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Many people with schizophrenia do not receive proper medical treatment and other necessary supports. Severe cognitive deficits and inexplicable perceptions make the person anxious as they struggle to cope with disordered thoughts, internal voices, visual hallucinations or other debilitating symptoms that may cause bizarre behaviours. Without patient education plus support from family, friends and professionals, people in the community may reject someone suffering from schizophrenia because they do not understand the enormous difficulties the person is experiencing.
Symptoms of schizophrenia are generally divided into three categories: POSITIVE symptoms, NEGATIVE symptoms, and COGNITIVE symptoms.
“Positive” as used here does not mean “good”. It refers to having symptoms that ordinarily should not be there.
Positive symptoms are sometimes called “psychotic” symptoms since the patient has lost touch with reality in certain important ways.
See further information on our site about Psychosis.
Cognitive impairment is now recognized as a core feature of schizophrenia. Present in most patients, it is independent of symptoms such as delusions and hallucinations, and a major cause of poor social and vocational outcome. It is also reliably associated with the neurobiology of the disorder.
After nearly a century of research it has been firmly established that neurocognitive deficits are a core feature of schizophrenia. Patients with schizophrenia show deficits in areas such as memory, attention and executive functions (Green, 1998). Waldo and colleges (1994) claim that 94% of patients with schizophrenia have neurocognitive deficits compared to non psychiatric controls. However, if you ask professionals who treat schizophrenia what the disorder is, the answer often takes the form of a list of psychotic symptoms.
Sometimes a professional description of the illness is more comprehensive and in-cludes a brief account of “negative” symp-toms. But rarely will neurocognitive deficits be mentioned. Compared to psychotic symptoms, neurocognitive deficits are not as noticeable, not as odd. They are not as yet part of any formal diagnostic system. But, the deficits are still there and they have a great impact on the patient’s life.
Schizophrenia is commonly associated with bizarre thoughts and invisible voices. But it is now clear that problems in cognition–reduced attention span, problems with memory and difficulties in reasoning and problem solving–are also key features of schizophrenia. Cognitive deficits are probably the most important factor for poor outcome in people with the illness. Memory is particularly impaired, and executive function–the ability to plan, prioritise and implement strategies–is also disrupted.
In actively psychotic phases, patients with schizophrenia are often hospitalized. When positive symptoms such as hallucinations and delusions are under control, the patient is usually sent home. However, a majority of patients experience relapses. There could be many reasons for this, but one important issue is that although antipsychotic medications have an impact on symptoms, they do not appear to help neurocognition.
Functional outcome appears to be more closely related to neurocognitive abilities than symptoms. The research of Michael Green (1998) and others has shown that verbal memory, executive functioning and visual vigilance predicts functional outcome in schizophrenia.
Even though it is clear that adults with chronic schizophrenia have cognitive deficits, little effort is made to examine cognitive functioning in people with the illness. There has been an increasing interest in cognitive training programs for this population in recent years, and some programs exist for people with schizophrenia. But much of this training is being done without proper testing to determine who might benefit from what. Before training, it should first be determined in which areas and to what degree individuals experience deficits.
If cognitive testing were performed more regularly it would be of great benefit to people with schizophrenia. Furthermore, an evaluation of collected data could be used to support more appropriate community service planning for all people who suffer from the disease.
– Adapted from Norwegian Social Science Data Services, Dr. Merete , University of Oslo2001 and 01/10/Institute of Psychiatry, King’s College London, 06/01/2003
Information about Cognitive Remediation in Canada
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