A REHABILITATION PROGRAM BASED ON COGNITIVE IMPAIRMENT

AND PSYCHOPATHOLOGY IN CHRONIC PSYCHIATRIC PATIENTS

Maria-Christina Ragousi, Maria Spanou, Sofia Karapanou, Nektarios Tapeinos, Orestis Giotakos
‘’Epanentaxi’ Psychosocial Rehabilitation Unit, N.G.O “Solidarity”of the Orthodox Church of Greece www.solidarity.gr

ABSTRACT

The aim of the present study is to investigate the relation between cognitive impairment and different
psychopathologies, in chronic psychiatric patients. The study was conducted with the participation of the
TABLE 5. CORRELATION COEFFICIENT
BPRS MMSE
residents of “Epanentaxi” Psychosocial Rehabilitation Unit, which operates under the flagship of the national
DIAGNOSTIC CATEGORIES CORRELATION COEFFICIENT
(a) (b)

psychiatric reform program “Psychargos” that aims to eliminate the phenomenon of chronic institutionalization
3,48% 50%
1,69% 0% -1 ≤ 1
in Psychiatric Hospitals.
3,57% 0%
0% -50%
r(a,b)=COV(a,b)/VAR(a)*VAR(b)
-2,56% 14,28%
COV(a,b)=E(a*b)-E(a)E(b)
3,84% 9,50%

METHOD PSYCHOTIC DISORDER 3,57%

7,46%
-8,33%
-4%
VAR(a)=(SUM(a-Ea)2)/v-1

17,46% 0% VAR(b)=0,23413
-3,70% -42,85%
The sample consisted of fifteen patients from whom eleven are diagnosed with Schizophrenia and other -2,12% 0% Low degree of correlation
-6,25% 1,36%
Psychotic Disorders, two with Huntington’s disease and two with Mental Retardation and Autism. The scales 40% 3,75%

used are Mini-mental state examination (MMSE) and Brief Psychiatric Rating Scale (BPRS) in order to MENTAL RETARDATION-
AUTISM
7,14% -3,50%

measure and correlate cognitive impairment within the three categories of psychopathology.
Values too small to extract conclusion
HUNTINGTON’S DISEASE -61,29% -66,60%

RESULTS DISCUSSION

According to the patients’ cognitive ability and psychopathology, different rehabilitation interventions are
TABLE 1. BRIEF PSYCHIATRIC RATING SCALE SCORES presented, including the P.C. rehabilitation programs, as well as different occupational techniques.
PERCENTAGE OF
SN DIAGNOSIS BPRS 2008 BPRS 2010
Occupational Therapy:
IMPROVEMENT/DECLINE
1 MENTAL RETARDATION-ΑUTISM 73 72 1,36% IMPROVEMENT
2 PSYCHOTIC DISORDER 86 83 3,48% IMPROVEMENT
3
4
PSYCHOTIC DISORDER
HUNTINGTON’S DISEASE
118
70
116
65
1,69 % IMPROVEMENT
7,14% IMPROVEMENT
Physical exercise group,
5 PSYCHOTIC DISORDER 56 54 3,57 % IMPROVEMENT Entertainment group,
6 PSYCHOTIC DISORDER 61 61 0%
Painting group
Handicraft group.
7 MENTAL RETARDATION-ΑUTISM 80 77 3,75 % IMPROVEMENT
8 HUNTINGTON’S DISEASE 31 50 61,29 % DECLINE
9 PSYCHOTIC DISORDER 78 80 2,56 % DECLINE

Computer aided rehabilitation of cognitive function:

10 PSYCHOTIC DISORDER 52 50 3,84 % IMPROVEMENT
11 PSYCHOTIC DISORDER 56 54 3,57 % IMPROVEMENT
12 PSYCHOTIC DISORDER 67 62 7,46 % IMPROVEMENT
13
14
PSYCHOTIC DISORDER
PSYCHOTIC DISORDER
63
27
52
28
17,46% IMPROVEMENT
3,70 % DECLINE
 Acoustic reactivity
15 PSYCHOTIC DISORDER 47 48 2,12 % DECLINE

The aim of the training is to improve reaction time and precision when responding to acoustic signals. The
FIGURE 1. TOTAL PSYCHOPATHOLOGICAL ALTERATIONS
patient is familiar with these sounds from everyday life.

26,66%
 Figural memory
IMPROVEMENT
6,66%
66,66% STABLE
DECLINE
This program trains the medium – term non-verbal and verbal memory (working memory). The patient has to
memorize pictures with concrete objects. After the “learning phase”, words roll by as if on a conveyor belt.
The patient is supposed to press the OK-button whenever a word for an object of the “learning phase” rolls
into the box at the edge of the screen.

