Rehabilitación de las Funciones Ejecutivas en la Esquizofrenia: Una revisión sistemática

Autores/as

  • Lena Wolnik Master neuropsicología clínica. Aten-D (Madrid), España

DOI:

https://doi.org/10.14198/DCN.2018.5.1.03

Palabras clave:

Esquizofrenia, Rehabilitación Cognitiva, Funciones Ejecutivas, Rehabilitación Neuropsicológica, Funciones Cognitivas

Resumen

Varios estudios señalan una relación entre el limitado rendimiento funcional de las personas afectadas por la esquizofrenia y el funcionamiento cognitivo deficitario, concretamente de las funciones ejecutivas. Se han desarrollado diversos programas de rehabilitación cognitiva para mejorar el rendimiento funcional de estos pacientes. Este articulo revisa la eficacia de los diferentes programas de rehabilitación y de los diferentes enfoques de entrenamiento sobre el rendimiento cognitivo, especialmente de las funciones ejecutivas y el rendimiento funcional de los pacientes. Los artículos revisados apoyan la evidencia de que la rehabilitación cognitiva supone un método prometedor en la terapia de esquizofrenia. A pesar de ello, algunos resultados obtenidos desafían el papel mediador de las funciones ejecutivas sobre el rendimiento funcional de las personas. Sin embargo, se detecta una falta de estudios con un mayor tamaño muestral y una metodología unificada, que posibilite la generalización y la comparación de los resultados obtenidos.

Citas

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013 May 22. doi: https://doi.org/10.1176/appi.books.9780890425596

Palmer B, Heaton RK, Paulsen JS, Kuck J, Braff D, Harris MJ, et al. Is it possible to be schizophrenic yet neuropsychologically normal? Neuropsychology 1997; 11: 437-446. doi: https://doi.org/10.1037/0894-4105.11.3.437

Vita A, De Peri L, Barlati S, Cacciani P, Cisima M, Deste G, et al. Psychopathologic, neuropsychological and functional outcome measures during cognitive rehabilitation in schizophrenia: a prospective controlled study in a real-world setting. Eur Psychiatry 2011; 26(5): 276-83. doi: https://doi.org/10.1016/j.eurpsy.2010.03.008

Royer A, Grosselin A, Bellot C, Pellet J, Billard S, Lang F, et al. Is there any impact of cognitive remediation on an ecological test in schizophrenia? Cogn Neuropsychiatry 2012; 17(1): 19-35. doi: https://doi.org/10.1080/13546805.2011.564512

Tsang MM, Man DW. A virtual reality-based vocational training system (VRVTS) for people with schizophrenia in vocational rehabilitation. Schizophr Res 2013; 144(1): 51-62. doi: https://doi.org/10.1016/j.schres.2012.12.024

Lu H, Li Y, Li F, Jiao X, Shi W, Guo K, et al. Randomized controlled trial on adjunctive cognitive remediation therapy for chronically hospitalized patients with schizophrenia. Shanghai Arch Psychiatry 2012; 24(3): 149-154.

O'Reilly K, Donohoe G, O'Sullivan D, Coyle C, Mullaney R, O'Connell P, et al. Study protocol: A randomised controlled trial of cognitive remediation for a national cohort of forensic mental health patients with schizophrenia or schizoaffective disorder. BMC Psychiatry 2016; 16:5. doi: https://doi.org/10.1186/s12888-016-0707-y

Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry 1996; 153: 321-330. doi: https://doi.org/10.1176/ajp.153.3.321

Gilbert SJ, Burgess PW. Executive function. Curr Biol 2008; 18: R110¬4. doi: https://doi.org/10.1016/j.cub.2007.12.014

Tirapu-Ustárroz J, Cordero-Andrés P, Luna-Lario P, Hernáez-Goñi P. Propuesta de un modelo de funciones ejecutivas basado en análisis factoriales. Rev Neurol 2017: 75-84. doi: https://doi.org/10.33588/rn.6402.2016227

