Optimizing Cognitive Function in Schizophrenia
More than 1,600 researchers from 53 different countries attended the 3rd Biennial Schizophrenia International Research Conference in Florence, Italy in April. Presenters discussed the most recent advances in schizophrenia research and treatment. Philip D. Harvey, PhD, professor of Psychiatry and Behavioral Sciences and Chief of the Division of Psychology at the Miller School of Medicine of the University of Miami discusses new information that may help psychiatrists treating the condition.
UNDERSTANDING THE COMPLEXITIES OF SCHIZOPHRENIA
Schizophrenia is a complex condition, but medical science has made strides toward understanding it in recent years. How does schizophrenia affect cognition and daily functioning?
All patients with schizophrenia have cognitive impairments that affect their daily functioning. But researchers are discovering that one of the biggest issues related to schizophrenia is that patients have a very difficult time evaluating their own condition. This can make it challenging to determine how well pharmacological interventions are working.
Further complicating the picture, researchers have also found that family members and friends of individuals suffering from schizophrenia also have difficulty assessing a patient's progress. And their assessments typically don't match up with the patient's self-evaluations. However, researchers found that trained specialists, such as case managers or psychiatrists, who saw their patients regularly were able to give reports that were highly correlated with objective measures of patient performance. The take-home message for psychiatrists is that if they see a patient regularly and for longer than three months, they should trust their own impressions of the patient's condition, rather than relying on reports from family or the patient him or herself.
TAILORING THERAPY TO OPTIMIZE COGNITIVE FUNCTION
How have treatments for schizophrenia evolved in recent years? What are the cognitive effects of typical and atypical antipsychotics?
There is a lot of interest in treating cognition and negative symptoms. Researchers are working to identify pharmacological treatments and cognitive remediation interventions for cognitive deficits and to improve everyday functioning.
Researchers have shown that computer-assisted cognitive remediation in addition to psychosocial interventions leads to lasting real-world gains for patients. They have also found that these two interventions work better when paired than they do independently. In fact, some very recent research suggests that patients prescribed the combination of cognitive remediation and psychosocial interventions show improvements in everyday functioning that clinicians can see within 12 weeks. These improvements remained at a three-month follow-up.
Another area of research focus is whether patients with early signs of psychosis should be treated if they don't meet diagnostic criteria. New evidence says yes, but there is still considerable controversy as to whether the "prodromal" or "early psychosis syndrome" should be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) when DSM-5 is released.
When it comes to typical and atypical antipsychotics, research has found that only a small subset of patients see cognitive improvements when treated with these drugs. So-called "good responders" comprise a very small minority of patients, and clinicians should not expect all patients to see a detectable improvement. There are some suggestions that a newer medication, lurasidone, has greater benefits compared to other medications, but more study is needed to replicate the findings.