Cognitive Problems

Many people who are not familiar with mental illness believe that difficulty thinking clearly, concentrating, and remembering are secondary problems in people with schizophrenia, the result of thought disorder, psychosis, or simply lack of ambition. In fact, cognitive problems appear to be true, primary symptoms of the disease and are included among the negative symptoms. They are also known as deficit symptoms. They can take the form of poor memory and an inability to pay attention or to make decisions. They can make it difficult for someone with schizophrenia to function easily in school, at work, and in his social life. Thought disorder is a strong impediment to maintaining an independent life.

Important Facts about Cognitive Problems in Schizophrenia

  • They do not always disappear when hallucinations and delusions stop.

  • They are not the result of laziness, indifference, or lack of effort.

  • They are not always the result of antipsychotic medications.

  • They do not result from long hospital stays.

  • Source: New York State Office of Mental Health

    If symptoms such as difficulty thinking and performing mental tasks were secondary to schizophrenia, you would not expect them to persist after the worst periods of psychosis are over, but they often do. Nor would you expect them to appear before the first psychotic episode, which they do.

    The idea that cognitive dysfunction can be a frontline symptom in schizophrenia is not surprising when you consider the results of functional brain imaging and neuroanatomical studies that show brain abnormalities in some patients.

    The cerebral cortex, the prefrontal cortex, the hippocampus, and other brain regions closely associated with cognition are affected by the disease. Depending on the site examined, scientists report detecting signs of decreased activity, missing neurons, or smaller than average neurons. If key parts of the brain responsible for thinking, planning, and reasoning are compromised by the disease, it makes sense that these abnormalities underlie the cognitive problems so often observed in people with schizophrenia.

    Question

    Do antipsychotic drugs fix cognitive problems?

    Most antipsychotic medications don't do much to improve cognitive problems in a direct way. However, by relieving the distractions caused by hallucinations and delusions, antipsychotic medications allow most patients to improve their ability to think, concentrate, remember, and interact. They also make it easier to make progress in therapy sessions designed to improve cognitive skills.

    Cognitive Problems Seen in Some People with Schizophrenia

  • Difficulty paying attention

  • Difficulty remembering and recalling information

  • Difficulty processing information quickly

  • Difficulty responding to information quickly

  • Difficulty with critical thinking, planning, organizing, and

  • problem solving

  • Difficulty initiating speech

  • Adapted from Alice Medalia and Nadine Revheim's Dealing with Cognitive Dysfunction Associated with Psychiatric Disabilities: A Handbook for Families and Friends of Individuals with Psychiatric Disorders.

    This does not mean that mental skills cannot be learned and improved in people with schizophrenia. Cognitive and other forms of therapy can provide useful skills that enable patients to improve their thinking abilities. Just as someone who has suffered an injury to a limb can improve his ability to function through physical therapy, someone who has schizophrenia has a chance of improving her ability to function through cognitive therapies. Consumers of mental health care can learn about the disease and learn how to participate in their own treatment. In many cases, they can even improve to the point at which they can function independently or with part-time assistance.

    Question

    Do all people with schizophrenia have cognitive problems?

    Most do. Neuropsychologists estimate that 85 percent or more will have some problem with intellectual tasks. The degree of impairment varies from person to person. Early in the course of the disease, cognitive problems may be particularly troublesome. In young people, cognitive impairment is a serious, early warning sign of schizophrenia even if it appears before psychotic symptoms.

    It is not unusual for cognitive problems to be overlooked when far less subtle psychotic symptoms dominate the concerns of patient, family, and doctor. After hallucinations and delusions are under better control, problems with mental acuity may become more apparent.

    Tips for Overcoming Memory Problems

  • Repeat reminders and instructions often and dispassionately. Don't nag, dominate, accuse, or allow your frustration to show. Remember, the person with a memory problem may feel defensive and upset because of it. Try to be understanding.

  • Work patiently with the person as you get him to repeat the instructions under consideration. Help him recall by offering clues and multiple choices. Expect errors, but concentrate on parts of the task he does remember.

  • Write it down. Maintain lists of tasks, appointments, chores, and activities related to school, work, and home life. Write down plans, goals, and steps to achieve them. Work with the person to create the lists and review them regularly.

  • Have a schedule for reviewing lists, plans, and routine chores or activities. Help the person learn through repetition.

  • Experiment with memory aids.

  • Try calendars, watch alarms, alarm clocks, journals, diaries, tape recorders, sticky pad note paper, and reminders taped to the refrigerator, front door, or in the car.

  • Keep the techniques that work and abandon those that don't. Keep trying to find an approach that helps.

  • Adapted from Alice Medalia and Nadine Revheim's Dealing with Cognitive Dysfunction Associated with Psychiatric Disabilities: A Handbook for Families and Friends of Individuals with Psychiatric Disorders.

    The delay in recognizing cognitive problems is one of the reasons they can be misinterpreted as signs of simple laziness, indifference, or even the result of treatment. Memory problems in people with schizophrenia can demand great patience on the part of the caregiver, but they are surmountable.

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