Rohling ML, Faust ME, Beverly B, Demakis G. Effectiveness of cognitive rehabilitation following acquired brain injury: a meta-analytic re-examination of Cicerone et al.'s (2000, 2005) systematic reviews. Neuropsychology 2009; 23: 20-39. doi: https://doi.org/10.1037/a0013659

Twamley EW, Dilip VJ, Bellack AS. A review of cognitive training in schizophrenia. Schizophr Bull 2003; 29: 359-382. doi: https://doi.org/10.1093/oxfordjournals.schbul.a007011

Dirette DK, Hinojosa J, Carnevale G. Comparison of remedial and compensatory interventions for adults with acquired brain injuries. J Head Trauma Rehabil 1999; 14: 595-601. doi: https://doi.org/10.1097/00001199-199912000-00008

Bucci P, Piegari G, Mucci A, Merlotti E, Chieffi M, De Riso F, et al. Neurocognitive individualized training versus social skills individualized training: A randomized trial in patients with schizophrenia. Schizophr Res 2013; 150(1): 69-75. doi: https://doi.org/10.1016/j.schres.2013.07.053

D'Amato T, Bation R, Cochet A, Jalenques I, Galland F, Giraud-Baro E, et al. A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia. Schizophr Res 2011; 125(2-3): 284-290. doi: https://doi.org/10.1016/j.schres.2010.10.023

Rodewald K, Holt DV, Rentrop M, Roesch-Ely D, Liebrenz M, Funke J, et al. Predictors for improvement of problem-solving during cognitive remediation for patients with schizophrenia. J Int Neuropsychol Soc 2014; 20(04): 455-60. doi: https://doi.org/10.1017/S1355617714000162

Bor J, Brunelin J, d'Amato T, Costes N, Suaud-Chagny MF, Saoud M, et al. How can cognitive remediation therapy modulate brain activations in schizophrenia?: An fMRI study. Psychiat Res.- Neuroim 2011; 192(3): 160-6. doi: https://doi.org/10.1016/j.pscychresns.2010.12.004

Rodewald K, Rentrop M, Holt DV, Roesch-Ely D, Backenstraß M, Funke J, et al. Planning and problem-solving training for patients with schizophrenia: a randomized controlled trial. BMC psychiatry 2011; 11(1): 73. doi: https://doi.org/10.1186/1471-244X-11-73

Wykes T, Reeder C. Cognitive Remediation Therapy for Schizophrenia: Theory and Practice. New York:Routledge; 2005. doi: https://doi.org/10.4324/9780203098707

Koren D, Seidman L, Goldsmith M, Harvey P. Real-world cognitive and metacogntive dysfunction in schizophrenia: a new approach for measuring (and remediating) more "right stuff". Schizophr. Bull 2006; 32(2): 310-326. https://doi.org/10.1093/schbul/sbj035

Franck N, Duboc C, Sundby C, Amado I, Wykes T, Demily C, et al. Specific vs general cognitive remediation for executive functioning in schizophrenia: a multicenter randomized trial. Schizophr Res 2013; 147(1): 68-74. doi: https://doi.org/10.1016/j.schres.2013.03.009

Tan BL, King R. The effects of cognitive remediation on functional outcomes among people with schizophrenia: A randomised controlled study. Aust N Z J Psychiatry 2013; 47(11): 1068-80. doi: https://doi.org/10.1177/0004867413493521

Lalova M, Baylé F, Grillon ML, Houet L, Moreau E, Rouam F, et al. Mechanisms of insight in schizophrenia and impact of cognitive remediation therapy. Compr Psychiatry 2013; 54(4): 369-80. doi: https://doi.org/10.1016/j.comppsych.2012.10.005

Vianin P, Urben S, Magistretti P, Marquet P, Fornari E, Jaugey L. Increased activation in Broca's área after cognitive remediation in schizophrenia. Psychiat Res.- Neuroim 2014; 221: 204-209. doi: https://doi.org/10.1016/j.pscychresns.2014.01.004

