Cognitive Explanations for Schizophrenia

12 Key excerpts on "Cognitive Explanations for Schizophrenia"

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  Marginality in Philosophy and Psychology

  The Limits of Psychological Explanation

  • George Tudorie(Author)
  • 2022(Publication Date)
  • Bloomsbury Academic

    (Publisher)

  For example, in the context of making the distinction between symptoms and diagnosis Frith says the following: Demonstrating that schizophrenic patients have certain cognitive abnormalities does not “explain” schizophrenia. “Explaining” schizophrenia inevitably involves Marginality in Philosophy and Psychology 204 saying something about cause. This leads us back to the mind-brain problem. The aetiology of schizophrenia almost certainly involves abnormal brain development. Cognitive abnormalities can tell us nothing directly about brain structure and function, let alone brain development. What studies of cognition can “explain” is not schizophrenia, but schizophrenic symptoms. (1992, 33) Schizophrenia itself, he continues, might be eventually explained by a faulty biological process. This is a dead end, a sign of conceptual confusions got out of hand. Schizophrenia just is, as a matter of definition, medical history, and history of use, an arrangement of symptoms. To have schizophrenia means to manifest certain symptoms. Add to this hesitation the fact that there is little connection between the more abstract observations made in this context, where the nature of psychological explanation is in question, and those made earlier, where a focus on symptoms was recommended for local methodological reasons (due to the fragility of diagnostic categories, not the etiological primacy of biology). It should be stressed that the sample above is no accident, but a symptom, one which resurfaces in a number of other writings by Frith. For example, in the 1996 British Medical Bulletin paper already mentioned, we find these remarks: [These studies] address the question of whether schizophrenia or certain signs and symptoms are associated with certain cognitive impairments. As is well known, such studies cannot address questions of causation and will always be unsatisfactory since an apparent link may be spurious, being mediated by some hidden factor.

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  Schizophrenia and Related Syndromes

  • P. J. McKenna(Author)
  • 2013(Publication Date)
  • Routledge

    (Publisher)

  Psychological theories of schizophrenia and particular schizophrenic symptoms abound, and there is if anything an embarrassment of findings of impaired performance on one or another psychological test. In order to review this large and sprawling area of research, a fairly ruthless approach needs to be taken. As a first step, discussion is restricted to studies that are concerned with cognitive function; the assumption is made that work on conditioning, arousal and the like are too far removed from the clinical picture to be able to shed much light on it. In addition, given the credibility problems that have dogged both the cognitive psychological and neuropsychological approaches to schizophrenia, any findings that emerge are required to pass a ‘stringency’ test to make sure they are as real and robust as they claim to be.

  The cognitive psychology of schizophrenia

  Traditionally, the hypothesis-driven experimental psychological approach has regarded its province as the florid, positive symptoms of schizophrenia; explanations of negative symptoms, if attempted at all, are usually tacked on as an afterthought. Both general and specific attacks have been mounted, the former attempting to bring many or all positive symptoms under the umbrella of a single psychological dysfunction, and the latter being directed to one class of symptom such as delusions, hallucinations or formal thought disorder.

  Whether general or specific, psychological theories of schizophrenia, like any theories, are only as good as the experimental support they receive. It is at this point that difficulties often arise. The evidence produced for a particular theory invariably consists of a demonstration that schizophrenic patients show impaired performance on what is typically a specially devised test of the psychological function in question. However, since schizophrenic patients are liable to perform poorly on any test, it becomes easy to obtain spurious support for the theory. In order to minimise the influence of this confounding factor, the stringency test that will be adopted is that any alleged abnormal psychological finding should be demonstrable in acute patients, in whom the general tendency to poor performance can reasonably be expected to be less of a problem than in chronic patients. Additionally, for theories of particular symptoms, the abnormality ought to be present in those who show the symptom in question and not in those who do not.

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  Cognitive Impairment in Schizophrenia

  Characteristics, Assessment and Treatment

  • Philip D. Harvey(Author)
  • 2013(Publication Date)
  • Cambridge University Press

    (Publisher)

