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Computer brain games aim to treat schizophrenia

Believing that brains can be trained through the use of specialized computer programs, researchers are focusing on helping people with schizophrenia, which can cause them to hear imagined voices or believe that others are controlling or plotting against them.

There are medications for the often-disabling disorder, but they have severe side effects and don’t get rid of all symptoms; many people will not stick with the drugs.

A California company, Posit Science, is developing a computer game that it hopes will become the first to earn approval from the Food and Drug Administration for treating schizophrenia.

The idea comes from Michael Merzenich, an emeritus professor of neuroscience at the University of California at San Francisco and a co-founder of Posit Science. Merzenich is something of a living legend in neuroscience, a co-inventor of cochlear implants and one of the pioneers of the theory of neuroplasticity, which asserts that the brain continues to develop throughout a lifetime.

Treating schizophrenia with brain training is based on the theory that the confusion and fear created by the disease may occur because the brain’s expectations about what will happen do not match up with what actually happens. That discrepancy might be traced to a problem with verbal and auditory processing of information, something that brain training targets.

Creating the brain-training program has not been simple. Many patients found initial versions of the game boring and stopped playing it after a couple of sessions.

So Posit Science hired a game developer, who came up with a cartoonlike design, virtual characters and a mellow soundtrack. But the most important improvement in the game was giving players the chance to make virtual money.

“Schizophrenic patients often don’t get to earn an income” because their social skills are limited, “so we decided to use that for motivation,” said Henry Mahncke, chief executive of Posit Science.

For achieving a particular goal – such as distinguishing between similar sounds or memorizing the location of words on the screen – players earn virtual dollars. At the end of an exercise round, when solving the repetitive tasks starts to become tedious, the amount is tripled to keep players engaged.

After players finish a session’s exercises, the game lets them go to their virtual homes, where the virtual money can be used to purchase furniture and other accessories. The concept seems to work.

“Most of our patients stick with the training,” Merzenich said. A typical treatment consists of about five hours with the software every week for three to four months.

An advantage of using schizophrenia for brain-training research lies in the severity of the disease. As a result, small gains achieved via the software can be of statistical significance. The company hopes that once such gains can be shown with schizophrenia, similar training can be tested for other conditions, such as dementia and even among healthy individuals, Mahncke said.

“I have no doubt we will succeed, but there are a lot of variables in these experiments that can decide the outcome,” Merzenich said. Clinical trials aimed at FDA approval are being conducted at a dozen sites in collaboration with the Schizophrenia Trials Network, a group of university researchers. The trials will involve 150 participants and finish next year.

Sophia Vinogradov, a psychiatry professor at the University of California at San Francisco, has done research on using brain games in psychiatry.

“Computer programs are especially suitable for targeting a disease like schizophrenia, because it’s in the teens when most of the affected are confronted with the disease – and in that age, they are particularly receptive to the games,” she said.

Vinogradov has collaborated with Merzenich and Posit Science for more than a decade. She said results of her studies show that “cognition improves in schizophrenia patients. … Something that has not been shown with any other kind of intervention.”

She added that brain imaging suggests that brain-activation patterns become more efficient and normal.

In one study, Vinogradov’s team found improved cognition among schizophrenia patients who trained with Posit’s software. A second study found improved ability to distinguish between what is real and what is not.

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