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22.02.2023 - Seminar Handout (1)

The seminar handout discusses cognitive deficits associated with various psychiatric illnesses, including schizophrenia, bipolar disorder, obsessive-compulsive disorder, and substance use disorders. It highlights the prevalence and impact of cognitive impairments on functioning and treatment outcomes, as well as the potential for cognitive rehabilitation strategies. The document emphasizes the importance of understanding these deficits for improving patient care and outcomes in psychiatric settings.

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Dr. Nivas Saminathan
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12 views4 pages

22.02.2023 - Seminar Handout (1)

The seminar handout discusses cognitive deficits associated with various psychiatric illnesses, including schizophrenia, bipolar disorder, obsessive-compulsive disorder, and substance use disorders. It highlights the prevalence and impact of cognitive impairments on functioning and treatment outcomes, as well as the potential for cognitive rehabilitation strategies. The document emphasizes the importance of understanding these deficits for improving patient care and outcomes in psychiatric settings.

Uploaded by

Dr. Nivas Saminathan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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SEMINAR HANDOUT

Topic – COGNITIVE DEFICITS IN PSYCHIATRIC ILLNESS.


Presenter – Dr. Siddhartha V
Mentor- Dr. Anoop Augustine
Chairperson – Dr. Preethi V Reddy
Date- 22/02/2023

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

3. Cognitive deficits in individual disorders:

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.

d) Substance use disorders:


• Substance use disorders (SUDs) represent a significant
global public health crisis
• Recovery of cognitive function during protracted
abstinence is highly predictive of treatment adherence,
relapse and overall substance use disorder prognosis,
suggesting that addiction may be best characterized as a
disease of executive function.
• PFC is critically involved in executive function, it is
disproportionately impacted by prolonged use of alcohol
and psychostimulants as compared to other brain regions.
• Deficits in executive function present prior to first drug use
serve as a risk factor that facilitates substance use initiation
and confers vulnerability to subsequent development of
SUDs
• Premorbid deficits in response inhibition, one of the core
executive functions alongside working memory and
cognitive flexibility, have been consistently implicated in
SUD vulnerability.

e) ECT induced cognitive deficits:


• Despite its established efficacy, the use of ECT in
treatment has been limited by its propensity to cause
cognitive side effects
• Specific cognitive deficits: Subjective memory deficits
and Retrograde amnesia.
• ECT induced cognitive deficits in depression
• ECT induced cognitive deficits in schizophrenia
• ECT induced cognitive deficits in bipolar disorder.

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
REFERENCES:

1. Keefe RSE, Fenton WS. How should DSM-V criteria for schizophrenia
include cognitive impairment? In: Schizophrenia Bulletin. 2007. p. 912-
20.
2. Cannon M, Caspi A, Moffitt TE, Harrington H, Taylor A, Murray RM, et
al. Evidence for early-childhood, pan-developmental impairment specific
to schizophreniform disorder results from a longitudinal birth cohort.
Arch Gen Psychiatry. 2002 May;59(5):449-56.
3. Han M, Huang X-F, Chen DC, Xiu MH, Hui L, Liu H, et al. Gender
differences in cognitive function of patients with chronic schizophrenia.
Prog Neuropsychopharmacol Biol Psychiatry. 2012 Dec 3;39(2):358-63.
4. Bilder RM, Goldman RS, Volavka J, Czobor P. Hoptman M, Sheitman B.
et al. Neurocognitive effects of clozapine, olanzapine, risperidone, and
haloperidol in patients with chronic schizophrenia or schizoaffective
disorder. Am J Psychiatry. 2002;159(6):1018-28
5. Rund BR. A review of longitudinal studies of cognitive functions in
schizophrenia patients. Schizophr Bull 1998,24(3) 425-35.
6. Brown EA. Overlooking the obvious. Rev Allergy. 1969:23(10):737-8.
7. Brekke JS, Hoe M, Long J, Green MF. How neurocognition and social
cognition influence functional change during community-based
psychosocial rehabilitation for individuals with schizophrenia. Schizophr
Bull. 2007;33(5):1247-56. Reichenberg A, Caspi A, Harrington H, Houts
R, Keefe RSE, Murray RM. et al. Static and dynamic cognitive deficits in
childhood preceding adult schizophrenia: A 30-year study. Am J
Psychiatry. 2010,167(2):160-9.
8. Luck SJ, Gold JM. The Construct of Attention in Schizophrenia. Biol
Psychiatry. 2008 Jul 1;64(1):34-9.
9. Addington J. Cognitive functioning and positive and negative symptoms
in schizophrenia. 1991;123-34. 42. Baddeley A. Working Memory
Components of Working Memory Individual Differences in Working
Memory The Slave Systems of Working Memory. 255(Mii).
10. Lee J, Park S. Working Memory Impairments in Schizophrenia: A Meta-
Analysis. J Abnorm Psychol 2005;114(4) 599-611.& Park S, Gooding
DC. Working memory impairment as an endophenotypic marker of a
schizophrenia diathesis. Schizophr Res Cogn 2014 Oct 12,1(3):127-36.

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