  Is an understanding of cognition essential to advance schizophrenia science and treatment or is it a secondary problem, an interesting sideline that addresses a correlate, but not a determinant of the disorder? This chapter considers evidence from both perspectives and argues for a critical appraisal of the role of cognition in psychotic illness. Early research on cognition in schizophrenia The psychiatric pioneers of schizophrenia research considered a variety of cognitive prob- lems in their clinical case descriptions, but these efforts were limited by the questionable validity of interviews and subjective data and observations as well as by sampling biases. For example, dementia praecox was regarded initially as a deteriorative disorder associated with poor outcome in the majority of cases (Kraepelin, 1919). Yet this poor prognosis probably reflected, in part, the nature of psychiatric caseloads in the early twentieth century. Patients with favorable outcomes were omitted or not followed and study samples were seldom representative of the patient population (Riecher-Rössler & Rössler, 1998). Another limitation was the estimation of cognitive profiles on the basis of clinical experience and observation alone. Thus Bleuler (1943) maintained that patients with schizophrenia had preserved or even superior memory for events and personal material Cognitive Impairment in Schizophrenia, ed. Philip D. Harvey. Published by Cambridge University Press. © Cambridge University Press 2013. 1 and were forgetful only on occasion due to “disorganization.” This conclusion was based on responses to questions posed during clinical interviews. Bleuler typically assessed autobio- graphical memory through the process of obtaining a patient’s life history. In contrast, “memory for experiences during the examination” was assessed by asking for an account of what had been discussed at the beginning of the interview.

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  Childhood and Adolescent Psychosis

  • D. Bürgin, H. Meng, Bürgin, Meng(Authors)
  • 2004(Publication Date)
  • S. Karger

    (Publisher)

  Adolescence appears to be a unique period of differential brain development in schizophrenia [Giedd et al., 1999]. Preuss 68 Cognition represents typical human functions such as planning, learning a large amount of information as well as establishing and maintaining dynamic social relationships as a result of fundamental mental functioning. Cognition can be referred to all features of learning, understanding and knowing of any object in the environment. Thus, problem solving, planning and understanding complex verbal and conceptual materials are important aspects of cognition. Essential terms of cognition are memory, attention, perception and abstraction. Cognitive Deficits as Important Symptoms of Psychotic and Schizophrenic Disorders Bleuler [1950] and Kraepelin [1919] both assumed cognitive deficits to be the primary characteristic features of psychotic and especially schizophrenic disorders. However, up to today some of the early questions concerning the appearance of cognitive dysfunctions are not definitively solved. Cognitive impairment does not cause positive symptoms. Poor cognitive performance of patients with a psychotic disorder is not caused by medication treatment, and cognitive deficits are not caused by poor motivation of patients suffering from psychosis. Overall cognitive deficits are related to negative symptoms, but they are probably not caused by them. These last issues summarize the knowledge of 50 years of research conducted on patients with psychotic disorders or schizo-phrenia. Addington [2000] and Davidson et al. [1995] found that the severity of positive symptoms and auditory hallucinations was not correlated with the severity of impairment in cognitive functioning. In another study, Cornblatt et al. [1999] demonstrated that intellectual functioning in psychotic patients was decreased before the actual manifestation of real psychotic symptoms.

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  Psychosis

  Biopsychosocial and Relational Perspectives

  • Floriana Irtelli(Author)
  • 2018(Publication Date)
  • IntechOpen

    (Publisher)

  The positive and depressive dimensions Cognitive Impairment in Schizophrenia: Description and Cognitive Familiar Endophenotypes.… http://dx.doi.org/10.5772/intechopen.78948 49 were not associated with neurocognitive measures. The patterns of association between these dimensions were stable in all neurocognitive domains and were independent of age, sex and chronicity of the disease. In addition, significantly high correlations were found for the nega -tive dimension in relation to verbal fluency and in the disorganized dimension for reasoning/ problem solving and attention. 2.6. Origin of cognitive deficit and family endophenotypes Traditionally, two hypotheses about this disease have been considered [ 111 ]: The neurodevel -opmental hypothesis, which considers that schizophrenia would come from an early disorder of brain development, which would be present in a relatively silent way during childhood, and that it would begin to exacerbate during adolescence and the beginning of adulthood with cerebral maturation [ 112 , 113 ]. The neurodegenerative hypothesis indicates the existence of an active pathological process associated with periods of exacerbation, due to the neurotox -icity of acute psychosis, which would explain the progressive deterioration observed in these patients in the first years of the disorder. The evidence points out that although there is an alteration in neurodevelopment in schizophrenia [ 2 , 111 , 114 , 115 ], but neither can be ignored that there are progressive brain changes in the appearance of psychotic crises not always associated with treatment [ 111 ]. There is evidence which shows that these cognitive disorders are prior to the onset of psy -chotic symptoms and the diagnosis of the disorder [ 114 ] and even seem to indicate that, the subjects who will suffer from schizophrenia, already in the 7–13 years of age, obtain lower scores in neurocognitive tests compared to subjects who did not develop it.

