At First Schizophrenia Episode, Cognition Is Already Seriously Impaired

According to study results published in Neuropsychology by researchers at Harvard Medical School and SUNY Upstate Medical University in Syracuse, NY, cognitive impairments are “reliably and broadly present” by the first episode of schizophrenia, “approach or match the degree of deficit shown in well-established illness,” and are “maximal in immediate verbal memory and processing speed,” making work, studying, and social interactions difficult for those suffering from the disorder.

Additionally, the researchers found that, compared to largely age- and gender-matched healthy controls, people who were experiencing a first episode of schizophrenia performed significantly worse on all cognitive measures, with patients having the greatest difficulty with processing speed, verbal learning, and memory, especially when encoding information. Drops in measured IQ and other cognitive abilities were most likely to occur in the interval starting immediately prior to first symptom appearance and continuing through to the first acute phase, with abilities remaining stable afterward, suggesting a cognitive pattern that, when combined with additional signs like family history and clinical symptoms, might be used in diagnosing schizophrenia.

This understanding of the early and central role of cognitive decline could help healthcare professionals with an early diagnosis of schizophrenia by allowing them to differentiate the condition from other neuropsychiatric conditions that are accompanied by cognitive problems, like ADHD, as well as to provide appropriate treatment.

According to co-authors Raquelle Mesholam-Gately, PhD, and Anthony Giuliano, PhD, “people with schizophrenia have experienced a high-risk period for a few months to two years before illness sets in, showing increased problems with daily living that foreshadow full-blown illness. Early intervention for cognitive problems might lessen their intensity and duration, allowing for a better prognosis, lower relapse rates, and better preservation of cognitive and social skills, and of family and social supports.”

Testing cognition could also be recommended for older children with a family history of schizophrenia and newly developing clinical symptoms. These latest findings, according to the authors, emphasize the importance of looking at family history and better clinical or behavioral symptom characterization.

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