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Ask the Experts

Question:

My son, 32, has disorganized schizophrenia, but his complex denial leads him to believe he has a spiritual maturity problem. He will often, but not always, answer even basic questions, such as, "What is your address? Name? Phone number? Date of birth?" with "I do not know" or "I do not remember."

Is this paranoia, an attention problem, difficulty in the speed of processing thoughts, some form of learned helplessness, or something else? And what is best strategy for dealing with it?

Answered by: L. Fredrick Jarskog

While it is clear that impaired cognitive functioning represents a core symptom dimension in schizophrenia, there is not a single cognitive domain that is responsible. Many areas of cognitive function are usually impaired, often 1 to 2 standard deviations below population norms.

It is unlikely to represent learned helplessness. More likely, your son suffers from a combination of cognitive disorganization together with some positive and negative symptoms of psychosis. The positive symptoms are things such as paranoia, delusions, and hallucinations, whereas negative symptoms include social withdrawal, poor motivation, and reduced spontaneous thought and speech.

Disorganized schizophrenia can be difficult to treat pharmacologically. If he has not previously received a trial of clozapine, this may be helpful, and should be discussed with his psychiatrist.

Non-pharmacological approaches include cognitive remediation, a method of helping patients improve their cognitive skills through specific learning tasks that often involve interactive computer-based exercises.