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Cognitive Impairment in Schizophrenia
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Book description

Although the precise mechanisms and pathways of schizophrenia remain something of a mystery, there is little dispute that cognitive deficits present as some of the clearest and most debilitating symptoms of the disease. This book describes the characteristics of cognitive deficits in schizophrenia, functional implications, the course of impairments, the genetic and biological contributions and reviews management options, including neuropsychological, psychological and pharmacological techniques. Chapters are written by leading experts in the field, in an accessible and highly informative style, ensuring the content is clinically relevant. State-of-the-art information about new developments in the treatment of related features of the illness, such as disability, is provided. The wide ranging focus of this volume will appeal to clinicians and academic researchers working with patients impaired by severe mental illness.

Reviews

'… an excellent and useful reference…'

Source: American Journal of Psychiatry

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Contents

Contents
  • Chapter 7 - Cognition and functional status in adult and older patients with schizophrenia
    pp 110-125
  • View abstract

    Summary

    This chapter considers evidence from both perspectives and argues for a critical appraisal of the role of cognition in psychotic illness. The psychiatric pioneers of schizophrenia research considered a variety of cognitive problems in their clinical case descriptions, but these efforts were limited by the questionable validity of interviews and subjective data and observations as well as by sampling biases. The cognitive impairment reliably occurs at very high rates in schizophrenia, typically approaching 75% of the patient population, which equals or exceeds the prevalence of impairment in many neurological disorders. The possibility of preserved cognition in a significant minority of people with schizophrenia has not been resolved and this challenges the assertion that cognitive impairment is a truly defining characteristic of the illness. The majority of patients with Parkinson's disease eventually develop cognitive deficits, but psychosis is much less common and largely a by-product of medication.
  • Chapter 9 - Cognitive functioning and awareness of illness in schizophrenia: a review and meta-analysis
    pp 142-160
  • View abstract

    Summary

    The chapter begins with some elaboration about the nature of the generalized cognitive impairment in schizophrenia. A number of large meta-analyses have provided clarifying evidence about the breadth of this deficit. Heinrichs and Zakzanis published the first large-scale meta-analysis of cognitive deficit findings in schizophrenia. Articles for the meta-analysis were located through key word searches in PubMed for the period 2006 to 2011. Standard criteria were used to select studies/samples for review: the study must have contrasted cognitive performance in schizophrenia patients and healthy controls; the study must have based schizophrenia diagnoses on contemporary diagnostic criteria; results must have been reported with sufficient detail to allow calculation of effect sizes; finally, the study must have been reported in English. Neuropsychological battery studies make it possible to compare schizophrenia cognitive deficits in different global regions using the same or very similar cognitive tests.
  • Chapter 10 - Genetic influences on cognition in schizophrenia
    pp 161-175
  • View abstract

    Summary

    This chapter discusses how the overlap and distinction of the primary psychotic and primary affective disorders may be understood in the context of cognition. The pattern of cognitive impairments in schizophrenia and bipolar disorders can be viewed from four dimensions: prevalence, breadth, magnitude, and course. Social cognition allows people to understand and interact with one another effectively; its impairment in both schizophrenia and bipolar disorders appears to be partially responsible for impairments in everyday functioning. Cognitive functions can be indexed at a level more proximal to neurological function through various psychophysiological methods, such as eye tracking and electroencephalogram experiments. Most comparative studies of cognition in schizophrenia and bipolar disorders focus the distinction at the level of diagnosis. Individuals with bipolar disorder and current psychotic features have cognitive impairments equivalent in magnitude to those observed in individuals with schizophrenia.
  • Chapter 11 - Neurobiologicaldeterminants of cognition
    pp 176-192
  • View abstract

