Note: This post was written by Jessica Brown, PhD student at the University of Manchester.
What kind of mental image springs to mind upon reading the word schizophrenia? Many envisage an individual locked in a dark institution, constantly plagued by non-existent voices and vivid hallucinations. Even as a final year BSc Biology student with a neuroscience research placement under my belt, I too was guilty of this reflex association. Upon skimming through project titles on FindaPhD.com, the word schizophrenia jumped out of the page. My excitement was sparked as I envisaged myself unravelling the intricacies of psychosis. As I examined the project title more closely, I admittedly experienced a minor surge of disappointment: the research was interested in targeting the cognitive deficits of schizophrenia. Cognitive deficits? I was unaware that cognition was significantly impaired in schizophrenia patients. And even if it was, did these symptoms really warrant extensive investigation? Surely, in the context of a disorder characterised by multimodal hallucinations and debilitating delusions, cognitive difficulties shouldnt be an urgent therapeutic priority.
The failure of current antipsychotics
A few hours of literature research and an interview with my PhD supervisor later, my appreciation of schizophrenia had been completely transformed.
Fortunately for our hypothetical institutionalised patient, modern antipsychotic drugs combating positive, psychotic symptoms have allowed many individuals to successfully function and flourish within their communities. So why, my supervisor pointed out to me, do so many schizophrenia patients still fail to achieve independent living, find employment and form relationships? Even more alarmingly, why are rates of symptomatic relapse so high? By the end of our conversation, I was convinced: the answer lies in the debilitating cognitive disturbances suffered by individuals, too often overlooked by research and crucially neglected by current drug therapies.
Cognitive impairment in schizophrenia: an unmet clinical need
Schizophrenia is a staggeringly heterogeneous disorder, with symptoms manifesting very differently in each patient. Amidst this variety, cognitive deficits are a consistent feature, persisting independently of circumstances such as medication, institutionalisation and advancement in cognition assessment tools. In particular, patients struggle in areas of verbal learning, processing speed and working memory.
Cognitive functioning in schizophrenia has been subjected to decades of research. However, the true impact of cognition upon disease outcomes has only recently come to light. A plethora of studies have drawn links between poor cognitive performance and impaired psychosocial functioning. One might argue that this is a rather obvious association. But why does it matter? Closer consideration reveals the enormous impact this has on daily life: if a schizophrenia patient is unable to perform hygiene-related tasks and keep up with their medications, they have little hope of finding employment or successfully integrating into community living.
As recently as January 2020, research has emphasised the detrimental effects of poor cognition. An Ecuadorian study conducted at the psychiatric Kennedy Hospital used the SCIP (Screening of Cognitive Deterioration in Psychiatry) tool alongside questionnaires assessing quality of life and sociodemographic status to reveal the inverse relationship between cognitive impairment and quality of life as perceived by the patient.
Even considering the impact of untreated cognitive symptoms upon quality of life, it is still reasonable to pose the question: so what? The sad reality is that for many patients, cognitive difficulties make antipsychotic drugs a futile intervention, leading to symptomatic remission and a substantial waste of resources. As if the significance of cognitive impairment had not been sufficiently demonstrated, a Swedish study following over 500 schizophrenia patients made the staggering finding that executive function independently predicted premature death.
Therapeutic intervention: a multi-pronged approach
In the face of such alarming data, it is unsurprising that the cognitive deficits of schizophrenia have become an urgent therapeutic target. But how can cognition be elevated? Amongst the most promising interventions are drugs targeting NMDA receptors located on neurons in the brain, these receptors mediate signalling crucial for learning and memory functions. One such medication is memantine, which has shown some promise in schizophrenia patients.
Unfortunately, using pharmacological treatments to improve cognition is far from straightforward. It is critical to remember that these patients still rely upon antipsychotics to manage positive symptoms, which often interfere with the activity of cognition-targeting drugs. Even without this complication, is it rational to expect a single-target approach to be effective in treating such a complex, multi-faceted disorder? This is where cognitive remediation therapy comes in. Using behavioural training, this technique is not only shown to improve performance across numerous cognitive domains, but also delay the relapse of symptoms.
