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Question:

I have just professionally seen a 22 year old diagnosed with schizophrenia two years ago and would like a reevaluation of his diagnosis. Is neuropsychiatric testing helpful since he has cognitive difficulties especially in abstract thinking and is anxious, but has no present psychotic features. Medication has been reduced by his family MD and he is improving except for cognitive difficulties according to family members and his family doctor.

Answered by: Joshua Kantrowitz

The neurocognitive deficits of schizophrenia develop in the years immediately preceding onset of symptoms, and represent a primary predictor of poor long-term outcome. Prevalence of cognitive dysfunction can also be estimated using baseline data from the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial in which despite cognitive dysfunction not being part of the inclusion criteria, the majority of patients had profound cognitive deficits. Moreover, in this trial, a global measure of cognitive functioning was significantly correlated with negative symptoms (Reductions in normal emotional and behavioral states), but unrelated to positive symptoms, suggesting both an interrelationship between these core deficits and a relative distinction from positive symptoms. These cognitive deficits often begin pre-psychosis, and a substantial decline in IQ during adolescence is common. Once cognitive dysfunction develops in schizophrenia, it appears to remain stable and persists even during periods of relative symptom remission. Despite its clear importance, no medications are presently approved for treatment of cognitive dysfunction in schizophrenia. At the Lieber Schizophrenia Research clinic, we are researching potential new drugs and behavioral treatments for improving cognition in patients for schizophrenia, and would be happy to conduct an evaluation.