Sánchez P, Peña J, Bengoetxea E, Ojeda N, Elizagárate E, Ezcurra J, Gutiérrez M. Improvements in negative symptoms and functional outcome after a new generation cognitive remediation program: a randomized controlled trial. Schizophr Bull 2014; 40(3): 707-715. doi: https://doi.org/10.1093/schbul/sbt057

Vita A, De Peri L, Barlati S, Cacciani P, Deste G, Poli R, et al. Effectiveness of different modalities of cognitive remediation on symptomatological, neuropsychological, and functional outcome domains in schizophrenia: A prospective study in a real-world setting. Schizophr Res 2011; 133: 223-231. doi: https://doi.org/10.1016/j.schres.2011.08.010

Buonocore M, Bosia M, Riccaboni R, Bechi M, Spangaro M, Piantanida M, et al. Combined neurocognitive and metacognitive rehabilitation in schizophrenia: Effects on bias against disconfirmatory evidence. Eur Psychiatry 2015; 30(5): 615-21. doi: https://doi.org/10.1016/j.eurpsy.2015.02.006

Vita A, Deste G, De Peri L, Barlati S, Poli R, Cesana BM, et al. Predictors of cognitive and functional improvement and normalization after cognitive remediation in patients with schizophrenia. Schizophr Res 2013; 150(1): 51-7. doi: https://doi.org/10.1016/j.schres.2013.08.011

Iwata K, Matsuda Y, Sato S, Furukawa S, Watanabe Y, Hatsuse N, et al. Efficacy of cognitive rehabilitation using computer software with individuals living with schizophrenia: A randomized controlled trial in Japan. Psychiatr Rehabil J 2017; 40(1): 4-11. doi: https://doi.org/10.1037/prj0000232

Katz N, Keren N. Effectiveness of occupational goal intervention for clients with schizophrenia. Am J Occup Ther 2011; 65(3): 287-96. doi: https://doi.org/10.5014/ajot.2011.001347

Levine B, Robertson IH, Clare L, Carter G, Hong J, Wilson BA, et al. Rehabilitation of executive functioning: An experimental-clinical validation of goal management training. JINS 2000; 6: 299-312. doi: https://doi.org/10.1017/S1355617700633052

Levine B, Stuss, DT, Winocur G, Binns MA, Fahy L, Mandic M, et al. Cognitive rehabilitation in the elderly: Effects on strategic behavior in relation to goal management. JINS 2007; 13: 142-152. doi: https://doi.org/10.1017/S1355617707070178

Cheung LCC, Tsang HWH. Factor structure of essential social skills to be salespersons in retail market: implications for psychiatric rehabilitation. J Behav. Ther Exp Psychiatry 2005; 36: 265-280. doi: https://doi.org/10.1016/j.jbtep.2004.08.006

Farreny A, Aguado J, Ochoa S, Huerta-Ramos E, Marsà F, López-Carrilero R, et al. REPYFLEC cognitive remediation group training in schizophrenia: Looking for an integrative approach. Schizophr Res 2012; 142(1): 137-44. doi: https://doi.org/10.1016/j.schres.2012.08.035

Farreny A, Aguado J, Ochoa S, Haro JM, Usall J. The role of negative symptoms in the context of cognitive remediation for schizophrenia. Schizophr Res 2013; 150(1): 58-63. doi: https://doi.org/10.1016/j.schres.2013.08.008

Gomar JJ, Valls E, Radua J, Mareca C, Tristany J, del Olmo F, et al. A multisite, randomized controlled clinical trial of computerized cognitive remediation therapy for schizophrenia. Schizophr Bull (Bp) 2015; 41(6): 1387-96. doi: https://doi.org/10.1093/schbul/sbv059

Veltro F, Mazza M, Vendittelli N, Alberti M, Casacchia M, Roncone R. A comparison of the effectiveness of problema solving trainig and of cognitive-emotional rehabilitaction on neurocognition, social cognition and social functionong in people with schizophrenia. Clin Pract Epidemiol Ment Health 2011; 7: 123-132. doi: https://doi.org/10.2174/1745017901107010123