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  Handbook of Medical Psychiatry

  • Jair C. Soares, Samuel Gershon, Jair C. Soares, Samuel Gershon(Authors)
  • 2003(Publication Date)
  • CRC Press

    (Publisher)

  methodology for investigating the neural basis of impaired cognition in schizophrenia. A prerequisite for applying these tools, however, is knowledge of the kinds of cognitive deficits which are common in schizophrenia, of their reliable measurement, and of their application in functional imaging and electrophy-siological studies in clinical populations. In this chapter we will discuss the range of cognitive deficits observed in patients with schizophrenia, begin-ning with a discussion of the involvement of the major cognitive systems of attention, memory, and language processing, as well as deficits in sensory processing. We will then discuss an overarching cognitive theory to account for the range of cognitive deficits present in schizophrenia, namely, the disruption of what has been referred to as cognitive control or executive functions. Finally, we will selectively review the literature relating cognitive dysfunction to specific neural systems in schi-zophrenia with an emphasis on how this literature might provide clues for future directions in the treat-ment of cognitive dysfunction in this illness. II. THE SCOPE OF IMPAIRED COGNITION IN SCHIZOPHRENIA A range of approaches may be used to study cognitive dysfunction in schizophrenia. Many studies have used batteries of neuropsychological tasks to characterize cognitive deficits in schizophrenia. This approach has a number of strengths, including standardization of test administration and extensive normative data against which to compare the performance of a specific patient. Such assessments remain very valuable tools in clinical assessment. However, this approach has three major limitations in the investigation of cognitive deficits in schizophre-nia. First, the tasks used in neuropsychological bat-teries are complex and cannot isolate distinct cognitive functions.

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  Schizophrenia

  A New Guide for Clinicians

  • John G. Csernansky(Author)
  • 2002(Publication Date)
  • CRC Press

    (Publisher)

  69 Cognitive Assessment in Schizophrenia Patients Anne L. Hoff University of California Davis School of Medicine Sacramento, and UC Davis Napa Psychiatric Research Center Napa, California INTRODUCTION Schizophrenia has been considered a disorder involving cognitive deficits from its earliest description. Kraepelin described it as a “dis-order of attention” and eventually coined the term “dementia praecox” to describe the deteriorating course of illness, which resembled an organic dementia in some patients (1). With the advent of anti-psychotic medications in the 1950s, it is now rare to observe the natural course of schizophrenic illness over a lifetime. Indeed, there is evidence to suggest that antipsychotic medications improve out-come. A group of recent studies suggest that longer duration of untreated psychosis is associated with a longer period of recovery, more negative symptoms, and worse social or occupational function-ing (2,3). What are cognitive deficits in schizophrenia and how are they measured? Cognitive deficits involve mental-processing capacities that range from elementary processes such as simple attention and vigilance to more complex processes such as abstract thinking and higher-order problem solving. The field of neuropsychology that originally focused on the effects of brain damage (from missile wounds, tumors, head 4 70 Hoff injuries, strokes, etc.) on cognitive processes has contributed greatly to a better understanding of cognitive disorders in schizophrenia. Psycho-logical tests created to measure functioning of different parts of the brain are now used routinely to assess patients with schizophrenia. Because many of these tests are based on principles of localization of different functions to certain brain regions established by brain-lesion studies, one could argue that they are inappropriately applied to patients who have a disorder that involves most, if not all, regions of the brain.

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  Language and Schizophrenia

  Perspectives from Psychology and Philosophy

  • Valentina Cardella(Author)
  • 2017(Publication Date)
  • Routledge

    (Publisher)

  DSM-5 has substantially revised schizophrenia’s concept, eliminating different subgroups and adopting a dimensional approach that seems to account better for symptom diversity. The focus on single symptoms rather than on single disorders can limit this variability and help identify the main anomalies.

  What are these anomalies? Cognitive science, despite having nowadays more than 60 years of history (it was officially born in 1956; see Gardner, 1985) considers the mind the same way it considered it more than half a century ago, that is, as a system that stores, processes, and elaborates information. Thus, when considering mental disorders, it has to identify some impairments in a specific passage of these processes. A specific defect has to be found on a basic level (e.g., in the processing of sensory information) or on a superior one (e.g., in the planning of behaviours apt to achieve some goals).

