Cognitive Impairment in Schizophrenia
Disclaimer: I am not a mental health professional, I can’t diagnose you. If you think you have a mental illness please reach out to your doctor or a mental health professional.
For schizophrenics like myself, some of the most stigmatized, and sensationalized symptoms are the positive ones, meaning delusions, hallucinations, and movement disorders to some extent. You see them in textbooks and in the media; seeing, hearing, smelling or feeling things that aren’t real. Believing strange ideas, and this is my own example, like that the alien government lizard people are coming after you. These draw the most attention from the public eye, and I can’t blame them, alien government lizard people is pretty out there. But what about the less talked about symptoms such as negative and cognitive symptoms? Well, this essay will examine the cognitive side of a schizophrenia diagnosis.
According to Columbia University (2016), “many people with [Schizophrenia] also have cognitive deficits, including problems with short- and long-term memory.” They go on to say that cognitive factors can be the most disabling for people, leading to difficulty holding down a job and maintaining social relationships. They don’t have many answers as to the cause or cure for memory problems. Sucks to be us I guess. I personally have a plethora of issues with memory, short term and long term. I find myself lost when the dialogue of TV shows gets even slightly complicated because I immediately forget what was said, maybe that’s just me but it takes a toll on my self-esteem when I can't follow slightly complicated dialogue. But anyway, back to memory. Apparently when a group of healthy controls were compared to a group with schizophrenia, the healthy group, unsurprisingly, did better at memory tasks. In fact the health control groups brains showed increased brain activity the tests got harder and decreased activity when it got easier while the people with schizophrenia showed significantly weaker activity across the board.
According to Bowie and Harvey (2006) cognitive symptoms are the central feature of schizophrenia. As well as that these impairments may even present before the emergence of positive symptoms. They also found that there were “moderate deficits in attention, verbal fluency, working memory, and processing speed, with superimposed severe deficits in declarative verbal memory and executive functioning.” What is executive functioning? Well to quote Goodman (2021), “[e]xecutive functioning skills help you get things done. These skills are controlled by an area of the brain called the frontal lobe.” Things executive functioning helps you do is “manage time, pay attention, switch focus, plan and organize, remember details, avoid saying or doing the wrong thing, do things based on your experience, and multitask” (Goodman, 2021).
I’ll cover some ways to deal with executive dysfunction in a later essay.
Most people with schizophrenia will show some kind of cognitive impairment, but the severity will vary across different people. One interesting thing about these cognitive impairments is that they will remain relatively stable over time. There are some different types of impairments that I will summarize.
General Intelligence
I take some offence at the description that all people with schizophrenia have lower IQ’s, I mean there are/were some very smart people with it, like John Nash, or the people Cernis, Vassos, Brebion, McKenna, Murray, David & MacCabe (2015) studied, finding that there is “a high-IQ variant of schizophrenia that is associated with markedly fewer negative symptoms than typical schizophrenia” However the science seems to be overwhelmingly favourable in the direction that people with it have lower IQ’s as a group. On the other hand, I don’t know what kind of people they picked for their healthy control group, because if they were all university grads then it’s not really fair. So take this with a grain of salt. While the tests say that we are as a group, less intelligent than the “general” population it doesn’t mean you specifically are not intelligent. We can be just as successful as anyone else.
Attention
This one is simple, people with schizophrenia have a deficit in their ability to maintain their attention, this occurs even before the first psychotic episode.
Working memory
I have a terrible working memory, bad enough for it to be considered a learning disability. However I’m not alone in this, many people with schizophrenia have some kind of dysfunction in working memory, and apparently specifically verbal working memory. Bowie and Harvey (2006) state that “Working memory can be conceptualized as the ability to maintain and manipulate informative stimuli.” This is in contrast to attention span, with working memory being more cognitively challenging and attention span being more simple. In working memory, “The information must be held online for processing, but does not necessarily transfer to long-term storage, unlike episodic memory” (Bowie and Harvey, 2006). And poor memory can even affect social and interpersonal relationships because of the inability to pay attention to “multiple streams of information” Bowie and Harvey, 2006).
