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Nonsocial and social cognition in schizophrenia: current evidence and future directions.
Literature Information
| DOI | 10.1002/wps.20624 |
|---|---|
| PMID | 31059632 |
| Journal | World psychiatry : official journal of the World Psychiatric Association (WPA) |
| Impact Factor | 65.8 |
| JCR Quartile | Q1 |
| Publication Year | 2019 |
| Times Cited | 248 |
| Keywords | Schizophrenia, brain network organization, childhood adversity, cognition, cognitive enhancement |
| Literature Type | Journal Article |
| ISSN | 1723-8617 |
| Pages | 146-161 |
| Issue | 18(2) |
| Authors | Michael F Green, William P Horan, Junghee Lee |
TL;DR
This review explores the multifaceted nature of cognitive impairment in schizophrenia, highlighting its impact on treatment and prognosis while detailing the types of cognitive deficits, their neuroimaging correlates, and their relationship to functional outcomes. It emphasizes the importance of emerging research areas, such as motivation's influence on cognition and novel intervention strategies, which may enhance our understanding and management of schizophrenia.
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Schizophrenia · brain network organization · childhood adversity · cognition · cognitive enhancement
Abstract
Cognitive impairment in schizophrenia involves a broad array of nonsocial and social cognitive domains. It is a core feature of the illness, and one with substantial implications for treatment and prognosis. Our understanding of the causes, consequences and interventions for cognitive impairment in schizophrenia has grown substantially in recent years. Here we review a range of topics, including: a) the types of nonsocial cognitive, social cognitive, and perceptual deficits in schizophrenia; b) how deficits in schizophrenia are similar or different from those in other disorders; c) cognitive impairments in the prodromal period and over the lifespan in schizophrenia; d) neuroimaging of the neural substrates of nonsocial and social cognition, and e) relationships of nonsocial and social cognition to functional outcome. The paper also reviews the considerable efforts that have been directed to improve cognitive impairments in schizophrenia through novel psychopharmacology, cognitive remediation, social cognitive training, and alternative approaches. In the final section, we consider areas that are emerging and have the potential to provide future insights, including the interface of motivation and cognition, the influence of childhood adversity, metacognition, the role of neuroinflammation, computational modelling, the application of remote digital technology, and novel methods to evaluate brain network organization. The study of cognitive impairment has provided a way to approach, examine and comprehend a wide range of features of schizophrenia, and it may ultimately affect how we define and diagnose this complex disorder.
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Primary Questions Addressed
- What are the specific types of nonsocial cognitive deficits observed in schizophrenia, and how do they differ from social cognitive deficits?
- How do cognitive impairments in schizophrenia during the prodromal period manifest compared to later stages of the illness?
- In what ways do neuroimaging findings enhance our understanding of the neural substrates underlying cognitive deficits in schizophrenia?
- What novel psychopharmacological treatments are currently being explored to address cognitive impairments in schizophrenia, and how effective are they?
- How might the influence of childhood adversity interact with cognitive deficits in individuals with schizophrenia throughout their lifespan?
Key Findings
Research Background and Objectives
Cognitive impairment is a fundamental characteristic of schizophrenia, impacting both nonsocial and social cognitive domains. This paper aims to review the current understanding of cognitive deficits in schizophrenia, including their types, neurobiological underpinnings, and implications for treatment and functional outcomes. It also discusses emerging areas of research that could provide future insights into cognitive impairment in schizophrenia.
Main Methods/Materials/Experimental Design
The study employs a comprehensive review approach, synthesizing findings from neuroimaging studies, cognitive assessments, and treatment outcomes related to cognitive impairments in schizophrenia. The focus is on comparing cognitive functions in schizophrenia with other disorders and exploring potential interventions.
Key Results and Findings
- Types of Cognitive Deficits: Cognitive impairments in schizophrenia encompass both nonsocial (e.g., attention, memory, processing speed) and social cognition (e.g., emotion processing, mentalizing).
- Neuroimaging Insights: Functional neuroimaging reveals abnormal activation patterns in key brain regions during cognitive tasks, indicating disrupted neural circuits associated with cognitive deficits.
- Functional Outcomes: Cognitive impairments are significantly correlated with functional outcomes in daily life, suggesting that improving cognition may enhance community integration.
- Intervention Outcomes: Pharmacological treatments targeting cognitive enhancement have shown limited success. However, cognitive remediation and social cognitive training have yielded more promising results, indicating a potential path forward for improving cognitive function in schizophrenia.
Main Conclusions/Significance/Innovation
The paper emphasizes that cognitive impairments are core features of schizophrenia that persist throughout the illness and significantly impact functional outcomes. Understanding these deficits is crucial for developing effective interventions. The study highlights the need for targeted treatments that address both nonsocial and social cognitive deficits to improve overall patient outcomes.
Research Limitations and Future Directions
- Limitations: The paper notes the variability in treatment responses among patients and the challenges in generalizing findings across different populations and studies.
- Future Directions: Emerging areas for future research include:
- Investigating the interplay between cognitive impairments and motivational deficits.
- Exploring the impact of childhood adversity on cognitive outcomes.
- Advancing metacognitive strategies to enhance treatment efficacy.
- Utilizing computational models to deepen the understanding of cognitive processes in schizophrenia.
- Integrating remote digital technologies for cognitive assessment and intervention.
Overall, this comprehensive review underscores the complexity of cognitive impairment in schizophrenia and the need for continued research to develop effective interventions that can enhance cognitive functioning and improve quality of life for affected individuals.
References
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Literatures Citing This Work
- The meaning of group differences in cognitive test performance. - Paul M Grant;Michael W Best;Aaron T Beck - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
- Innovative methods for improving cognition, motivation and wellbeing in schizophrenia. - Barbara J Sahakian;George Savulich - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
- Cognitive impairment as a diagnostic criterion and treatment target in schizophrenia. - Michael Davidson - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
- Cognitive impairment and psychosis in schizophrenia: independent or linked conditions? - Abraham Reichenberg;Eva Velthorst;Michael Davidson - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
- Why are there no approved treatments for cognitive impairment in schizophrenia? - Richard S E Keefe - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
- The need to develop personalized interventions to improve cognition in schizophrenia. - Peter Falkai;Andrea Schmitt - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
- Cognition and disability in schizophrenia: cognition-related skills deficits and decision-making challenges add to morbidity. - Philip D Harvey;Martin T Strassnig - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
- Nonsocial and social cognitive function in psychosis: interrelationships, specificity and innovative approaches. - Deanna M Barch - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
- Cognition in schizophrenia: a marker of underlying neurodevelopmental problems? - Ingrid Melle - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
- Linking resting-state networks and social cognition in schizophrenia and bipolar disorder. - Amy M Jimenez;Philipp Riedel;Junghee Lee;Eric A Reavis;Michael F Green - Human brain mapping (2019)
... (238 more literatures)
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