22.02.2023 - Seminar Handout (1)
22.02.2023 - Seminar Handout (1)
OUTLINE:
1. Introduction:
Cognition denotes a relatively high level of processing of specific information
including thinking, memory, perception, motivation, skilled movements and
language. Research in the area of neurocognition has started unlocking various
secrets of psychiatric disorders, such as revealing the biological
underpinnings, explaining the underlying psychopathology and issues related
to course, outcome and treatment strategies.
2. Domains of Cognition:
a. Speed
b. Attention
c. Executive function
d. Comprehension
e. Learning and Memory
f. Visuo-Spatial construction
a) Schizophrenia:
• Cognitive deficits are essential features of schizophrenia.
• Prevalence - >80%
• Natural course of cognitive deficits in schizophrenia
• Cognitive deficits in specific domains
• It is seen that cognitive deficits are seen much earlier than
the emergence of positive symptoms, i.e during childhood
and adolescence.
b) Bipolar Disorder:
• Patients with BD exhibit significant cognitive impairment
during all clinical states including euthymia
• Impairment is observed across multiple cognitive domains
- more severe in verbal memory and executive functioning
• Residual depressive symptoms, poor clinical course and
higher number of previous manic episodes may negatively
impact cognitive performance in patients with BD
• Severity of impairment appears to be most prominent in
schizophrenia, less prominent in BD, and possibly least
affected in MDD.
• Evidence exists to suggest patients may show some
improvements in cognitive functioning with appropriate
treatment following the first manic episode
• Cognitive functioning is a major predictor of occupational
and day-to-day functioning in patients with BD and may
have more impact than other clinical factors such as
symptoms severity.
c) Obsessive-Compulsive Disorder:
• Cognitive deficits could be functioning as an intermediate
variable between neurobiological abnormalities and OCD
symptoms.
• Executive Function deficits have been seen in several
studies among OCD patients
• Visuospatial and visuoconstructional deficits are among
the most consistent findings in neuropsychological
assessment studies of patients with OCD
• Verbal memory is generally preserved in studies of
patients with OCD.
• Significant impairment in spatial working memory was
seen as compared controls after a delay (error in recall); its
extent also increased with increasing severity.
f) Cognitive rehabilitation:
• Cognitive rehabilitation has been defined as “the
therapeutic process of increasing or improving an
individual's capacity to process and use incoming
information so as to allow increased functioning in
everyday life. This includes methods to train and restore
cognitive function and compensatory techniques”
• Cognitive remediation strategies: Compensatory and
Restorative
• Treating cognitive deficits may also be considered as a
potential tool to prevent or delay the onset of
schizophrenia in a primary (e.g., in high risk population)
and secondary (e.g., in subjects with recent onset disease)
prevention framework
• Cognitive remediation is most likely to impact functional
outcome when individuals are given opportunities to
practice the cognitive skills in real-world settings
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