Verbal fluency
People like us sometimes find it rather difficult to speak in a coherent fashion, I remember many instances where I’ve tried to speak only for word salad to spill out of my mouth, and the looks of confusion and worry on other peoples faces is just great, really what I wanted to happen, not embarrassing at all. This inability to speak is due to “poor storage of verbal information as well as inefficient retrieval of information from semantic network” (Bowie and Harvey, 2006). Furthermore, "information that is stored is not always retrieved as a result of this inability to properly access semantic networks” (Bowie and Harvey, 2006).
Verbal and learning memory
A main impairment of schizophrenia is the difficulty of retaining verbal information. From what I understand, recognition memory seems to be able to work well in most cases, but “the pattern of deficits in schizophrenia tends to be reduced rates of learning over multiple exposure trials and poor recall of learned information” (Bowie and Harvey, 2006). So basically it takes a while for us to learn something but once we do we have good recognition memory. Now, recognition memory is the ability to recall something when you’ve seen it before, so I think what happens is if you’re able to process the information into long term memory you’ll be able to recall when you encounter that information again. Maybe I’m totally wrong, I don’t know.
Executive functioning
Now most schizophrenics have difficulties with most of all of the processes involved with executive dysfunction. Bowie and Harvey (2006) say that “schizophrenia patients have trouble adapting to changes in the environment that require different behavioral responses” which is directly due to issues with executive dysfunction. Furthermore, this “inflexibility” is highly associated with what Bowie and Harvey call “occupational difficulties.” This makes sense, when someone can’t plan, practice self-care, engage in social and interpersonal matters or participate in community functions, it’s gonna take a toll on your work life.
Treatment
Atypical antipsychotics seem to be the best treatment for cognitive impairments, though the results are sorta weak, Bowie and Harvey (2006) admit that “they have had very limited, if any, success in producing cognitive improvements. However, the search for new compounds designed specifically for cognitive enhancement in schizophrenia continues to be a promising area for future research.”
However there is also behavioural treatments, but there isn’t a lot of research on this topic. On the other hand, what little research there is, is very promising. “These strategies include training on computerized tasks similar to existing cognitive tests, teaching new learning strategies, training on novel tasks, and/or performing tasks repetitively” (Bowie and Harvey, 2006).
In the end, it seems that a combination of medication and therapy is the key. On the other hand, research by Everding (2005) states that “memory problems in schizophrenia can indeed be reduced and suggests that helping people use the right memorization strategy is critical to success.” The right strategies seem to be to remember more ‘deeply’ or according to Jantzi, Mengi, Serfaty, et al., (2019) to engage in retrieval practice, also Antzi, Mengi, Serfaty, et al.’s (2019) study is “the first to demonstrate that retrieval practice is also superior to restudy in improving later recall in patients with schizophrenia presenting with episodic memory impairment.” This is great news for us because it presents a real way of improving our memories, which apparently most of us need.
REFERENCES
Study finds brain marker of poor memory in schizophrenia patients: possible key to understanding and treating cognitive symptoms of the disease, (2016). Columbia University. Retrieved from https://www.cuimc.columbia.edu/news/study-finds-brain-marker-poor-memory-schizophrenia-patients
Bowie, C. R., & Harvey, P. D. (2006). Cognitive deficits and functional outcome in schizophrenia. Neuropsychiatric disease and treatment, 2(4), 531–536. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671937/
Černis ,E,. Vassos, E,. Brébion, G,. McKenna, PJ,. Murray, RM,. David, AS,. MacCabe, JH. (2015). Schizophrenia patients with high intelligence: A clinically distinct sub-type of schizophrenia? Eur Psychiatry. (5):628-32. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25752725/
Gerry Everding (2005). Memory study shows brain function in schizophrenia can improve with support, holds promise for cognitive rehabilitation: need cues, memory aids. Washington University. Retrieved from https://source.wustl.edu/2005/07/memory-study-shows-brain-function-in-schizophrenia-can-improve-with-support-holds-promise-for-cognitive-rehabilitation/
Jantzi, C., Mengin, A., Serfaty, D. et al. (2019). Retrieval practice improves memory in patients with schizophrenia: new perspectives for cognitive remediation. BMC Psychiatry 19, 355. Retrieved from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2341-y#citeas
Goodman, B. (2021). Executive function and executive dysfunction disorders. WebMD. Retrieved from https://www.webmd.com/add-adhd/executive-function