    Summary

    This chapter presents the relationship between symptom dimensions and neuropsychological functioning in psychosis. It presents short overview on neuropsychological functioning in schizophrenia and in other psychotic disorders. The chapter describes the studies investigating the association between symptom dimensions and neuropsychological functioning in both schizophrenia and other psychoses. The schizophrenia patients show deficits on a wide range of cognitive domains including verbal memory, working memory, executive functions, attention, and processing speed on a background of general intellectual impairment. Studies that examined differences in cognitive functioning between schizophrenia and affective psychoses reported an increasing gradient of severity of cognitive impairment, from less severe deficits in bipolar disorder to most severe deficits in schizophrenia-like disorders. Validity of symptom dimensions as neurobiological constructs has been supported by several genetic and neurobiological studies. Research on symptom dimensions in psychosis focuses predominantly on schizophrenia.
  • Chapter 12 - Translational cognitive neuroscience of schizophrenia: bridging neurocognitive and computational approaches toward understanding cognitive deficits
    pp 193-230
  • View abstract

    Summary

    This chapter discusses associations between neurocognition and functional outcome that are typically stronger than those found between psychotic symptoms and functional outcome, and sometimes even stronger than those between negative symptoms and outcome. Research in social cognition in schizophrenia has tended to cluster around four types of social cognitive processes: emotion processing, social perception, attributional style, and mental state attribution. Neurocognitive and social cognitive tasks often share cognitive demands, such as working memory and perception. Negative symptoms reflect a decrease or absence of normal functions within two broad domains: internal experience-related impairments, including diminished emotional experience, motivation to engage in productive activities, and desire for social affiliation; expressive or communicative impairments, including diminished facial expressivity, gestures, prosody, and speech production. It has been known for a long time that, neurocognition, negative symptoms are consistent predictors of daily functioning.
  • Chapter 14 - Performance-based measures of functioning in schizophrenia
    pp 247-265
  • View abstract

    Summary

    Schizophrenia has a profound effect on reducing the capacity of individuals to sustain productive employment. Impaired work functioning has implications for both the overall quality of life for people with the disorder, and for the costs to their families and society. Work for people with schizophrenia is associated with a range of benefits, including social contact and a better quality of life. Poor vocational functioning in schizophrenia is the result of a host of different factors related to the illness. Two of the most important of these factors are poor premorbid adjustment and curtailed level of educational attainment. The psychotic and negative symptoms of schizophrenia can interfere with the ability to work. Cognitive impairments frequently precede the onset of schizophrenia, and worsen during the prodrome. The Individual Placement and Support (IPS) model of supported employment was developed and standardized to improve competitive work in people with serious mental illness.
  • Chapter 15 - Pharmacological approaches to cognitive enhancement
    pp 266-283
  • View abstract

    Summary

    Although the symptom profile of schizophrenia is diverse across patients and over the course of the illness, most patients experience cognitive and functional decline and impairments in everyday living skills and social functioning. This chapter begins by discussing normative age-related changes in cognition followed by a short discussion of memory impairments, dementia, and aging. The incidence of visual impairments such as cataracts and macular degeneration increases with age. Age is the greatest risk factor for pathological neurological conditions such as Alzheimer's disease (AD) and other neurodegenerative disorders. Mild cognitive impairment (MCI) refers to changes in memory or other cognitive domains that are reported by the patient or collateral informant, and it is confirmed by neuropsychological testing. The performance of psychiatrically healthy adults aged 70 years and older was superior to the performance of the youngest patients with schizophrenia on measures of working and episodic memory, executive function, and psychomotor speed.
  • Chapter 16 - Computerized cognitive training in schizophrenia: current knowledge and future directions
    pp 284-315
  • View abstract

    Summary

    The investigations of social cognition can be roughly categorized into five domains including theory of mind (ToM), social perception, social knowledge, attributional style, and emotional processing. The majority of work on attributional style in schizophrenia has focused on the two biases most commonly seen in individuals with paranoid or persecutory delusions. The relationship between social cognition and neurocognition has been of interest to many in the research community with the primary debate focusing on the independence of the two constructs. In an effort to address this possibility and to clarify the nature of the relationship between these constructs in schizophrenia, researchers have utilized four primary strategies: direct examination of the correlations between social cognition and neurocognition, factor analytical techniques, paradigms designed to test for generalized versus specific impairments, and examinations of the contributions of social cognition and neurocognition to functional outcome.

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