Medalia A, Richardson R. What predicts a good response to cognitive remediation interventions? Schizophr Bull 2005; 31(4): 942-953. doi: https://doi.org/10.1093/schbul/sbi045

Fiszdon JM, Cardenas AS, Bryson GJ, Bell MD. Predictors of remediation success on a trained memory task. J Nerv Ment Dis 2005; 193(9): 602-608. doi: https://doi.org/10.1097/01.nmd.0000177790.23311.ba

Kurtz MM, Seltzer JC, Fujimoto M, Shagan DS, Wexler BE. Predictors of change in life skills in schizophrenia after cognitive remediation. Schizophr Res 2009; 107(2-3): 267-274. doi: https://doi.org/10.1016/j.schres.2008.10.014

Frese FJ, Knight EL, Saks E. Recovery from schizophrenia: with views of psychiatrists, psychologists, and others diagnosed with this disorder. Schizophr Bull 2009; 35(2): 370-380. doi: https://doi.org/10.1093/schbul/sbn175

Velligan DI, Kern RS, Gold JM. Cognitive rehabilitation for schizophrenia and the putative role of motivation and expectancies. Schizophr Bull 2006; 32(3): 474-485. doi: https://doi.org/10.1093/schbul/sbj071

Silverstein SM, Wilkniss SM. At issue: the future of cognitive rehabilitation of schizophrenia. Schizophr Bull 2004; 30(4): 679-692. doi: https://doi.org/10.1093/oxfordjournals.schbul.a007122

Demily C, Franck N. Cognitive remediation: a promising tool for the treatment of schizophrenia. Expert Rev Neurotherapeutics 2008; 8(7): 1029-1036. doi: https://doi.org/10.1586/14737175.8.7.1029

Levaux MN, Vezzaro J, Larøi F, Offerlin-Meyer I, Danion JM, Van der Linden M. Cognitive rehabilitation of the updating sub-component of working memory in schizophrenia: a case study. Neuropsychol Rehabil 2009; 19(2): 244-273. doi: https://doi.org/10.1080/09602010802091829

Krabbendam L, Aleman A. Meta-analyses of randomized controlled trials of social skills training and cognitive remediation. Psychol Med 2003; 33(4): 756-758.

Prouteau A, Verdoux H, Briand C, Lesage A, Lalonde P, Nicole L, et al. The crucial role of sustained attention in community functioning in outpatients with schizophrenia. Psychiatry Research 2004; 129(2): 171-177. doi: https://doi.org/10.1016/j.psychres.2004.07.005

Grynszpan O, Perbal S, Pelissolo A, et al. Efficacy and specificity of computer-assisted cognitive remediation in schizophrenia: a meta-analytical study. Psychol Med 2011; 41: 163-173. doi: https://doi.org/10.1017/S0033291710000607

Klingberg S, Wölwer W, Engel C, et al. Negative symptoms of schizophrenia as primary target of cognitive behavioral therapy: results of the randomized clinical TONES study. Schizophr Bull 2011; 37(2): 98-110. doi: https://doi.org/10.1093/schbul/sbr073

Gharaeipour M, Scott BJ. Effects of cognitive remediation on neuro cognitive functions and psychiatric symptoms in schizophreniain patients. Schizophr Res 2012; 142(1): 165-70. doi: https://doi.org/10.1016/j.schres.2012.09.018

Villalta-Gil V, Vilaplana M, Ochoa S, Haro JM, Dolz M, Usall J, Cervilla J, NEDENA Group. Neurocognitive performance and negative symptoms: are they equal in explaining disability in schizophrenia patients? Schizophr Res 2006; 87: 246-253. doi: https://doi.org/10.1016/j.schres.2006.06.013

Ventura J, Hellemann GS, Thames AD, Koellner V, Neuchterlein KH. Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: a meta-analysis. Schizophr Res 2009; 113: 189-199. doi: https://doi.org/10.1016/j.schres.2009.03.035

Bark N, Revheim N, Huq F, Khalderov V, Watras Ganz Z, Medalia A. The impact of cognitive remediation on psychiatric symptoms of schizophrenia. Schizophr Res 2003; 63: 229-235. doi: https://doi.org/10.1016/S0920-9964(02)00374-2

Frith CD. The cognitive neuropsychology of schizophrenia. Lawrence Sussex: Erlbaum Associates;1992.