Concluding thoughts
As scientists, I believe we are often drawn to the one size fits all approach: current medicine is geared toward identifying a magic bullet to target a single, disease-causing agent. The game plan is clear: find this drug, roll it out to patients and the problem will be solved.
Sadly, as research continues to search for successful schizophrenia treatment strategies, one thing is becoming painstakingly clear: one size does not fit all. A particular cocktail of drugs and behavioural therapies allowing one patient to thrive may be completely unsuccessful in another. Encouragingly, current efforts are directed toward identifying patients most likely to benefit from certain treatment strategies, using biological indicators or biomarkers.
In the world of science, it is all too easy to become immersed in the daily frustrations and unsolved mysteries of research and forget why one is even investigating a particular disorder. As a colleague in neuroscience R&D at Eli Lilly once said to me: in every meeting, there should always be a chair reserved for the most important person in the room. And that person is the patient.
There is an undeniably long way to go before schizophrenia patients will be able to make a complete recovery, with a low risk of relapse and a satisfactory quality of life. But recognising cognition as the wrongly neglected aspect of schizophrenia is certainly a step in the right direction.
References:
J, Avila, Villacrs L, Rosado D, and Loor E. Cognitive Deterioration and Quality of Life in Patients with Schizophrenia: A Single Institution Experience. Cureus 12, no. 1 (25 January 2020).
Molina, Juan, and Ming T. Tsuang. Neurocognition and Treatment Outcomes in Schizophrenia. In Schizophrenia Treatment Outcomes: An Evidence-Based Approach to Recovery, edited by Amresh Shrivastava and Avinash De Sousa, 3541. Cham: Springer International Publishing, 2020.
Schaefer, Jonathan, Evan Giangrande, Daniel R. Weinberger, and Dwight Dickinson. The Global Cognitive Impairment in Schizophrenia: Consistent over Decades and around the World. Schizophrenia Research 150, no. 1 (October 2013): 4250.
Evans, Jovier D., Robert K. Heaton, Jane S. Paulsen, Barton W. Palmer, Thomas Patterson, and Dilip V. Jeste. The Relationship of Neuropsychological Abilities to Specific Domains of Functional Capacity in Older Schizophrenia Patients. Biological Psychiatry 53, no. 5 (1 March 2003): 42230.
Semkovska, Maria, Marc-Andr Bdard, Lucie Godbout, Frdrique Limoge, and Emmanuel Stip. Assessment of Executive Dysfunction during Activities of Daily Living in Schizophrenia. Schizophrenia Research 69, no. 23 (1 August 2004): 289300.
Tsai, G. E. Ultimate Translation: Developing Therapeutics Targeting on N-Methyl-d-Aspartate Receptor. Advances in Pharmacology (San Diego, Calif.) 76 (2016): 257309.
Thomas, Michael L., Michael F. Green, Gerhard Hellemann, Catherine A. Sugar, Melissa Tarasenko, Monica E. Calkins, Tiffany A. Greenwood, et al. Modeling Deficits From Early Auditory Information Processing to Psychosocial Functioning in Schizophrenia. JAMA Psychiatry 74, no. 1 (1 January 2017): 3746.
Trapp, Wolfgang, Michael Landgrebe, Katharina Hoesl, Stefan Lautenbacher, Bernd Gallhofer, Wilfried Gnther, and Goeran Hajak. Cognitive Remediation Improves Cognition and Good Cognitive Performance Increases Time to RelapseResults of a 5 Year Catamnestic Study in Schizophrenia Patients. BMC Psychiatry 13 (9 July 2013): 184.
Helldin, Lars, Fredrik Hjrthag, Anna-Karin Olsson, and Philip D. Harvey. Cognitive Performance, Symptom Severity, and Survival among Patients with Schizophrenia Spectrum Disorder: A Prospective 15-Year Study. Schizophrenia Research 169, no. 13 (December 2015): 14146.
