Cognitive Deficits in Schizophrenia – How to Help

Printable PDF version: Managing Cognitive Problems in Mental Illness

Managing Cognitive Problems in Mental Illness

  •  Cognitive (or thinking) skills are often affected by severe mental illness such as schizophrenia
  • Cognitive skills are mental abilities that are needed for attention, information-processing, memory, and critical thinkingThese difficulties can be present even when the individual is stable on medication and not experiencing positive symptoms (e.g. hallucinations)
  • Cognitive difficulties can affect people’s ability to be successful in daily activities in every area of life, including social situations, independent living, and school or work
  • Every individual has different strengths and weaknesses in cognition, and a person’s cognitive abilities can change over time

Cognitive skills can be strengthened and improved

  • Encourage a balance of activities – physical, mental, social activities
  • Encourage a healthy lifestyle – adequate rest, good nutrition, effective medication management, stress management
  • Get to know your family member’s learning style (tailor information to learning style)
  • ‘Shape’ attention span – gradually increase duration of focused attention
  • Teach some simple memory strategies
  • Play computer games – choose games that are engaging and make use of thinking skills

“Learn coping strategies to help minimize the impact of cognitive difficulties. This can reduce distress for the individual and the family, and reduce interference with daily activities.”

Attention deficit can cause problems with daily activities such as:

  • Staying focused on a topic of conversation
  • Staying focused on a task
  • Reading or watching TV
  • Navigating a telephone menu
  • Completing basic housework (dishes, cooking, laundry etc)
  • Blocking out background noises
  • Keeping track of time

Strategies for coping with attention deficit:

    • Present information in a straightforward & direct manner
    • Limit how much information is given at one time
    • Vary tone & rhythm of speech
    • Use eye contact to maintain attention
    • Avoid “multi-tasking”
    • Break tasks down into smaller steps
    • Allow for breaks
    • Encourage involvement in tasks of personal interest
    • Reduce background noises & distractions

Slow information-processing can result in:

  • Needing more time to solve problems & complete tasks
  • Needing more time to process & respond in conversation
  • Seeming disinterested in interaction
  • Not understanding instructions presented too quickly
  • Slowness at tasks needing motor speed & coordination

Strategies for coping with slow information-processing:

  • Don’t rush things
  • Plan for extra time to complete tasks
  • Allow time to respond in conversations
  • Don’t finish sentences for a person having difficulties
  • Ask to have instructions repeated back
  • Over-practice tasks

Memory difficulties can result in:

  • Difficulty learning new things
  • Difficulty with learning bus routes
  • Forgetting appointments, names, conversations
  • Not attending to simple requests made by others
  • Forgetting to take medications
  • Losing things
  • Forgetting health care instructions

Strategies for coping with memory difficulty:

  • Repeat instructions or important information
  • Ask the individual to paraphrase
  • Put things in writing when possible
  • Develop routines
  • Designate standard spots for important items
  • Over-learn skills
  • Use memory aids and tools (notebooks, calendars, to do lists, etc)

 Difficulties with critical thinking and decision-making can cause problems with daily activities such as:

  • Money management
  • Shopping (comparing products, keeping track of dollar amount)
  • Following directions such as recipes
  • Organizing routines, home, work, etc
  • Planning tasks, day, menu, work activities, etc
  • Initiating tasks
  • Time management
  • Prioritizing tasks
  • Remembering to do something at a specified time (e.g. take medication)
  • Figuring out how to do something without specific instructions
  • Knowing how to respond to problem or emergency situations

Strategies for helping with critical thinking and

    decision-making:

  • Write out instructions in straightforward, step-by-step fashion (e.g. recipes, etc)
  • Create step by step checklists for multi-step housekeeping tasks
  • Help set up a ‘home-office’ kit & calendar for money management, paying bills, organizing paperwork, etc
  • Develop routines & systematic procedures for doing things
  • Use guiding questions rather than ready-made answers (e.g. what’s the first step, what’s next?)
  • Use ‘thinking-aloud’ to model problem solving & decision making
  • Demonstrate & model methodical approaches to completion of various tasks
  • Schedule regular ‘problem solving’ meetings to brainstorm possible solutions.

People with serious mental illness can also have difficulty with social cognition. This can cause day-to- day interpersonal problems such as:

  • Inability to pick up on another’s feelings through expression & tone of voice
  • Lack of awareness of personal space needs
  • Inability to perceive another’s intentions or point of view
  • Difficulty understanding hints, jokes, figurative language, sarcasm
  • Lack of awareness of common unwritten social rules
  • Lack of understanding of different expectations in different situations
  • Behaving inappropriately or making awkward comments
  • Difficulty solving interpersonal problems & issues
  • Trouble initiating interactions & making friends

Strategies for coping with social cognition difficulties:

  • Discuss social norms of various situations
  • Point out unwritten social rules
  • Practice recognizing facial expressions (use magazines, TV)
  • Play charades with emotions
  • Don’t make assumptions or use hints
  • Use I statements to express feelings
  • Be specific and clear about expectations
  • Discuss social situations explicitly, and practice interactions

–  Thanks to Anita McNeil, O.T. – Volunteer, Manitoba Schizophrenia Society


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