  In this chapter, I will deal with the different impairments that have been regarded as the cause of the features of schizophrenic language. It is important to specify that the cognitive interpretation of schizophrenic language is deeply influenced by the way cognitive scientists consider language itself. This has some consequences. In the research I will present here, language is not seen as an autonomous system with its biological and cognitive specificities, but rather as something grounded in other cognitive domains that could break down only when other cognitive systems are affected. As we will see, the domains that are singled out by the vast majority of these scholars are ultimately three: memory, executive functions, and theory of mind. The basic claim shared by this research is that the schizophrenic language alterations (essentially affecting semantics and pragmatics) depend on impairments that do not affect language directly, but that involve other domains that in turn have an effect on language. In order to illustrate the way cognitive science investigates language in schizophrenia, I will quote what Gold et al. say in their review on schizophrenia and cognitive functions:

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  Social Cognition and Metacognition in Schizophrenia

  Psychopathology and Treatment Approaches

  • Paul Lysaker, Giancarlo Dimaggio, Martin Brüne(Authors)
  • 2014(Publication Date)
  • Academic Press

    (Publisher)

  Returning to schizophrenia, the issue of the meaning people with this condition make of their lives in the midst of the disorder is thus essential to consider in the same sense, as we should consider how anyone makes sense of any challenge. This is especially important, given that, as noted by Bleuler, the processes that allow meaning making within one’s life may be disrupted in schizophrenia. In other words, this sense making may be unusually problematic for people with schizophrenia and so potentially not just a necessary generic condition for well-being, but also a specific source of disability in schizophrenia.

  Support for the contention that there is more to disability than symptoms and neurocognition comes from a wealth of studies suggesting that symptoms and neurocognitive deficits alone do not fully account for either conversion from a high-risk state to schizophrenia or the emergence or persistence of psychosocial deficits when the disorder is manifest. It is also consistent with observations that current treatments that include many elaborate attempts to treat symptoms and skill deficits are not entirely efficacious.

  In response to this problem, researchers and scholars from diverse settings have been exploring over the last 20 years (e.g., Frith, 1992 ) whether people with schizophrenia experience deficits in the ability to make coherent and useful sense of what is happening in their own minds and in the minds of others. Others have, in parallel, been seeking to devise treatments that might assist people with schizophrenia to form the types of understanding of themselves and others that might offer greater opportunities for recovery. This has included work, including all of the chapters of this book, which refers to these processes as ‘social cognition’ and others that refer to it as ‘metacognition.’

  This book has sought to bring together work using both terms in order to offer the most current advances in the field. It also aims to elucidate the general conclusions that can be drawn from this approach, what types of debates are ongoing, and what types of research these conclusions call for. In this final chapter, we will turn to the latter three questions. We will first briefly summarize and then synthesize the preceding information about the biologic and social underpinnings of disturbances in social cognition and metacognition, the more precise nature of social cognitive and metacognitive disturbances in schizophrenia, and the various forms of treatment available. We will next pose four areas of debate: the relationships of the construct of social cognition and metacognition, the factors that cause and sustain these difficulties, the implications for conceptualizing the disorder, and issues at stake when trying to treat disturbances in social cognition and metacognition. Finally, directions for future work are discussed. As with all other chapters in this book, our goal is to stimulate dialogue, advance the study of schizophrenia as an element of the human condition, and promote practices that advance the well-being and quality of life of people with this condition.

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  Essential CNS Drug Development

  • Amir Kalali, Sheldon Preskorn, Joseph Kwentus, Stephen M. Stahl(Authors)
  • 2012(Publication Date)
  • Cambridge University Press

    (Publisher)

  Chapter 12 The importance of treating cognition in schizophrenia and other severe mental illnesses: background, strategies, and findings to date Philip D. Harvey and Richard S. E. Keefe Cognitive impairments have long been known to predict everyday functioning in people with various neuropsychiatric conditions (Heaton and Pendleton, 1981) and schizophrenia is a clear example of that. While there have been multiple reviews and meta-analyses (e.g. Green et al., 2000) of the relationship between cognition and everyday functioning in schizophrenia, recent research has suggested that cognitive deficits may exert their influence on everyday functioning through their relationship with functional capacity (Bowie et al., 2008). Functional capacity refers to the ability to perform the component skills required for everyday functioning, including such things as managing money, making telephone calls, shopping, and traveling (Harvey et al., 2007). It has been found in several studies that cognitive deficits are strongly related to measures of functional capacity, which are in turn related to everyday functioning (see Leifker et al., 2011, for a review). These relationships, presented graphically in Figure 1, suggest that treatment of cognitive impairment may facilitate the chances of improved everyday functioning; moreover, they also suggest that direct improvements in functional capacity, if possible, may also improve everyday out- comes. As can be seen in the figure, of the multiple cognitive domains measured in this study (Bowie et al., 2008), only one had a direct and unmediated influence on the performance-based measures of functional capacity, in this case the UCSD performance- based skills assessment (UPSA; Patterson et al., 2001a) and the Social Skills Performance Assessment (SSPA; Patterson et al., 2001b). As impairments in everyday functioning are very common and severe in schizophre- nia, reducing these deficits is critically important.