Featured Image#9/100 Jigsawbelongs to the flickr account ofRum Bucolic Apeand is used under a CC BY-ND 2.0 Creative Commons CC license
Images in text
Read this article:
Cognition in schizophrenia: a missing piece of the therapeutic puzzle - PLoS Blogs
- Mental Exhaustion Drives Aggressive Behavior - Neuroscience News - November 12th, 2024 [November 12th, 2024]
- NeuroAI: A field born from the symbiosis between neuroscience, AI - The Transmitter: Neuroscience News and Perspectives - November 12th, 2024 [November 12th, 2024]
- The neuroscience of deeper learning in math - SmartBrief - November 12th, 2024 [November 12th, 2024]
- What the brain can teach artificial neural networks - The Transmitter: Neuroscience News and Perspectives - November 12th, 2024 [November 12th, 2024]
- How Anthony Zador thinks neuroscience can help improve AI - The Transmitter: Neuroscience News and Perspectives - November 12th, 2024 [November 12th, 2024]
- Discovering Cancer Therapies through Neuroscience - The New York Academy of Sciences - November 12th, 2024 [November 12th, 2024]
- Neuroscience Market Projected to Reach USD 50.2 Billion by 2032, Growing at a 4.0% CAGR S&S Insider - GlobeNewswire - November 12th, 2024 [November 12th, 2024]
- Insights on Brain Aging and Lifelong Cognitive Health - Neuroscience News - November 12th, 2024 [November 12th, 2024]
- A neuroscience PhD student at the University of Oxford has died - The Tab - November 12th, 2024 [November 12th, 2024]
- Exploring the connection between autism and sleep - The Transmitter: Neuroscience News and Perspectives - November 12th, 2024 [November 12th, 2024]
- Astrocytes star in memory storage, recall - The Transmitter: Neuroscience News and Perspectives - November 12th, 2024 [November 12th, 2024]
- Gut Bacteria Modulate Stress Responses Over Time - Neuroscience News - November 12th, 2024 [November 12th, 2024]
- Gut Bacteria Could Hold the Key to Promoting Healthy Aging - Neuroscience News - November 12th, 2024 [November 12th, 2024]
- Microglias pruning function called into question - The Transmitter: Neuroscience News and Perspectives - October 26th, 2024 [October 26th, 2024]
- Depression Alters Brain Circuits, Heightening Negative Perception - Neuroscience News - October 26th, 2024 [October 26th, 2024]
- UNE Researchers Showcase Groundbreaking Work at Global Neuroscience Conference - University of New England - October 26th, 2024 [October 26th, 2024]
- Scientists discover "glue" that holds memory together in fascinating neuroscience breakthrough - PsyPost - October 26th, 2024 [October 26th, 2024]
- Systems neuroscience: combining theory and neurotechnology for a multiscale account of the brain - Nature.com - October 26th, 2024 [October 26th, 2024]
- Seaport Therapeutics adds another $225 million to coffers to embrace the golden age of neuroscience - STAT - October 26th, 2024 [October 26th, 2024]
- ANRO Investors Have Opportunity to Join Alto Neuroscience, Inc. Fraud Investigation with the Schall Law Firm - Business Wire - October 26th, 2024 [October 26th, 2024]
- Youth Face Rising Risks of Harassment and Exploitation in the Metaverse - Neuroscience News - October 26th, 2024 [October 26th, 2024]
- Exercise During Chemotherapy Boosts Cognitive Function - Neuroscience News - October 26th, 2024 [October 26th, 2024]
- Removing Pre-Bed Screen Time Improves Toddler Sleep - Neuroscience News - October 26th, 2024 [October 26th, 2024]
- Bright Minds Biosciences and Firefly Neuroscience to Collaborate After the BREAKTHROUGH Study: A Phase 2 Trial of BMB-101 in Absence Epilepsy and... - October 26th, 2024 [October 26th, 2024]
- How Visual Clutter Disrupts Information Flow in the Brain - Neuroscience News - October 26th, 2024 [October 26th, 2024]
- Menopausal Hormone Therapys Effects on Brain Health - Neuroscience News - October 26th, 2024 [October 26th, 2024]