Wykes T, Reeder C, Huddy V, Taylor R, Wood H, Ghirasim N, Kontis D, Landau S. Developing models of how cognitive improvements change functioning: mediation, moderation and moderated mediation. Schizophr Res 2012; 138: 88-93. doi: https://doi.org/10.1016/j.schres.2012.03.020

Reeder C, Smedley N, Butt K, Bogner D, Wykes T. Cognitive predictors of social functioning improvements following cognitive remediation for schizophrenia. Schizophr Bull 2006; 32: 123-131. doi: https://doi.org/10.1093/schbul/sbl019

Üçok A, Çakır S, Duman ZÇ, Dişcigil A, Kandemir P, Atlı H. Cognitive predictors of skill acquisition on social problem solving in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2006; 256: 388-394. doi: https://doi.org/10.1007/s00406-006-0651-9

Kopelowicz A, Liberman RP, Ventura J, Zarate R, Mintz J. Neurocognitive correlates of recovery from schizophrenia. Psychol Med 2005; 35: 1165-1173. doi: https://doi.org/10.1017/S0033291705004575

Wykes T, Reeder C, Landau S, Everitt B, Knapp M, Patel A, et al. Cognitive remediation therapy in schizophrenia: Randomised controlled trial. Br J Psychiatry 2007; 190: 421-427. doi: https://doi.org/10.1192/bjp.bp.106.026575

Eack SM, Pogue-Geile MF, Greenwald DP, Hogarty SS, Keshavan MS. Mechanisms of functional improvement in a 2-year trial of cognitive enhancement therapy for early schizophrenia. Psychol Med 2011; 41: 1253-1261. doi: https://doi.org/10.1017/S0033291710001765

Green MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the"right stuff"? Schizophr Bull 2000; 26: 119-136. doi: https://doi.org/10.1093/oxfordjournals.schbul.a033430

Mueller DR, Roder V. Integrated psychological therapy and integrated neurocognitive therapy (INT). In: Roder V, Medalia A, eds. Neurocognition and Social Cognition in Schizophrenia Patients. Basic Concepts and Treatment. Basel, Switzerland: Karger; 2010: 118-144. doi: https://doi.org/10.1159/000284383

Fett AK, Viechtbauer W, Dominguez MD, Penn DL, van Os J, Krabbendam L. The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neurosci Biobehav Rev 2011; 35: 573-588. doi: https://doi.org/10.1016/j.neubiorev.2010.07.001

Irani F, Seligman S, Kamath V, Kohler C, Gur RC. A meta- analysis of emotion perception and functional outcomes in schizophrenia. Schizophr Res 2012; 137: 203-211. doi: https://doi.org/10.1016/j.schres.2012.01.023

Mueller DR, Schmidt SJ, Roder V. One-year randomized controlled trial and follow-up of integrated neurocognitive therapy for schizophrenia outpatients. Schizophr Bull 2015; 41(3): 604-16. doi: https://doi.org/10.1093/schbul/sbu223

Rispaud SG, Rose J, Kurtz MM. The relationship between change in cognition and change in functional ability in schizophrenia during cognitive and psychosocial rehabilitation. Psychiatry Res 2016; 244: 145-50. doi: https://doi.org/10.1016/j.psychres.2016.07.033

Rassovsky Y, Horan WP, Lee J, Sergi MJ, Green MF. Pathways between early visual processing and functional out- come in schizophrenia. Psychol Med 2011; 41: 487-497. doi: https://doi.org/10.1017/S0033291710001054

Green MF, Hellemann G, Horan WP, Lee J, Wynn JK. From perception to functional outcome in schizophrenia: modeling the role of ability and motivation. Arch Gen Psychiatry 2012; 69: 1216-1224. doi: https://doi.org/10.1001/archgenpsychiatry.2012.652

