Psychiatry - December 2008 - (Page 57)

[research to practice] evaluation of patients with schizophrenia. Including cognitive impairment in the criteria for schizophrenia may increase psychiatrists’ attention toward a core component of the disorder that is the largest determinant of long-term functioning. Since cognitive impairment is also rarely considered as an important treatment target, its inclusion in the diagnosis may help to educate clinicians about the importance of cognition in their treatment options. Furthermore, representatives from the US Food and Drug Administration (FDA) have indicated that the recognition of cognitive impairment in the diagnostic nomenclature would be an important step in approving a drug for a cognitive improvement indication for patients with schizophrenia. A large number of pharmaceutical companies and government agencies are involved in intense work to develop compounds that may improve cognition with schizophrenia. If successful, these compounds have the potential to alter the treatment of schizophrenia. However, if clinicians are not trained to recognize cognitive deficits distinct from psychotic symptoms, a potential great benefit to patients would be missed. I think that the inclusion of cognitive impairment in the diagnostic criteria for schizophrenia may force educational systems to teach clinicians how to recognize cognitive impairment, measure improvement, and direct treatments accordingly. extreme deficits will tend to have the greatest difficulty functioning in the long run, while patients who can perform in the “normal range” will tend to do better. WHAT SPECIFIC TESTS CAN BE USED TO EVALUATE COGNITIVE DYSFUNCTION IN SCHIZOPHRENIA? Dr. Keefe: This is a tough issue. There are no specific tests that will identify schizophrenia, and it appears as though many, many aspects of cognition are affected. It really depends upon the purpose of cognitive-enhancing drugs in schizophrenia and also developed an intensively vetted battery of tests for use in clinical trials. This set of tests, the MATRICS Consensus Cognitive Battery (MCCB), was approved by the FDA and is currently in use for over a dozen multisite clinical trials of new compounds for schizophrenia. The MCCB can be used in clinical practice, but it is used mainly to determine a single overall composite outcome measure. While domain scores can be calculated, a comprehensive assessment of Including cognitive impairment in the criteria for schizophrenia may increase psychiatrists’ attention toward a core component of the disorder that is the largest determinant of long-term functioning. the cognitive tests. We need to ask what the objective of the assessment is. A comprehensive identification of neuropsychological strengths and weaknesses across multiple domains can take several hours of testing, but a brief assessment of overall cognitive skill can probably be completed in about a half-hour. treatment effects on different cognitive domains, like executive function, may require additional testing. WHAT IS EXECUTIVE FUNCTION? Dr. Keefe: The term measures of executive functioning refers to a set of processes involved in complex, goal-directed thought and behavior. Common executive abilities include judgment, problem solving, decision making, planning, and social conduct, and depend upon many of the other cognitive abilities, such as attention, perception, memory, and language. WHAT IS MATRICS? CAN IT BE USED IN CLINICAL PRACTICE? Dr. Keefe: In response to increased interest in developing new pharmacological compounds to treat cognitive impairment in schizophrenia, the National Institute of Mental Health (NIMH) funded the Measurement and Treatment Research to Improve Cognition (MATRICS) project. This project engaged over 120 leaders from industry, government, and academia to devise methods for conducting clinical trials for [VOLUME 5, HOW DO YOU MEASURE EXECUTIVE FUNCTION? Dr. Keefe: Executive functions may be among the most interesting cognitive tests, as they tend to be the aspects of cognition that are the most complex and most associated with what we think of as 12, DECEMBER] IS THE EXTENT OF COGNITIVE DEFICIT A PROGNOSTIC AS WELL AS DIAGNOSTIC MARKER? Dr. Keefe: Cognitive impairment has clear prognostic value. Patients with the most NUMBER Psychiatry 2008 57

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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