With funds from BC Schizophrenia Society Foundation donors, Dr. Ivan Torres continues to research how difficult-to-treat schizophrenia impacts cognition.
What is Treatment-resistant Schizophrenia?
Schizophrenia is a serious mental illness that affects how a person thinks, feels, and acts. Schizophrenia is a type of psychotic disorder, which is an umbrella term for mental illnesses that cause psychotic symptoms, most simply described as a disconnect from reality. Thanks to advances in treatment—especially with medications called antipsychotics—many people with schizophrenia can manage their symptoms. However, about one in three people continue to struggle despite receiving appropriate treatment. This condition is known as treatment-resistant schizophrenia. People with treatment-resistant schizophrenia often experience more severe symptoms, including what clinicians call “positive symptoms” (e.g. hallucinations and delusions) or “negative symptoms” (e.g. reduced motivation or emotional expression). These challenges can make daily life much harder—affecting their ability to work, maintain relationships, or live independently.
The importance of understanding cognitive symptoms
In addition to the better-known positive and negative symptoms, people with schizophrenia often have trouble with memory, attention, and decision-making—what clinicians call cognitive symptoms. These difficulties can significantly affect day-to-day functioning, from holding a job to managing basic self-care. Understanding these cognitive symptoms is especially important in treatment-resistant cases. Yet, surprisingly little is known about how these issues show up in people with treatment-resistant schizophrenia.
Neuropsychology, a subfield of psychology, focuses on measuring cognitive symptoms. Most commonly, people have experience or knowledge of neuropsychological testing through things like IQ tests, but neuropsychology can provide a much more in-depth picture of cognitive abilities and functioning beyond this, with tests focusing on different cognitive domains as well as real-world abilities. Through neuropsychological testing, clinicians can get a clear picture of how thinking and problem-solving can be impacted by a mental illness.
The BC Psychosis Program: A unique opportunity to study cognitive symptoms in patients with treatment-resistant schizophrenia
The BC Psychosis Program is a specialized hospital unit that cares for people with psychosis who haven’t responded to standard treatments. Since 2012, patients admitted to this service have received neuropsychological assessment, which involves a comprehensive evaluation of cognitive abilities by a neuropsychologist. Assessments of cognition are part of the standard of care at BC Psychosis, meaning they are offered to all patients on the unit. These assessments go far beyond what’s typically done in routine care, making this program a rare and valuable resource for research. Impressively, over 80% of patients are able to engage in these assessments.
Progress so far
Dr. Ivan Torres and his team have used data from the BC Psychosis Program to build a database focused on cognitive symptoms in people with treatment-resistant schizophrenia. With about 300 patients in the database, this represents a one-of-a-kind opportunity to learn about cognition in this population. Their goal: to understand these symptoms better and to improve the way they’re assessed and treated in clinical settings.
Dr. Torres reports that,
“we have learned that clinical neuropsychological evaluations can assist with predicting a person’s functioning in their everyday life, and assessment findings can thus be very useful for providing recommendations about a person’s care needs and required supports in the community.”
Work published on this dataset so far includes exploring how cognitive functioning is measured, looking at ways of making testing more efficient and manageable for patients. The research team has also identified several aspects of cognition that are not traditionally tested in neuropsychological evaluations but have proven to be important in people’s daily functioning. These include social cognition, which refers to how we think about, understand, and interact with others, as well as subjective cognition, meaning how well someone can assess their own cognitive abilities. This has led to incorporating these measures routinely in clinical assessments.
More About Dr. Ivan Torres
Dr. Torres is a clinical neuropsychologist and a leading expert in cognitive functioning in mental illness in BC. Being both a clinician and researcher, Dr. Torres works in multiple capacities at a provincial and national level to improve understanding of cognitive symptoms, as well as how they are measured and treated in people with schizophrenia. He received funding in 2021 for his five-year project at BC Psychosis through a partnership agreement between the British Columbia Schizophrenia Society Foundation and Michael Smith Health Research BC.
As a member of the Canadian Network for Research in Schizophrenia and Psychoses, he is currently involved in developing standardized cognitive testing in psychotic disorders to improve how these symptoms are measured in research and clinical contexts. He is also working on the provincial Cognitive Remediation Therapy Provincial Advisory Group, which aims to develop a program to treat cognitive symptoms for patients with severe mental illness. Dr. Torres also plays a key role in educating other health professionals on cognitive assessment in patients with severe mental illness.