patient use in the form of INVEGA (TM). However, further studies will help clinicians to decide the efficacy, safety of long term use and adverse effects of paliperidone in addition to its influences on mortality, behavior, satisfaction and cost-effectiveness.
3. Cognitive behavioral therapy for better lives
Researchers are always searching for therapeutic methods to improve the ability of patients to live independently in society. A new development by cognitive behavior therapy pioneer, Dr. Aaron T Beck in this area aims to improve the lives of severe schizophrenics who are considered beyond help.
Beck’s therapy targets negative symptoms such as listlessness, the flat effect and isolation by increasing motivation. In a study at the University of Pennsylvania, 31 patients/subjects were guided by experienced psychiatrists working from manuals on how to set achievable targets and then work to meet them. For instance, one target was to correct self-defeating beliefs such as “making new friends is not worth the energy”.
A significant rise in motivation was observed in the patients after 6 months. After 18 months improvements on the Global Assessment Scale were as much as an impressive 10 points. However, more research is required before the therapy can be applied at rehabilitation centers. It takes longer than standard courses, and may not be economically viable for clinics at this point. Moreover, a question often asked is whether the same results, as the highly trained professionals, can be achieved by community therapists.
Via: http://www.beckinstitute.org/, http://www.med.upenn.edu/
4. Kalirin replacement: scope for treatment at the genetic level
A breakthrough discovery made by scientists at Northwestern University’s Feinberg School of Medicine has established that patients with schizophrenia have very low levels of the brain protein kalirin. This adversely affects the formation of neural networks. The research was carried out using mice that were genetically modified to lack the gene that produces kalirin. The mice eventually exhibited delayed onset of schizophrenic tendencies.
Kalirin’s crucial involvement in the creation of dendrites in the spinal cord suggests that lack of the protein can make it difficult for the patient to process information. This discovery can help researchers in their search for kalirin replacements in schizophrenic patients. It may also open doors to gene-based drugs in the form of viral injections or nanoparticles that could help to repair cognitive disabilities. This could be an exciting and progressive direction for research in the near future.
5. Vanderbilt drugs for normal brain function
There is a new breakthrough in the area of research in which scientists have been trying to get brain cells to function more normally in schizophrenia patients. Currently available anti-psychotic drugs cannot treat both positive and negative cognitive and social impairments. Vanderbilt University researchers have discovered a compound that may enable brain cells to function more normally in a patient than is possible today.
Traditional drugs work by inhibiting dopamine and serotonin receptors in the brain. They are able to check hallucinations and delusions but they can’t address attention deficiencies and social withdrawals. The vanderbilt compound on the other hand inhibits glycine transporter 1 and enables the brain to function more normally, without the side effects of traditional drugs.
The research is still at an early stage, but is advanced enough to be handed over by the university to a Boston pharmaceutical company. If it is successfully developed and approved by the FDA, it could give patients of schizophrenia a greater control over their lives and allow them to live independently as they never have.