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  The Neuropsychology Of Schizophrenia

  • JOHN P CUTTING, Anthony David(Authors)
  • 2019(Publication Date)
  • Psychology Press

    (Publisher)

  Chapter 4 ). Nuechterlein and co-workers studied PET scans and EEG coherence, during an attention task—the continuous performance test—known to be sensitive to right hemisphere activity, and found impairment in schizophrenia. These results are consistent with other neurobiological and psychological studies implicating right hemisphere dysfunction in schizophrenia, although prefrontal areas may also be implicated.

  One study which is in some way an exception is that by Bentall (Chapter 19 ), who presents a coherent account of the nature and cognitive underpinnings of paranoid delusions. What is distinctive about this chapter is that it underplays the role of brain dysfunction or even abnormal perceptual experiences. Instead, Bentall portrays delusions as extensions of normal beliefs and this is backed up by experimental evidence from patients. Like Fleminger’s chapter (Chapter 20 ), Bentall’s is complementary to the entirely brain-based accounts contained elsewhere in this book.

  This discussion leads on to another hybrid label: cognitive neuropsychology. This is a new branch of psychology as well as a very old one (see Ellis & Young, 1988; McCarthy & Warrington, 1990). Here the aim of study is to elucidate the cognitive subcomponents of psychological processes. The existence of these subcomponents or abstract “modules” (Fodor, 1983), is inferred from their absence in cases of focal brain damage or disease. The study of patients with cerebral lesions is therefore only a means to an end. Can this approach be tailored to psychiatric disorders? Ellis and de Pauw (Chapter 18 ) provide a rationale concerning the origin of Capgras syndrome, one form of delusional misidentification, and David (Chapter 17

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  Clinical Manual for Treatment of Schizophrenia

  • John Lauriello, Stefano Pallanti, John Lauriello, Stefano Pallanti(Authors)
  • 2012(Publication Date)
  • American Psychiatric Association Publishing

    (Publisher)

  Cognitive impairments have been shown to be more reliable than positive symptoms in predicting social functioning and integration, self-care, and employment for the current illness episode and for the future course of the schizophrenic disorder. In particular, the domains of attention and vigilance were found to be related to social functioning. Verbal learning and memory, on the other hand, were related to social and occupational integration. Executive functions were associated with independent living and processing speed with employment. However, the correlation between cognition and functional outcome is not yet sufficient for reliable predictions. The explained variance ranges from 20% to 60%, which leaves a consistent margin of uncertainty. To improve this relation and to increase the value of cognitive deficits for the prediction of outcome, additional factors have been postulated that may indirectly mediate or modulate the effect of cognition on important determinants of outcome, such as motivation, quality of life, self-esteem, satisfaction, hope, responsibility, or goals. As possible mediators between cognition and the subjective and social determinants of functional outcome, negative symptoms such as anhedonia, amotivation, and avolition have been considered. These motivational factors have been shown to be important for social integration and in particular for employment and have been found to mediate between symptoms and outcome. The relation between cognition and these factors is not yet conclusive, however.

  Cognition and Schizophrenia Treatment

  The investigation of cognition with neuropsychological methods has yielded important insights about possible basic mechanisms of schizophrenic pathology. In contrast to European schools of psychopathology, in American psychiatry the link between basic cognitive disorders and symptomatology is not the focus of interest. Rather, empirical measures of neuropsychological performance are related to objective and quantitative measures of behavioral performance rather than to the subjective and/or psychologically complex schizophrenic symptoms, especially in the positive symptoms domain. Consequently, important contributions link cognitive deficits to pervasive behavioral deficits, mostly found in the negative symptom domain, and to long-term social functioning.

  Different approaches make the assessment of cognitive disorders useful for treatment. These approaches use the relation of cognitive symptoms with pervasive deficit symptoms to predict the course of the illness; the possibility of training cognitive performance with specific programs, thus addressing cognitive disorders as treatment targets; and the relation of specific cognitive disorders with interpersonal communication domains for individual clinical motivation and conflict management.

  Treatment Programs Targeting Cognitive Deficits

  Standardized recovery criteria go beyond symptom remission (Andreasen et al. 2005 ) and put special emphasis on an improved personal and social functioning in residence, work, and leisure (Bellack 2006 ; Brekke and Nakagami 2010 ; Leucht and Lasser 2006

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