 Shopping
TABLE 2. MINI MENTAL STATE EXAMINATION SCORES
PERCENTAGE OF This program allows the realistic training of an everyday situation-shopping in a supermarket. All necessary
steps need to be taken just like in real life. Planning and coordinating actions as well as the short-time
SN DIAGNOSIS MMSE 2008 MMSE 2010
IMPROVEMENT/ DECLINE
1 MENTAL RETARDATION-ΑUTISM 17 16 6,25 % DECLINE
2 PSYCHOTIC DISORDER 4 8 50 % IMPROVEMENT memory will be trained thoroughly (the time between looking into the shopping cart and looking at the
3
4
PSYCHOTIC DISORDER
HUNTINGTON’S DISEASE
16
7
16
0
0%
3,5 % DECLINE
shopping list).
5 PSYCHOTIC DISORDER 26 26 0%
6 PSYCHOTIC DISORDER 12 8 50 % DECLINE
 Visuoconstructive abilities
7 MENTAL RETARDATION-ΑUTISM 9 15 40 % IMPROVEMENT
8 HUNTINGTON’S DISEASE 30 18 66,6 % DECLINE
9 PSYCHOTIC DISORDER 12 14 14,28 % IMPROVEMENT This program trains visual reconstruction of concrete pictures. The patient has to memorize a displayed
picture in everyday detail. Then – after it has been taken apart into several puzzle parts-the patient has to
10 PSYCHOTIC DISORDER 19 21 9,5 % IMPROVEMENT
11 PSYCHOTIC DISORDER 26 24 8,33 % DECLINE
12 PSYCHOTIC DISORDER 26 25 4 % DECLINE reassemble it.
13 PSYCHOTIC DISORDER 30 30 0%
14 PSYCHOTIC DISORDER 30 21 42,85 % DECLINE
15 PSYCHOTIC DISORDER 30 30 0%  Logical Reasoning

FIGURE 2. TOTAL COGNITIVE ALTERATIONS

This training is aimed at improving logical reasoning. The patient should add the correct symbol to a row of
symbols that has been assembled according to a specific rule.
26,66%

 Topological Memory
IMPROVEMENT
46,66%
STABLE
DECLINE
26,66%
This program trains topological memory. Like in the game “memory”, the patient should memorize the
position of cards with pictures (e.g. of a lion, a flower, a house, a car, etc.) or geometric figures on them.
When the cards are hidden the patient should remember which picture was at what place.
TABLE 3. COGNITVE STATES

 Plan a Day
MMSE SCORE CATEGORIES COGNITIVE STATE 2010 COGNITIVE STATE 2008

NO COGNITIVE IMPAIREMENT 33,33% 46,67%

MILD COGNITIVE IMPAIREMENT 20% 7%

SEVERE COGNITIVE IMPAIREMENT 46,66% 46,67% PLAN is a computerized training which simulates setting up a one-day-schedule of different scope in
everyday life. The aim of the training is to improve executive functions and to establish strategies for the
ability to coordinate activities. PLAN is an exercise method which makes demands on both basic and-
FIGURE 3. COGNITIVE STATE 2010 FIGURE 3.1 COGNITIVE STATE 2008

33,33% NO COGNITIVE NO COGNITIVE

especially in higher levels of difficulty-complex cognitive abilities.
46,66% IMPAIRMENT 46,67% 46,67% IMPAIRMENT

 Verbal Memory
MILD COGNITIVE MILD COGNITIVE
IMPAIRMENT IMPAIRMENT
20% 7%
SEVERE COGNITIVE SEVERE COGNITIVE
IMPAIRMENT IMPAIRMENT

This RehaCom program intends to improve the ability of short-term retention. Short stories are presented
TABLE 4. ALTERATIONS IN THREE DIAGNOSTIC CATEGORIES and patients should memorize as many details as possible. In the reproduction phase, questions concerning
SN DIAGNOSTIC CATEGORIES
BPRS
IMPROVEMENT
MMSE
IMPROVEMENT
BPRS
DECLINE
MMSE
DECLINE
these details should be answered.
1 MENTAL RETARDATION-AUTISM 5,11% 40% 0% 6,25%
2 PSYCHOTIC DISORDER 5,89% 24,59% 2,79% 26,34%
3 HUNTINGTON'S DISEASE 7,14% 0% 61,29% 83,30%

FIGURE 4. ALTERATIONS IN THREE DIAGNOSTIC CATEGORIES  Sample size inadequate to make a valid conclusion about general population
The conclusions extracted for the specific sample only yielded the following:
a. A low degree of correlation was found between Psychotic Disorder and Cognitive Impairment.
Deterioration in psychopathology is related with deterioration in cognitive impairment and the
opposite.
b. No conclusion could be drawn for the diagnostic categories of Mental Retardation-Autism and
Huntington’s disease due to inadequate sample size.
For future research in the diagnostic category Psychotic Disorder factors such as age and chronic
institutionalization should be taken into account.
For the diagnostic category of Huntington’s disease factors such as age of onset and specific disease
characteristics should be taken into account.

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