Abstract
Objectives The aim of this study was to use neurofeedback (NF) training as the add-on therapy in patients with schizophrenia to improve their clinical, cognitive, and psychosocial condition. The study, thanks to the monitoring of various conditions, quantitative electroencephalogram (QEEG) and brain-derived neurotrophic factor (BDNF), was supposed to give an insight into mechanisms underlying NF training results. Methods Forty-four male patients with schizophrenia, currently in a stable, incomplete remission, were recruited into two, 3-month rehabilitation programs, with standard rehabilitation as a control group (R) or with add-on NF training (NF). Pre- and posttherapy primary outcomes were compared: clinical (Positive and Negative Syndrome Scale (PANSS)), cognitive (Color Trails Test (CTT), d2 test), psychosocial functioning (General Self-Efficacy Scale (GSES), Beck Cognitive Insight Scale (BCIS), and Acceptance of Illness Scale (AIS)), quantitative electroencephalogram (QEEG), auditory event-related potentials (ERPs), and serum level of BDNF. Results. Both groups R and NF improved significantly in clinical ratings (Positive and Negative Syndrome Scale (PANSS)). In-between analyses unveiled some advantages of add-on NF therapy over standard rehabilitation. GSES scores improved significantly, giving the NF group of patients greater ability to cope with stressful or difficult social demands. Also, the serum-level BDNF increased significantly more in the NF group. Post hoc analyses indicated the possibility of creating a separate PANSS subsyndrome, specifically related to cognitive, psychosocial, and BDNF effects of NF therapy. Conclusions Neurofeedback can be effectively used as the add-on therapy in schizophrenia rehabilitation programs. The method requires further research regarding its clinical specificity and understanding mechanisms of action.
Highlights
Schizophrenia is a chronic and relapsing disease characterized by the occurrence of delusions and hallucinations and by the progressive development of cognitive and social deficits [1, 2]
NF training is a relatively new, noninvasive therapeutic method that is being tested in current schizophrenia studies and gives hope for improving the effectiveness of its therapy [24]
NF training, based on classical feedback between the behavioral activity and neurophysiological functioning, made it possible to obtain results going beyond simple compensation of disease deficits
Summary
Schizophrenia is a chronic and relapsing disease characterized by the occurrence of delusions and hallucinations and by the progressive development of cognitive and social deficits [1, 2]. Up to one-half of the patients remain residual or actively psychotic despite optimal pharmacological treatment [9]. Those patients should be offered any of various rehabilitation programs. Optimal treatment of schizophrenia remains a strategic challenge and should integrate various and specific psychosocial interventions in addition to the optimal use of medications [10]. Looking for new, more effective methods of treatment and rehabilitation of schizophrenia, systematic attempts are being made to use neurofeedback (NF) [11].
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