Schizophrenia extends beyond psychotic symptoms: alongside hallucinations and delusions, patients also regularly experience cognitive impairments of learning and memory, which can dramatically affect their daily lives. Many people drop out of school or university as a result. But while patients are fairly well treated with antipsychotic medication, there are no certified drugs to address the cognitive side of schizophrenia yet.
Neuropsychologist Barbara Sahakian and her colleagues at the University of Cambridge have been exploring new avenues, and have created a "brain training" app to help improve these cognitive impairments. They spent nine months developing the game, called "Wizard," which is underpinned by neuropsychological training models.
In the game, memory tasks are woven into a narrative in which the player can choose their own character and name; the game rewards progress and gives feedback. "It's a very unusual type of game and I view it as a real breakthrough," Sahakian told me.
For a study published today in the Philosophical Transactions of the Royal Society B, the researchers tested 22 patients with schizophrenia, assigning them to either the cognitive training group or a control group. Participants in the training group played the game for eight hours in a four-week period, while the control group continued treatment as normal.
The study found that the people who played the game were significantly better at the CANTAB memory test, a widely-used and test of episodic memory—a type of memory often affected in schizophrenia.
The participants also had a significantly improved score on the Global Assessment of Functioning (GAF) scale, which measures psychological functioning. Sahakian was delighted. "When we looked at their activities of daily living, they also improved—so it wasn't just improvement in the task, there also seemed to be improvements in psychosocial functioning," she said. "We were very pleased with that because they only played the game for eight hours over four weeks."
"It de-stigmatizes the treatment because you don't have to go into the hospital to do it—everybody plays games."
Sahakian hopes that as a result the app could help people with schizophrenia in their daily lives. "If a young person develops schizophrenia at school or at university, they have trouble sometimes going back because they're having trouble learning and remembering things and that's really what our app addresses," she said.
Alongside the psychological and cognitive issues, motivation can also be a problem in schizophrenia, and the app aims to address this too. "We worked with the patients themselves to make sure they got it immediately and enjoyed it," said Sahakian. "This seemed to be something they really enjoyed doing, it's not something that feels like a chore."
The app has several advantages: there are none of the side effects you might get with prescription medication, and Sahakian also hopes it could help de-stigmatize treatment. "I wanted it to be a game and not have the stigma of the treatment for people with schizophrenia," she explained. "It de-stigmatizes the treatment because you don't have to go into the hospital to do it—everybody plays games."
Another potential benefit is the relatively low cost. Schizophrenia is estimated to cost around £13.1 billion per year in the UK. Sahakian said that, while she hoped the government would continue to invest in mental health, the use of apps such as this one might reduce costs of treatment.
The app has now been taken over by brain training company Peak, which has redeveloped it for wider use, making it suitable for iPhones or iPads. The developed version is called "Cambridge University & Peak Advanced Training Plan."
It was a priority for Sahakian that this shouldn't just be an app developed for people with schizophrenia but for everyone. "We all enjoy games, so you might as well play one that's good for you as well," she said.