Wednesday, July 27, 2016

The Worst Part Of Schizophrenia Isn’t What You Think It Is

That is the title of this article I am reviewing today and this is the last part of two parts. "'It’s like having a personal trainer in the gym, keeping you in just the right zone to build strength and fitness, without slacking or overtraining. And like a physical fitness regime, improvement only comes with persistence — Vinogradov’s experiments typically involve up to 50 hours of training, given over 8 to 10 weeks. 'If you don’t do it intensively, you’re not going to get the same results,' Vinogradov told BuzzFeed News. 'You need to come back every three days, and do your reps again.' After his first psychotic episode, Staglin returned to his classes at Dartmouth College in New Hampshire, but his grades plummeted. He was eventually able to drag them back up, but only by isolating himself socially to devote his mental energy to his studies. Reading was an effort. He felt socially awkward and struggled to make friends. After college, Staglin worked for a satellite engineering company in Palo Alto, California, and was applying to grad school at MIT when the pressure became too much again. 'I had to resign from my job. I couldn’t focus. I couldn’t concentrate,' Staglin said.
It wasn’t until the late 1990s that Staglin took part in some of Vinogradov’s earliest experiments, which were designed to help people with schizophrenia make sense of speech and other sounds. Among other tasks, he had to tell whether a rapidly played tone was rising or falling in pitch. Staglin diligently did his reps and saw some benefits after many years of struggling with the cognitive symptoms of schizophrenia.'" After my first episode of mental illness I do not think I could concentrate on anything.  An example when I had a episode in the state hospital I was in school there and could not concentrate on anything I asked the teacher to take me back to the ward.
The article goes on to say: "'For Staglin, realizing that he was getting better at the games boosted his confidence. As his performance improved, he became more outgoing. 'I think it’s because of the cognitive benefits of being able to perceive and understand conversations better,' he said.
Despite the initial experiment’s benefits to Staglin and other volunteers, it took several years to win funding for the work. In their first major study, published in 2009, Vinogradov’s team invited people with schizophrenia to visit their lab and play a variety of games to improve how they understood sounds. As well as distinguishing the rising or falling tones, they also had to distinguish between distorted syllables containing similar sounds, such as 'pag' and 'bag,' and were given more complex tasks including remembering details from conversations played on the screen. The volunteers who’d trained on these tasks subsequently took tests in which they had to recall words. They performed better than a control group who had trained on computer puzzle games. They also did better on general tests of cognitive ability. Encouragingly, the gains were about twice as large as those typically reported in previous cognitive training studies. And the benefits could still be seen six months later.
Since this initial success, Vinogradov and her colleagues have experimented with different training games, some targeting brain circuits that process social information — for example, by asking volunteers to read the emotions on pictures of people’s faces. The researchers have also tried to intervene earlier in the disorder. (Like Staglin and Webster, most people with schizophrenia experience their first psychotic episode as young adults.)  Last year at the International Congress on Schizophrenia Research in Colorado Springs, Vinogradov’s team reported that the training did more than boost the cognitive abilities of recently diagnosed young people: It also seemed to reduce the severity of their psychotic symptoms, measured six months later.'" The games I played did not have sounds they were pictures of birds and you had to remember them.  They were not all birds but picture of things that you had to remember that is why the guy that took them with me said they did not work because it was memory.
The article ends: "'That doesn’t mean that brain training can replace the drugs that keep hallucinations and delusions at bay. But it suggests that the games may help to protect the brain from the disrupted wiring that is thought to be the root cause of schizophrenia’s symptoms. The researchers want to turn the cognitive improvements into real life-changers, but it’s not yet clear whether the training can make a big difference to holding down a job and building friendships. Vinogradov thinks this may require combining the computer games with other treatments, such as occupational therapy to help people with schizophrenia manage everyday tasks, and low doses of stimulant drugs that can improve focus. Webster got involved in Vinogradov’s research last year, volunteering for a study to see whether the training would work on an iPad — so that young people with schizophrenia can give their brains a workout at home. Like Staglin, Webster had struggled with mental tasks and felt socially isolated. These problems were compounded, he said, by several concussions during his time in jail, when he was beaten by fellow inmates. Unfamiliar with the jail’s unspoken rules, he first got into trouble by sitting in a part of the canteen claimed by black prisoners. After his release, Webster found it difficult to resume his studies. 'I would do homework and I would feel that I had to get up and stop and go listen to music or something,' Webster said. Trying to keep working wasn’t a good idea, he found: 'I get extremely frustrated when I’m in that state. I’ll start slamming doors and stuff, and throwing things across the room.'  Webster felt that the iPad training helped. 'I started noticing that I was less anxious when I was in public,' he said. 'My thoughts became less disorganized.'
Games designed to help a patient understand what they are seeing, in particular, seemed to boost his peripheral vision, increasing his awareness while driving. And his mom noticed that he responded more quickly when they talked — previously, their conversations had been punctuated by long pauses. Still, Webster would often quit the games before he was supposed to, because he found the exercises boring. 'I was supposed to do five hours a week. I ended up doing three,' he said. 'With schizophrenia, it’s really common to have a lack of motivation.' Cameron of UC Davis, who has collaborated with Vinogradov’s group, believes that the computer games industry — masters of cliff-hangers and cinematic thrills — should be able to solve that problem.  Vinogradov's team is  now concentrating on intervening even earlier, in young people who haven’t experienced a full-blown psychotic episode but are starting to behave oddly or having trouble distinguishing dreams from reality. The researchers have already shown that the training helps young people rated at high risk of developing psychosis get better at remembering words. But the idea of starting treatment before people have experienced a psychotic break is controversial. 'Attenuated psychosis syndrome,' intended to describe people at risk of schizophrenia, was rejected  as a new psychiatric diagnosis in 2012. Critics argued that more than 70% of young people who have strange thoughts and minor hallucinations do not go on to develop schizophrenia. If this diagnosis became mainstream, they worried, it could lead to a massive and unwarranted expansion in the prescription of powerful antipsychotic drugs. Getting young people to play computer games doesn’t arouse quite the same fears. 'Cognitive training is probably benign enough,' Allen Frances of Duke University, who led the opposition to the proposed diagnosis, told BuzzFeed News by email. But he remains worried about young people who may never develop schizophrenia being stigmatized by an 'at risk' label.
Webster would have welcomed the opportunity to seek early treatment. He began to have problems concentrating from the age of 14, and found it hard to socialize with other kids. 'I think my life would have different,' he said, 'if they’d caught this disease before I had a full-blown episode.'" Yeah you have to worry that the games get boring.  That is what happened to us that tried the games here at work. I could do better at remembering everyday that I would not play it every morning like I was supposed to.

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