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Schizophrenia “Following MATRICS, there has been a huge interest on the part of both the pharmaceutical industry and academia in targeting these domains for schizophrenia for which there have never been effective treatments,” Dr. Marder says. Facilitated by the methods developed in the UCLA-led initiative, a number of promising drugs targeting either the cognitive or negative symptoms have moved into late-stage clinical trials and could be approved by the U.S. Food and Drug Administration sometime in 2014. At the same time, Dr. Marder notes, there has been substantial activity in the use of various cognitive-training programs designed to help patients improve memory, attention and social cognition. “A number of studies have shown these treatments to be effective,” says Dr. Marder. Effective programs he, Dr. Green and William Horan, PhD, have studied include group-based psychosocial approaches that employ videos and other tools to assist patients in recognizing facial expressions, emotions and gestures. In the UCLA Aftercare Research Program, an outpatient clinic of the Jane and Terry Semel Institute of Neuroscience and Human Behavior at UCLA directed by Keith Nuechterlein, PhD, which provides diagnosis and treatment services for early-phase schizophrenia patients, faculty have found that Internet-based programs that present a series of challenging mental tasks can, over time, build patients’ cognitive skills in a way that may help them at work and in social interactions. “Cognitive skills are associated with success at work and school,” says Joseph Ventura, PhD, senior research psychologist and the program’s “This is a very exciting period in the development of treatments for schizophrenia. There are already some new approaches offering benefits out there, with a very strong possibility of other treatments becoming available very soon.” director of cognitive remediation. “Most people diagnosed with schizophrenia have deficits — often substantial — in areas such as attention, focus, reasoning, problem solving and the ability to learn new information, and these can be the primary reasons they have trouble in daily living. The premise of this type of training is based on the plasticity of the brain — its ability to respond to environmental stimulators in a way that can improve neuronal connections and improve the brain’s performance.” The group led by Drs. Nuechterlein and Ventura has studied the impact of programs that engage participants in computer-based games in which they are challenged to improve on their performance. The researchers conduct a series of cognitive tests both before and after six months of training to determine the extent to which the skills honed in the computer exercises improve overall cognition. The studies have found that participants show a moderate degree of improvement in the cognitive tasks after the six- month training. In addition, study participants showed moderate improvement in their level of engagement in workplace activities. The UCLA researchers are now seeking to determine the optimal level of training for patients, the sustainability of the effects, and how to modify programs to help participants who fail to respond to the training. The need for medical treatments to improve cognition and negative symptoms for people with schizophrenia led the National Institute of Mental Health to fund a large initiative, based at UCLA. “We are very encouraged,” says Dr. Ventura. “We see this type of cognitive training as potentially being one component of a larger package of treatment for people with schizophrenia. It’s not going to replace drug treatment, case management and psychosocial support, but it can be a good complement that, in combination with these other strategies, can significantly improve these patients’ quality of life.” 5 UCLA Physicians Update