Cognitive Pragmatic Rehabilitation Program in Schizophrenia: A Single Case fMRI Study

Abstract

Introduction. The present study was intended to evaluate the effects of a rehabilitative training, the Cognitive Pragmatic Treatment (CPT), aimed at improving communicative-pragmatic abilities and the related cognitive components, on the cerebral modifications of a single case patient diagnosed with schizophrenia. Methods. The patient underwent two functional magnetic resonance imaging (fMRI) sessions, before and after the treatment. In order to assess brain changes, we calculated the Amplitude of Low Frequency Fluctuation (ALFF) index of the resting-state fMRI signal, which is interpreted as reflecting the intensity of the spontaneous regional activity of the brain. Behavioural measures of the patient's communicative performance were also gathered before and after training and at follow-up. Results. The patient improved his communicative performance in almost all tests. Posttraining stronger ALFF signal emerged in the superior, inferior, and medial frontal gyri, as well as the superior temporal gyri. Conclusions. Even if based on a single case study, these preliminary results show functional changes at the cerebral level that seem to support the patient's behavioural improvements.

The Ability of Patients With Schizophrenia to Comprehend and Produce Sincere, Deceitful, and Ironic Communicative Intentions: The Role of Theory of Mind and Executive Functions

“…According to the theory, these assumptions hold both for communicative acts expressed using both language and extralinguistic means, for example, gestures (see Bara and Tirassa, 1999) and hold both in cases of comprehension and production of a communicative act. A similar trend of increasing difficulty in the comprehension and production of communicative acts proffered with the intention to be sincere, ironic or deceitful has been detected in several studies (Angeleri et al, 2008; Bosco and Bucciarelli, 2008; Gabbatore et al, 2017). However, an alternative explanation for this trend of increasing difficulty could be a primary and increasing role of the EF and ToM involved in the comprehension and production of the abovementioned pragmatic phenomena.…”

Communicative-pragmatic abilities mediate the relationship between cognition and daily functioning in schizophrenia.

“…Therefore, as for cognitive and sociocognitive trainings, rehabilitative interventions targeting pragmatics are likely to impact daily activities, by enhancing different domains of functioning. Up to now only a small number of pragmatic treatments have been developed (Bambini, Tonini, et al, 2020; Blake et al, 2013; Lundgren et al, 2016) and very few have been tested in schizophrenia (Bosco et al, 2016; Gabbatore et al, 2017). The evidence collected here should thus promote the development of interventions aimed at enhancing pragmatics, in the context of individualized programs tailored to each individual’s neuropsychological and functional profile, with the final aim to promote recovery, thus allowing for a full participation in society.…”

Pragmatics, Theory of Mind and executive functions in schizophrenia: Disentangling the puzzle using machine learning

“…Communicative-pragmatic difficulty has been associated with a reduction in quality of life, early age of onset, and poor response to treatment [38,86,87], and can thus contribute to the poor social functioning exhibited by patients with schizophrenia. The identification of communicative difficulties as an important factor in predicting SCZ may contribute to improving and refining existing rehabilitative training [88,89,90], psychoeducational programs and clinical interventions aimed at reducing relational and social impairments typical of the illness. However, our results also confirm the role played by other factors, i.e.…”