Psychiatry - December 2008 - (Page 56)

[research to practice] antipsychotic treatment and are not caused by psychotic symptoms in patients who are able to complete cognitive testing, which includes the overwhelming majority. DO THE COGNITIVE DEFICITS IDENTIFIED IN SCHIZOPHRENIA CORRELATE WITH BEHAVIOR OR SOCIAL FUNCTIONING? Dr. Keefe: Absolutely. This is the most consistent and relevant aspect of cognition in schizophrenia. Many of the various cognitive deficits in schizophrenia have been shown to be associated with functional outcomes, such as difficulty with community functioning, difficulty with instrumental and problemsolving skills, reduced success in psychosocial rehabilitation programs, and the inability to HOW DO YOU DIFFERENTIATE SPECIFIC ASPECTS OF COGNITIVE DYSFUNCTION FROM HALLUCINATIONS, DELUSIONS, AND PARANOIA? Dr. Keefe: They are very different. In fact, they are largely unrelated. In the CATIE study, we assessed cognition as well as Several studies have found that cognitive deficits are better able to explain important functional outcomes, such as work performance and independent living, than the positive or negative symptoms we generally associate with schizophrenia. symptoms at baseline before randomized treatment, and none of the cognitive domains were significantly correlated with hallucinations or delusions, despite a sample size exceeding 1,000 patients (n=1,331). maintain successful employment. Several studies have found that cognitive deficits are better able to explain important functional outcomes, such as work performance and independent living, than the positive or negative symptoms we generally associate with schizophrenia. In the CATIE patient sample, cognition was found to be significantly related to quality of life although residual symptoms were also important. Problems, Eleventh Revision (ICD11) include cognition as part of the diagnosis.1 It is interesting that while most schizophrenia experts consider cognition to be a core component of the disorder, and it is mentioned several times in the DSM-IV-TR (Fourth Edition, Text Revision) description of schizophrenia, it has not been part of the diagnostic criteria. We have proposed the following criterion for consideration in the diagnostic criteria for DSM-V and ICD-11 schizophrenia: “A level of cognitive functioning suggesting a consistent severe impairment and/or a significant decline from premorbid levels considering the patient’s educational, familial, and socioeconomic background.” If these diagnostic systems focus less on specific criteria in favor of a completely dimensional approach, which seems likely at this point, the above recommendation could be easily revised to include cognitive impairment as one of the key dimensions. DO YOU THINK THAT THERE ARE DIFFERENT FORMS OF SCHIZOPHRENIA BASED UPON THE EXTENT OF COGNITIVE DYSFUNCTION? Dr. Keefe: No. I don’t see evidence of that. You can always cut up a pie in different ways, but it is still a pie. I think that almost everyone who has schizophrenia has some cognitive impairment. It is the core of the disorder. ARE THERE NEUROANATOMICAL OR NEUROPHYSIOLOGICAL CORRELATES OF THE COGNITIVE DYSFUNCTION YOU DESCRIBE Dr. Keefe: Certainly. Functional magnetic resonance imaging (fMRI), positron emission tomography (PET), electroencephalogram (EEG), and even structural MRI studies all show relations between neuroanatomical measures and cognitive deficits in schizophrenia. These relations are strongest in frontal regions, temporal cortex, and hippocampus. CAN COGNITIVE TESTING ASSIST IN THE DIAGNOSIS OF SCHIZOPHRENIA? Dr. Keefe: This is controversial, but I think so. In fact, we have recently proposed that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) and International Statistical Classification of Diseases and Related Health 12, DECEMBER] WOULD THE INCLUSION OF COGNITIVE ASSESSMENTS IN THE EVALUATION OF SCHIZOPHRENIC PATIENTS FACILITATE TREATMENT PLANNING? Dr. Keefe: I think so. In my experience, psychiatrists rarely consider cognitive function in their 56 Psychiatry 2008 [ V O L U M E 5, NUMBER

Table of Contents Feed for the Digital Edition of Psychiatry - December 2008

Psychiatry - December 2008 Editor’s Message Contents Editorial Advisory Board Antidepressant Prescribing by Specialty and Treatment of Premenstrual Dysmorphic Disorder Pain, Pain, Go Away: Antidepressants and Pain Management Why Psychotherapy Helps the Patient in Chronic Pain General Medical Drugs Associated with Depression Katatonia: A New Conceptual Understanding of Catatonia and a New Rating Scale Thermoregulation and the Role of Calcium Signalling in Neurotransmission Cognition and Schizophrenia: Is There a Role for Cognitive Assessments in Diagnosis and Treatment? Journal Watch Information for Authors

Psychiatry - December 2008

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