June 29, 2023
US Pharmacist
Staff Reporter

In a recent publication in the journal Schizophrenia Research, the authors revealed that a specific type of computerized brain training was “an effective nonpharmacological treatment in decreasing impulsive aggression” in patients with schizophrenia who had a history of aggressive episodes.

The authors indicated that compared with other psychiatric and general population samples, schizophrenia is correlated with a “4- to 6-fold increase in the risk of engaging in verbal and physical threats and a 4- to 7-fold increase in the risk of violent acts.”

The authors wrote, “Schizophrenia is associated with an elevated risk for impulsive aggression for which there are few psychosocial treatment options. Neurocognitive and social cognitive deficits have been associated with aggression, with social cognitive deficits seemingly a more proximal contributor.”

In this study, researchers conducted a two-center randomized, controlled trial at New York inpatient tertiary care psychiatric facilities (Manhattan Psychiatric Center and the Psychotic Disorder Division at New York Presbyterian Hospital Westchester Behavioral Health Center) in agreement with the Declaration of Helsinki.

The study involved 130 participants (68 were randomized to the Cognitive Remediation Training [CRT] plus control group and 62 were randomized to the CRT plus Social Cognition Training [SCT] group). The participants received 36 sessions of either a combination of cognitive remediation and social cognition treatment or cognitive remediation plus a computer-based control. The participants had at least one aggressive incident within the past year or a Life History of Aggression (LHA) score of 5 or more. At baseline and endpoint, participants completed measures of neurocognition, social cognition, symptom severity, and aggression. This study employed the brain training app known as BrainHQ from Posit Science. The social cognition exercises employed were from a computerized program called MRIGE.

The intervention group was requested to utilize BrainHQ exercises for 24 1-hour sessions of cognitive remediation training plus 12 1-hour sessions of social cognition exercises, and the control group was asked to use BrainHQ for 24 1-hour sessions plus 12 1-hour control sessions of computer games.

The study’s primary objective was to examine the effects of combining cognitive remediation and social cognition training compared with CRT alone on impulsive aggression among individuals with schizophrenia with a history of aggression.

The authors wrote, “We hypothesized that the combined CRT plus SCT intervention would show greater improvements in cognitive functions and aggression as compared to CRT alone.”

The results revealed that 84.5% of study participants were male, had an average age of 34.9 years, and had 11.5 years of education. The researchers discovered that both CRT plus SCT and CRT plus control groups were linked with noteworthy decreases in aggression measures with no group variances except on a block of the Taylor Aggression Paradigm (TAP), a behavioral task of aggression which favored the CRT plus SCT group. Moreover, both groups demonstrated substantial improvements in neurocognition and social cognition measures, with CRT plus SCT associated with more significant improvements.

Based on their findings, the authors concluded, “CRT proved to be an effective nonpharmacological treatment in reducing impulsive aggression in schizophrenia in patient participants with a history of aggressive episodes. The addition of social cognitive training did not enhance this anti-aggression treatment effect but did augment the CRT effect on cognitive functions, on emotion recognition, and on mentalizing capacity of our participants.”

In a press release on Globe Newswire, Henry Mahncke, PhD, CEO of Posit Science, stated, “There are now more than 70 peer-reviewed papers on the impact of BrainHQ on people with schizophrenia. Collectively, these results point to an important potential treatment path that would benefit from greater research funding.”

Dr. Mahncke added, “Social and emotional function is sometimes viewed as distinct from cognitive function, but these new results confirm that these brain functions are deeply interrelated and suggest that improving foundational cognitive performance may help people with schizophrenia in broad aspects of their daily lives, including interpersonal interactions.”