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Towards Medication-Enhancement of Cognitive Interventions in Schizophrenia

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Novel Antischizophrenia Treatments

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 213))

Abstract

Current antipsychotic medications do little to improve real-life function in most schizophrenia patients. A dispassionate view of the dispersed and variable neuropathology of schizophrenia strongly suggests that it is not currently, and may never be, correctable with drugs. In contrast, several forms of cognitive therapy have been demonstrated to have modest but lasting positive effects on cognition, symptoms, and functional outcomes in schizophrenia patients. To date, attempts to improve clinical outcomes in schizophrenia by adding pro-cognitive drugs to antipsychotic regimens have had limited success, but we propose that a more promising strategy would be to pair drugs that enhance specific neurocognitive functions with cognitive therapies that challenge and reinforce those functions. By using medications that engage spared neural resources in the service of cognitive interventions, it might be possible to significantly enhance the efficacy of cognitive therapies. We review and suggest several laboratory measures that might detect potential pro-neurocognitive effects of drugs in individual patients, using a “test dose” design, aided by specific biomarkers predicting an individual’s drug sensitivity. Lastly, we argue that drug classes viewed as “counter-intuitive” based on existing models for the pathophysiology of schizophrenia—including pro-catecholaminergic and NMDA-antagonistic drugs—might be important candidate “pro-cognitive therapy” drugs.

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Acknowledgments

The authors acknowledge the valuable assistance of Ms. Maria Bongiovanni and Ms. Jo Talledo in the preparation of this manuscript. NRS was supported by MH093453, MH059803; MH042228 and a PALA Award from the VISN-22 MIRECC; HHC was supported by 5T32MH018399 – 25 and MH093453; ET was supported by MH080150.

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  1. Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0804, USA

    Hsun-Hua Chou, Elizabeth Twamley & Neal R. Swerdlow

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  1. Hsun-Hua Chou
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  2. Elizabeth Twamley
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  3. Neal R. Swerdlow
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Correspondence to Neal R. Swerdlow .

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  1. Dept. Psychiatry, University of California San Diego, Gilman Drive 9500, La Jolla, 92093-0804, California, USA

    Mark A. Geyer

  2. Institut für Pharmakologie, Universität, Neuroscience Research, Abbott GmbH & Co. KG, Knollstraße, Ludwigshafen, 67061, Germany

    Gerhard Gross

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Chou, HH., Twamley, E., Swerdlow, N.R. (2012). Towards Medication-Enhancement of Cognitive Interventions in Schizophrenia. In: Geyer, M., Gross, G. (eds) Novel Antischizophrenia Treatments. Handbook of Experimental Pharmacology, vol 213. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-25758-2_4

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