Drake R, Lewis SW. Insight and neurocognition in schizophrenia. Schizophr Res 2003; 62: 165-73. doi: https://doi.org/10.1016/S0920-9964(02)00382-1

Lysaker PH, Whitney KA, Davis LW. Awareness of illness in schizophrenia: associations with multiple assessments of executive function. J Neuropsychiatry Clin Neurosci 2006; 18(4): 516-20. doi: https://doi.org/10.1176/jnp.2006.18.4.516

Rossell SL, Coakes J, Shapleske J, Woodruff PWR, David AS. Insight: its relationship with cognitive function, brain volume and symptoms in schizophrenia. Psychol Med 2003; 33: 111-9. doi: https://doi.org/10.1017/S0033291702006803

David AS. Insight and psychosis. Br J Psychiatry 1990; 156: 798-808. doi: https://doi.org/10.1192/bjp.156.6.798

Glahn DC, Ragland JD, Abramoff A, Barrett J, Laird AR, Bearden CE, Velligan DI. Beyond hypofrontality: A quantitative meta-analysis of functional neuroimaging studies of working memory in schizophrenia. Hum Brain Mapp 2005; 25: 60-69. doi: https://doi.org/10.1002/hbm.20138

Minzenberg MJ, Laird AR, Thelen S, Carter CS, Glahn DC. Meta-analysis of 41 functional neuroimaging studies of executive function in schizophrenia. Arch Gen Psychiatry 2009; 66: 811-822. doi: https://doi.org/10.1001/archgenpsychiatry.2009.91

Meyer-Lindenberg AS, Olsen RK, Kohn PD, Brown T, Egan MF, Weinberger DR, Berman KF. Regionally specific disturbance of dorsolateral prefrontal-hippocampal functional connectivity in schizophrenia. Arch Gen Psychiatry 2005; 62: 379-386. doi: https://doi.org/10.1001/archpsyc.62.4.379

Penadés R, Pujol N, Catalán R, Massana G, Rametti G, García-Rizo C, et al. Brain effects of cognitive remediation therapy in schizophrenia: a structural and functional neuroimaging study. Biol Psychiatry 2013; 73(10): 1015-23. doi: https://doi.org/10.1016/j.biopsych.2013.01.017

Broyd SJ, Demanuele C, Debener S, Helps SK, James CJ, Sonuga-Barke EJ. Default-mode brain dysfunction in mental disorders: A systematic review. Neurosci Biobehav Rev 2009; 33: 279-296. doi: https://doi.org/10.1016/j.neubiorev.2008.09.002

Garrity AG, Pearlson GD, McKiernan K, Lloyd D, Kiehl KA, Calhoun VD. Aberrant "default mode" functional connectivity in schizophrenia. Am J Psychiatry 2007; 164: 450-457. doi: https://doi.org/10.1176/ajp.2007.164.3.450

Wykes T, Brammer M, Mellers J, Bray P, Reeder C, Williams C, Corner J. Effects on the brain of a psychological treatment: cognitive remediation therapy: functional magnetic resonance imaging in schizophrenia. Br J Psychiatry 2002; 181: 144-152. doi: https://doi.org/10.1017/S0007125000161872

Penadés R, Boget T, Lomena F, Mateos JJ, Catalan R, Gasto C, Salamero M. Could the hypofrontality pattern in schizophrenia be modified through neuropsychological rehabilitation? Acta Psychiatr Scand 2002; 105(3): 202-208. doi: https://doi.org/10.1034/j.1600-0447.2002.1o421.x

Medalia A, Choi J. Cognitive remediation in schizophrenia. Neuropsychol Rev 2009; 19: 353-364. doi: https://doi.org/10.1007/s11065-009-9097-y

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15-01-2018

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Wolnik, L. (2018). Rehabilitación de las Funciones Ejecutivas en la Esquizofrenia: Una revisión sistemática. Revista De Discapacidad, Clínica Y Neurociencias, 5(1), 31–57. https://doi.org/10.14198/DCN.2018.5.1.03

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