Presented at the Annual Conference of PSR/RPS, Winnipeg, Canada, September 2008

Rehabilitation of the Seriously Mentally Ill:

Role of the Family in Recovery of Brain Function

Brain

Plasticit

y

Brain Plasticity

Brains Have the Ability to Change and Adapt

IN RESPONSE TO TREATMENT

The brain can change and rebuild new connections, and this provides a basis for recovery

The following slides present key concepts from our work and NIMH’s work on brain function in Schizophrenia

WHAT FAMILIES SHOULD KNOW

EEG Brain Biofeedback

The EEG Record is of a subject diagnosed with Schizophrenia. Data collected as part of a New York State Office of Mental Health Grant

The EEG Record shows a change in brain function from an abnormal state to a normal state associated with working on a computerized attention task

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R Abnormal NormalTreatment

Brain Activity During

Computerized Attention Task

The red shows increased frontal activity

Activity is in a slow Delta Wave Range(8 to 12 cycles a second)

Basic Science/Brain Function

The Homeostatic Brain Model describes normal and abnormal activating and inhibiting systems

Psychiatric symptoms occur when there are disruptions in activating and inhibiting Frontal, Temporal, Parietal, and Limbic regions of the brain.

The human brain is plastic, and can recover function and establish new neural-pathways

Present And Future Methods Of

Improving Brain Functioning

Chemotherapy-the use of specific chemicals to change brain functioning and promote recovery of functioning. The current generation of medications focus increasingly on improving cognitive functioning.Brain Plasticity Training (cognitive retraining)-Individual’s work with computers and manuals to rebuild cognitive functioning.Improving Executive Functioning – cognitive exercises and adaptive devices to enhance frontal lobe functioning and to enable frontal lobe tasks such as planning, reasoning, and prospective memory. EEG Biofeedback – online EEG recording is used to train people with schizophrenia to keep their brain in a normal Alpha RhythmMagnets and Transcranial Magnetic Stimulation - electromagnets or traditional magnets next to different brain areas to use magnetic force to disable and restart brain function.Neuropsychological Therapeutic Community – environments where individuals work towards “becoming a whole person”.

The Latest Images from UCLA NIMH Funded Imaging Team

Comparing Schizophrenia

Subjects with Normals Controls

The Main Points are:There is a great deal of structural variability in the brains of

people with schizophrenia

The inter-connection between the right and left side of the brain and the Corpus Callosum tissue contributes to problems in communication between the two sides of the brain

We discussed similar ideas in our 1983 papers on the homeostatic brain

A Population-Based Schizophrenia Brain Atlas

(Schizophrenia Atlas Team:) Narr KL, Thompson PM, Sharma T, Moussai J, Zoumalan CI, Rayman J, Mazziotta JC, Toga AW

Construction of a population-based atlas of the brain in schizophrenia is well underway. Based on large human populations, and containing thousands of 3D structure models, this atlas encodes patterns of anatomical variation. The atlas can also detect group-specific patterns of anatomic or functional alterations. Disease-specific features and asymmetries are beginning to emerge that are not apparent in the individual anatomies. A sharply-defined mosaic of variability and asymmetry patterns are being found across the cortex. These patterns and brain asymmetries also vary according to the functional specialization of each brain system (see below) .

http://www.loni.ucla.edu/~thompson/SZ/SCHIZO_cc_EDITED.gif

Hopewell is a healing environment for individuals recovering from mental illness.

The Mirans adapt the Neuropsychological Therapeutic Community Treatment Model for remediating cognitive deficits and improving brain function.

Time-Line Development of the Miran’s Treatment

1982:Right Brain/Left Brain Models lead to a Homeostatic Brain Model

1989: Adapting the NYU Rusk and the Recanati Institute’s

Neuropsychological Therapeutic Community Model (a brain injury treatment)

2000: Grant from NYS Office of Mental Health

2000- present: Treatment sites at- FEGS (Brooklyn), Jaffa Community Mental Health Center (Israel)

and Hudson River Psychiatric Center (NY)

2006-present: Collaboration with Hopewell (OH)

Treatment Techniques:

Family involvement

Assessment-personality neuropsychological

Therapeutic community meetings

Brain plasticity training

Interpersonal skills development

Brain biofeedback training

New MetricsMeasuring Effectiveness based Performance

Effectiveness based treatment demonstrates:

– improved psychophysiological functioning

– improved ecologically valid functional behavior

– the ability to engage in the treatment process

Measuring

Effectiveness Based Treatment

In this presentation we measure:

Improved functional behavior by the Orientation Remediation Module subtest Zero Accuracy Conditioner

Improved psychophysiological functioning by EEG Brain Biofeedback

The ZAC is a computerized cognitive training task (developed by Yehuda Ben-Yishay, Ph.D. at the NYU Rusk Institute, Working Approaches to Remediation of Cognitive Deficits in Brain Damaged Persons, 1983)

Includes three subtests• Immediate stop• Short coast• Long coast

Subtests are progressively more difficult and involve more frontal lobe activity

Zero Accuracy Conditioner (ZAC)

Zero Accuracy Conditioner (ZAC)

Next slide is a picture of the stimuli as seen by the subject on the computer screen

Top Picture – Subject achieves the correct response. The clock hand stops

at the top mark.

Bottom Picture – Subject deviates from the correct response. Deviations are

counted.

Zero Accuracy Conditioner

(ZAC)

Trial 1

Trial 2

Trial 3

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ZACNumber Correct Responses

3 Trials (each trial is a summary of 12 re-sponses)

Subject Diagnosed with Schizophrenia at Hopewell

Immediate Stop

Short Coast

Long Coast

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The subject gradually improves ability to achieve a correct response:

The summary of the immediate stop begin at a score in the range of 6-7 and increase to a score in the range close to 8 (The immediate stop is a less demanding task)

The summary of the short coast begin at a score of “0” and increase sharply to a score in the range close to 3.

The summary of the long coast begin at a score of “0” and increase on a straight line to the range close to 3.

ZACCorrect Response by Trials

Trial 1

Trial 2

Trial 3

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Immediate Stop

Short Coast

Long Coast

Immediate Stop

Short Coast

Long Coast

ZACMagnitude of Deviation from Correct Response

3 Trials (each trial is a summary of 12 responses)Subject Diagnosed with Schizophrenia at Hopewell

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The subject gradually improves ability to achieve a smaller magnitude of deviation:

The summary of the immediate stop begin at a score close to “0”

and end at the same score (The immediate stop is a less demanding task)

The summary of the short coast begin at a score between 20-30 and decrease to a score close to “0”

The summary of the long coast begin at a score between 80-90 and decrease to a score close to “0”

ZACMagnitude of Deviation

The results suggest that individuals can:

Improve information processing and functional behavior

ZAC charts from three trials of 12 responses on a single day.

The subject is focused and is able to engaged in the treatment

process

Improve psychophysiological functioning

EEG Record As frontal lobe circuits are activated, hallucinations and circular negative thoughts are diminished by the process of reciprocal inhibition

Caveat

The above slides present single case data demonstrating the possibility of producing changes in brain functioning.

Due to the small sample size we cannot claim that this data generalizes to any larger population.

It would be desirable to do a study with a larger sample size and randomized controls.

An Environment of peace and security: with support, structure, and family collaboration

State-of-the-Art brain treatment: the brain is plastic and can regain functioning

Hopewell and the Miran Approach

EDUCATE YOURSELF• Learn about

psychosocial rehabilitation programs

• View videos, read books, and read literature from treatment sites

• Learn about your feelings of grief and loss of your ideal child

Family Members and Significant Others Can

Can Advocate for Your Loved One

•You are the most powerful advocate

•Work collaboratively with treatment team

•Work with advocacy and supports groups

Family Members and Significant Others Can

MOTIVATIONThe strongest reinforcer for the significant

struggle to overcome brain dysfunction is

the increased self-esteem based on the

awareness of success in accomplishing a

realistically challenging task.

Families – a journey of recovery with loved ones

Hopewell –

a nurturing residential environment

Miran’s Neuropsychological TreatmentImproves functional behavior and brain activity

New Metrics –measures effectiveness based treatment

New Technologies for Treatment – enables the transformation of brain function

In Conclusion:

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CONTACT INFORMATION

HOPEWELL THEAPEUTIC COMMUNITYCandace Carlton9637 State Route 534PO Box 193Mesopotamia, OH 44439-0193(440) 693-4074 Voiceinfo@hopewell.ccwww.hopewell.cc

MIRAN APPROACHEsta Miran272 Sylvan Rd.Rochester, NY 14618(585) 473-3558 Voiceemiran@mirantherapy.comwww.mirantherapy.org