- After-hours movers: McDonald's, Starbucks, Seagate, Alto Neuroscience and more - StreetInsider.com - October 26th, 2024 [October 26th, 2024]
- Alto Neuroscience Reports Topline Results from a Phase 2b Trial Evaluating ALTO-100 as a Treatment for Major Depressive Disorder - StockTitan - October 26th, 2024 [October 26th, 2024]
- Cristina Savin and Tim Vogels discuss how AI has shaped their neuroscience research - The Transmitter: Neuroscience News and Perspectives - October 13th, 2024 [October 13th, 2024]
- Should I stay (and eat) or should I go? How the brain balances hunger with competing drives - The Transmitter: Neuroscience News and Perspectives - October 13th, 2024 [October 13th, 2024]
- How neuroscience comics add KA-POW! to the field: Q&A with Kanaka Rajan - The Transmitter: Neuroscience News and Perspectives - October 13th, 2024 [October 13th, 2024]
- Neuroscience research sheds light on how psilocybin alters spatial awareness - PsyPost - October 13th, 2024 [October 13th, 2024]
- Newly Discovered Protein Complex Shapes Synapses and Mental Health - Neuroscience News - October 13th, 2024 [October 13th, 2024]
- The Neuroscience Behind Immersive Filmmaking - Raindance - October 13th, 2024 [October 13th, 2024]
- What are mechanisms? Unpacking the term is key to progress in neuroscience - The Transmitter: Neuroscience News and Perspectives - October 13th, 2024 [October 13th, 2024]
- Kentucky neuroscience doctor honored with national distinction - wnky.com - October 13th, 2024 [October 13th, 2024]
- Cell X Technologies and Aspen Neuroscience collaborate to address throughput and scalability in manufacturing automation to facilitate iPSC cell... - October 13th, 2024 [October 13th, 2024]
- Tracking Daily Habits Lasting Effects on the Brain - Neuroscience News - October 13th, 2024 [October 13th, 2024]
- Dak Prescott Was Silent After Hearing It From a Teammate. Its a Lesson in Emotional Intelligence (Backed By Neuroscience) - Inc. - October 13th, 2024 [October 13th, 2024]
- Helping Kids Fact-Check in the Age of Misinformation - Neuroscience News - October 13th, 2024 [October 13th, 2024]
- Study Links Calorie Restriction to Longevity - Neuroscience News - October 13th, 2024 [October 13th, 2024]
- A Princeton Professor Walks into a Neuroscience Meeting -- Many Years Later It Leads to a Nobel Prize in Physics - TAPinto.net - October 13th, 2024 [October 13th, 2024]
- Try these neuroscience-backed tactics to train your brain to make better decisions - Fast Company - October 2nd, 2024 [October 2nd, 2024]
- Tips to navigate SfN as a trainee - The Transmitter: Neuroscience News and Perspectives - October 2nd, 2024 [October 2nd, 2024]
- Neuroscience Says This 10-Minute Brain Exercise Will Make You Mentally Sharper and Keep You Focused All Day - Inc. - October 2nd, 2024 [October 2nd, 2024]
- Successful people do this 1 thing to be 'happier, more productive, less stressed' at work, says CEO and neuroscience researcher - CNBC - October 2nd, 2024 [October 2nd, 2024]
- Utilizing the Power of Neuroscience, Isabella Kensington May Have Cracked the Code Between Music and Healing - AOL - October 2nd, 2024 [October 2nd, 2024]
- Steve Jobs swore the 10-minute rule made him smarter. Modern neuroscience is discovering he was right - The Star Online - October 2nd, 2024 [October 2nd, 2024]
- Steve Jobs Swore the 10-Minute Rule Made Him Smarter. Modern Neuroscience Is Discovering He Was Right - Inc. - October 2nd, 2024 [October 2nd, 2024]
- Neural manifolds: Latest buzzword or pathway to understand the brain? - The Transmitter: Neuroscience News and Perspectives - October 2nd, 2024 [October 2nd, 2024]
- Neuroscience Says 3 Brainy Habits Will Make You More Efficient, Productive, and Focused - Inc. - October 2nd, 2024 [October 2nd, 2024]
- Ethics, AI, and Neuroscience Converge at Mental Health, Brain, and Behavioral Science Research Day - The University of Utah - October 2nd, 2024 [October 2nd, 2024]
