Optimizing Cognitive Function in Schizophrenia

Based on the research presented at the Schizophrenia International Research Society Conference, are there treatment recommendations that can be made to optimize cognitive function in patients with schizophrenia?

Psychiatrists should pay careful attention not to overuse anticholinergic medications, which have been shown to negate the benefits of cognitive remediation.

What role do cognitive enhancing agents play in this patient population?

Nothing that is currently approved for other conditions (e.g., cholinesterase inhibitors for dementia) has ever been consistently demonstrated to work in schizophrenic populations. There are also demonstrated safety concerns related to the use of stimulant medications. That said, the most recent research has suggested that amphetamine-like compounds can improve cognitive functioning, functional capacity and negative symptoms. But safety concerns remain a factor.


What treatments are on the horizon for schizophrenia?

Two types of drugs that have shown some promise are alpha7 nicotinic agonist and glycine transport inhibitors. The alpha7s have been shown to be effective in reducing cognitive deficits. The glycine transport inhibitors seem to be effective in improving negative symptoms. However, the reverse is not true, which suggests that negative symptoms and cognitive issues are caused by different underlying factors. These drugs don’t interact with one another, so once they are approved, assuming that the positive results continue, psychiatrists will likely want to use the drugs together.

Researchers are also focused on the genetics of schizophrenia. However, instead of looking at standard inheritance patterns, they are examining ways that genetic mutations, including possibly heritable mutations, influence the condition. There are relatively few interventions available currently from a pharmacogenomics standpoint, but it is likely that researchers will rapidly create interventions as evidence evolves.

Are there any other issues that psychiatrists should pay attention to in coming months?

One issue that psychiatrists may want to weigh in on is a move to revise the forthcoming DSM update, DSM-5, to include prodromal symptoms. Psychiatrists may be interested in offering positive or negative comments. Opinions on the issue are split. One of the arguments against the change is that only 20% of individuals designated as prodromal actually go on to develop a psychotic condition. So many people who are being treated under this definition would never have developed psychosis in the first place. Psychiatrists can submit their thoughts on the DSM-5 website.