Tuesday, January 22, 2019

Guanfacine May Enhance Effects of Social, Cognitive Therapy for Patients With Schizotypal Personality Disorder

Guanfacine, a medication believed to help enhance cognitive function, appears to improve reasoning and problem solving among patients with schizotypal personality disorder when combined with cognitive and social skills training, according to a report in AJP in Advance.

Schizotypal personality disorder is characterized by a pattern of social and interpersonal deficits including eccentric behavior and unusual thoughts. Cognition, the ability to think and reason, has been shown to be highly correlated with functional outcome in patients with schizophrenia spectrum disorders, including schizotypal personality disorder.

“[T]hese results suggest that this agent [guanfacine], which is hypothesized to enhance an individual’s attentional ability, augments the results of cognitive remediation and social skills training,” wrote Margaret McClure, Ph.D., of Mt. Sinai Icahn School of Medicine and colleagues.

The researchers randomly assigned 28 patients with schizotypal personality disorder to either guanfacine (2.0 mg/day) or placebo combined with cognitive remediation and social skills training for eight weeks. Cognitive remediation was administered using a multimedia computer software program with problem-solving exercises. Twice-weekly social skills training groups were led by a doctoral-level clinical psychologist.

The researchers measured five domains of cognition—speed of processing, working memory, verbal learning, visual-spatial learning, and reasoning and problem solving—using the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery (MCCB). Four domains of functioning—comprehension/planning, finance, communication, and transportation/mobility—were also assessed using the University of California San Diego Performance-Based Skills Assessment (UPSA). Patients in the study also participated in the Movie for the Assessment of Social Cognition (MASC), which involves watching a 15-minute movie about four characters getting together for a dinner party. Throughout the movie, the video is paused to ask participants questions concerning the characters’ feelings, thoughts, and intentions.

Participants treated with cognitive remediation, social skills training, and guanfacine demonstrated statistically significant improvements in reasoning and problem solving, as well as in functional capacity, compared with those treated with cognitive remediation, social skills training, and placebo. Patients in the guanfacine group also performed better on the MASC assessment, though the results fell short of statistical significance.

“The results of our study suggest that cognitive remediation and social skills training are an effective intervention for improving cognitive performance and functional skills in individuals with schizophrenia spectrum disorders and that guanfacine is a promising agent for enhancing the effectiveness of the intervention,” McClure and colleagues wrote. “Because cognitive impairments are closely linked to functional outcomes for individuals across the schizophrenia spectrum, this augmented therapy is an important next step in improving real-world outcomes for individuals with these disorders.”

For related information, see the Psychiatric News article “Handgrip Linked to Cognition in Mood Disorders, Schizophrenia.”

(Image: iStock/Squaredpixels)

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