- The neuroscience of campus memories - The Stanford Daily - October 2nd, 2024 [October 2nd, 2024]
- How the Brain Enhances Sleep Through Synaptic Strength - Neuroscience News - October 2nd, 2024 [October 2nd, 2024]
- Neanderthoids and space brains: Stem cell researcher pushes the boundaries of neuroscience - Medical Xpress - October 2nd, 2024 [October 2nd, 2024]
- Nancy Padilla-Coreano - The Transmitter: Neuroscience News and Perspectives - October 2nd, 2024 [October 2nd, 2024]
- Utilizing the Power of Neuroscience, Isabella Kensington May Have Cracked the Code Between Music and Healing - Spin - October 2nd, 2024 [October 2nd, 2024]
- Genetic Variants Linked to Alzheimers Trigger Inflammation in Females - Neuroscience News - October 2nd, 2024 [October 2nd, 2024]
- New Astrocyte Target for Alzheimers Therapy - Neuroscience News - October 2nd, 2024 [October 2nd, 2024]
- Is an ankle sprain also a brain injury? How neuroscience is helping athletes, astronauts and average Joes - The Conversation Indonesia - October 2nd, 2024 [October 2nd, 2024]
- 5 Brain Strategies to Dramatically Reduce Conflict and Boost Your Leadership, Backed by Neuroscience - Inc. - September 23rd, 2024 [September 23rd, 2024]
- Fascinating neuroscience research reveals a key mechanism underlying human cognition - PsyPost - September 23rd, 2024 [September 23rd, 2024]
- Averaging is a convenient fiction of neuroscience - The Transmitter: Neuroscience News and Perspectives - September 23rd, 2024 [September 23rd, 2024]
- Repeat scans reveal brain changes that precede childbirth - The Transmitter: Neuroscience News and Perspectives - September 23rd, 2024 [September 23rd, 2024]
- Neuroscience helps explain the teenage brain and mental health - ABC News - September 15th, 2024 [September 15th, 2024]
- XX Marks the Spot: Addressing Sex Bias in Neuroscience - The Scientist - September 15th, 2024 [September 15th, 2024]
- Neuroscience-based tools for transformative leadership - Fast Company - September 15th, 2024 [September 15th, 2024]
- How 100 Years of EEG Have Transformed Neuroscience - Being Patient - September 15th, 2024 [September 15th, 2024]
- Reconstructing dopamines link to reward - The Transmitter: Neuroscience News and Perspectives - September 15th, 2024 [September 15th, 2024]
- The neuroscience of itch in relation to transdiagnostic psychological approaches - Nature.com - September 15th, 2024 [September 15th, 2024]
- A README for open neuroscience - The Transmitter: Neuroscience News and Perspectives - September 15th, 2024 [September 15th, 2024]
- Dopamine and the need for alternative theories - The Transmitter: Neuroscience News and Perspectives - September 15th, 2024 [September 15th, 2024]
- Kim Stachenfeld on the dance between neuroscience and artificial intelligence - The Transmitter: Neuroscience News and Perspectives - September 15th, 2024 [September 15th, 2024]
- Vijay Mohan K. Namboodiri - The Transmitter: Neuroscience News and Perspectives - September 15th, 2024 [September 15th, 2024]
- Varied Cognitive Training Boosts Learning and Memory - Neuroscience News - September 15th, 2024 [September 15th, 2024]
- Issue | September 2024 | XX Marks the Spot: Addressing Sex Bias in Neuroscience - The Scientist - September 15th, 2024 [September 15th, 2024]
- The Transmitter Partners With World Wide Neuro and Brain Inspired, Building on Mission to Inform, Connect Neuroscience Community - StreetInsider.com - September 15th, 2024 [September 15th, 2024]
- Gene Therapy Offers Hope for Glaucoma and AMD - Neuroscience News - September 15th, 2024 [September 15th, 2024]
- The Neuroscience of Phantom Sensations: Can We Feel Whats Not Really There? - SciTechDaily - September 2nd, 2024 [September 2nd, 2024]
- Tau May Protect Brain Cells from Oxidative Damage - Neuroscience News - September 2nd, 2024 [September 2nd, 2024]