Researchers testing potential treatment for schizophrenia
BY KATHY CHANG Staff Writer
For the past five years, lead researchers Dr. StevenM. Silverstein, ofMetuchen, and Dr. Stephanie Marcello, of Princeton, with the University of Medicine and Dentistry of New Jersey (UMDNJ)- University Behavioral Healthcare, Newark, have been applying a reward-based learning and attention-shaping method to enhance skills training in schizophrenia patients.

"People with schizophrenia have severe problems paying attention, which is a common symptom," said Silverstein, who has been with University Behavioral Healthcare for a little over two years.

The doctor said "a bad attention span" limits what a person can do, whether it is working on a job or learning the skills to live independently.

"Our treatment helps peoplewith chronic schizophrenia [learn] how to manage their own medication, how to meet new people, how to avoid substance abuse, and more," said Silverstein.

The research team at University Behavioral Healthcare is seeking persons with chronic schizophrenia who are interested in participating in a study using the attentionshaping method to improve their attention span while working toward learning and developing life skills.Men and women between the ages of 18 and 55 are eligible to be considered for acceptance into the study.

Silverstein and Marcello have more than three years remaining in the study that coaches patients in a skills-training group setting, providing equal focus on the content of the group and the level of attentiveness of individual participants.

The doctors and their colleagues started researching the attention-shapingmethod in themid-1990s,when they began treating one patient at a time.

Schizophrenia, according to the National Institute of Mental Health, is a chronic, severe and disabling brain disorder that has been recognized throughout recorded history. People with schizophrenia may hear voices, andmay believe that others are reading their minds or plotting to harm them.

Silverstein said these "thoughts" or "voices" that people with schizophrenia have are not good thoughts.

"But we can work with a person who says, 'I'm the devil'week after week on challenging the person to learn that he or she is not the devil,"he said. "Wehave themtelluswhat they believewill happen, and test out their theory."

The symptoms of schizophrenia fall into three broad categories: positive, negative, and cognitive.

Positive symptoms are unusual thoughts or perceptions, including hallucinations, delusions, thought disorder, and disorders of movement.

Negative symptoms represent a loss or a decrease in the ability to initiate plans, speak, express emotion or find pleasure in everyday life. These symptoms are harder to recognize as part of the disorder and can be mistaken for laziness or depression.

Cognitive symptoms are problems with attention, certain types of memory, and the executive functions that allow us to plan and organize. Cognitive deficits can also be difficult to recognize as part of the disorder, but are the most disabling in terms of leading a normal life.

"Currently, people generally recognize that while medications are helping people with schizophrenia or psychotic disorders, they really just control the main symptoms, like hearing voices or delusional ideas," said Silverstein. "They don't really help much with problems like distractibility and poor memory,which are actually the ones that are more related to how people function at work and in relationships."

The method involves small class sessions of eight patients who have chronic schizophrenia, working on alternating the behavior of each patient.

The classes last a few weeks.

"For example, if a person has only a oneminute attention span, we want to expand that to one and a half minutes, and so on … once that increased time is reached, we give the person a lot praise, so it gives the person an awareness that increasing their attention span is a good thing," Silverstein said.

"If a person is inattentive, their clock is started again and no praise is given," he said. "Rewards are given at the end of the class, such as a ticket for a free cup of coffee, snacks or even money. The point for this is, who meets their goal andwho doesn't.Wewant to create a culture of succeeding."

Silverstein added that attention and motivation are related.

"Having a person pay attention and praising them with tickets, it's attention reinforcement," he said. "The person can learn to do well and meet their goals gradually, they can see the people around them experience success, which willmotivate themmore, and they can see that they can do it."

Silverstein said he has seen patients succeed with the attention-shaping method.

"Patients have started out with a 30-second attention span and I've seen it increase to 45 to 50 minutes [which is the length of the class]," he said.

The current study is the largest one to date. Itwill look at outcomes beyond those examined in the past studies, including whether people receiving the attention-shapingmethod are able to pay attentionmore in other treatment groups, whether the attentiveness gains last up to sixmonths after the study participation ends, and whether the skills that are learned in the groups lead to improvements in their social lives.

An earlier study of theAttention Shaping intervention, published in 2008 in "Schizophrenia Bulletin," determined that patients receiving social skills training augmented withAttention Shaping demonstrated significantly more attentiveness in group sessions and a higher level of acquired skills.

Silversteinsaid researchshows that factors leading to schizophrenia involve social and environmental stress and substance abuse.

"Schizophrenia tends to start in men when they are between the ages of 18 and 26 and when women are between the ages of 23 and 29," he said.

Prospective participants will be required to complete an evaluation and meet specific criteria. Interested persons should call (732) 235-9281 or e-mail schizophrenia.re source@umdnj.edu.