Aiming to Improve Schizophrenia Treatment Through the NIMH CNTRICS Initiative

Biological Psychiatry is particularly proud to announce the publication of an issue dedicated to the product of the National Institute of Mental Health (NIMH) Cognitive Neuroscience Approaches to the Treatment of Impaired Cognition in Schizophrenia, or CNTRICS, initiative.

This July 1, 2008 issue includes eight articles on CNTRICS: one commentary, one overview paper of the CNTRICS meeting, and six review papers on the ideas developed at the first of the three scheduled CNTRICS meetings.

John H. Krystal, M.D., Editor of Biological Psychiatry and one of the authors on the overview paper, highlights the importance of this venture: “Schizophrenia is a disabling illness despite the emergence of a second generation of antipsychotic treatments. To develop better medications, we first need a better understanding of the brain and how it goes awry in schizophrenia.” He explains that the CNTRICS initiative aims “to better define the cognitive processes and the neural circuits that carry out these processes that will be the focus for schizophrenia research now and in the future.”

Thomas R. Insel, M.D., Director of the NIMH and co-author of the commentary, adds: “Cognitive neuroscience has made enormous strides in the past two decades by mapping the brain's rules and routes for information processing. CNTRICS endeavors to translate the tools and insights from cognitive neuroscience into better treatments for schizophrenia.”

In the overview paper, the authors describe the background, organization and results of the meeting, which brought together academic and industry experts from basic and clinical cognitive neuroscience and drug development. Cameron Carter, M.D., Deputy Editor of Biological Psychiatry and lead author of the overview paper adds that, “In embracing basic cognitive and affective neuroscience as a translational bridge linking cellular and molecular neuroscience with clinical symptoms, and by bringing together basic and clinical scientists with those focused on treatment development, the CNTRICS process […] presents us with a new paradigm for how we go about treatment development in psychiatry.”

he experts sought to develop a consensus building process on which aspects of impaired cognition in schizophrenia should be targeted for new treatment development. The perspectives of the experts, results of discussions and recommendations for cognitive treatment targets are summarized in the six related review papers that comprise the major products of this first CNTRICS meeting.

One of the review papers, by Kevin Ochsner, Ph.D., focuses on the deficits in social and emotional functioning that are hallmarks of schizophrenia. As Dr. Ochsner explains, “The emerging disciplines of social cognitive and affective neuroscience offer new methods to study these abilities and their breakdown in schizophrenia. This paper synthesizes recent advances in these disciplines and proposes a framework for understanding the neural organization of five key social and emotional abilities.” Dr. Carter notes that “by bringing a modern social cognitive neuroscience perspective to this aspect of schizophrenia and outlining a novel and informative model of human social and emotional processing, Ochsner has provided the field an opportunity for a fresh start as well as a powerful set of tools to inform future research and treatment development.”

Charan Ranganath and colleagues, in another of the review papers, focused on addressing episodic memory impairment, which limits the daily function of individuals with schizophrenia, and is an important target for treatment development. Specifically, the CNTRICS panel nominated item-specific and relational memory tasks for immediate translational development and this paper summarizes the significant progress that cognitive neuroscience has made in understanding the cognitive and neural underpinnings of these processes. Dr. Carter comments that “Ranganath et al. provide the reader with a state of the art systems view of human memory and use this as a context for how we might advance our understanding of disabling memory deficits in schizophrenia and the abnormal brain functioning underlying them.”

The authors of the Carter et al. paper comment, “As the CNTRICS process unfolds, we hope to bring the full force of the new knowledge and technology that is cognitive neuroscience to bear on the effort to develop effective therapies for impaired cognition in schizophrenia.” Biological Psychiatry is pleased to be the home for the presentation of this work, as the field of psychiatry looks to the ideas that develop out of CNTRICS to further inform and improve schizophrenia treatment.