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Cognitive Impairment in Schizophrenia

Disclaimer: I am not a mental health professional, I can’t diagnose you. If you think you have a mental illness please reach out to your doctor or a mental health professional.

For schizophrenics like myself, some of the most stigmatized, and sensationalized symptoms are the positive ones, meaning delusions, hallucinations, and movement disorders to some extent. You see them in textbooks and in the media; seeing, hearing, smelling or feeling things that aren’t real. Believing strange ideas, and this is my own example, like that the alien government lizard people are coming after you. These draw the most attention from the public eye, and I can’t blame them, alien government lizard people is pretty out there. But what about the less talked about symptoms such as negative and cognitive symptoms? Well, this essay will examine the cognitive side of a schizophrenia diagnosis.

According to Columbia University (2016), “many people with [Schizophrenia] also have cognitive deficits, including problems with short- and long-term memory.” They go on to say that cognitive factors can be the most disabling for people, leading to difficulty holding down a job and maintaining social relationships. They don’t have many answers as to the cause or cure for memory problems. Sucks to be us I guess. I personally have a plethora of issues with memory, short term and long term. I find myself lost when the dialogue of TV shows gets even slightly complicated because I immediately forget what was said, maybe that’s just me but it takes a toll on my self-esteem when I can't follow slightly complicated dialogue. But anyway, back to memory. Apparently when a group of healthy controls were compared to a group with schizophrenia, the healthy group, unsurprisingly, did better at memory tasks. In fact the health control groups brains showed increased brain activity the tests got harder and decreased activity when it got easier while the people with schizophrenia showed significantly weaker activity across the board.

According to Bowie and Harvey (2006) cognitive symptoms are the central feature of schizophrenia. As well as that these impairments may even present before the emergence of positive symptoms. They also found that there were “moderate deficits in attention, verbal fluency, working memory, and processing speed, with superimposed severe deficits in declarative verbal memory and executive functioning.” What is executive functioning? Well to quote Goodman (2021), “[e]xecutive functioning skills help you get things done. These skills are controlled by an area of the brain called the frontal lobe.” Things executive functioning helps you do is “manage time, pay attention, switch focus, plan and organize, remember details, avoid saying or doing the wrong thing, do things based on your experience, and multitask” (Goodman, 2021).

I’ll cover some ways to deal with executive dysfunction in a later essay.

Most people with schizophrenia will show some kind of cognitive impairment, but the severity will vary across different people. One interesting thing about these cognitive impairments is that they will remain relatively stable over time. There are some different types of impairments that I will summarize.

General Intelligence

I take some offence at the description that all people with schizophrenia have lower IQ’s, I mean there are/were some very smart people with it, like John Nash, or the people Cernis, Vassos, Brebion, McKenna, Murray, David & MacCabe (2015) studied, finding that there is “a high-IQ variant of schizophrenia that is associated with markedly fewer negative symptoms than typical schizophrenia” However the science seems to be overwhelmingly favourable in the direction that people with it have lower IQ’s as a group. On the other hand, I don’t know what kind of people they picked for their healthy control group, because if they were all university grads then it’s not really fair. So take this with a grain of salt. While the tests say that we are as a group, less intelligent than the “general” population it doesn’t mean you specifically are not intelligent. We can be just as successful as anyone else.

Attention

This one is simple, people with schizophrenia have a deficit in their ability to maintain their attention, this occurs even before the first psychotic episode.

Working memory

I have a terrible working memory, bad enough for it to be considered a learning disability. However I’m not alone in this, many people with schizophrenia have some kind of dysfunction in working memory, and apparently specifically verbal working memory. Bowie and Harvey (2006) state that “Working memory can be conceptualized as the ability to maintain and manipulate informative stimuli.” This is in contrast to attention span, with working memory being more cognitively challenging and attention span being more simple. In working memory, “The information must be held online for processing, but does not necessarily transfer to long-term storage, unlike episodic memory” (Bowie and Harvey, 2006). And poor memory can even affect social and interpersonal relationships because of the inability to pay attention to “multiple streams of information” Bowie and Harvey, 2006).

Verbal fluency

People like us sometimes find it rather difficult to speak in a coherent fashion, I remember many instances where I’ve tried to speak only for word salad to spill out of my mouth, and the looks of confusion and worry on other peoples faces is just great, really what I wanted to happen, not embarrassing at all. This inability to speak is due to “poor storage of verbal information as well as inefficient retrieval of information from semantic network” (Bowie and Harvey, 2006). Furthermore, "information that is stored is not always retrieved as a result of this inability to properly access semantic networks” (Bowie and Harvey, 2006).

Verbal and learning memory

A main impairment of schizophrenia is the difficulty of retaining verbal information. From what I understand, recognition memory seems to be able to work well in most cases, but “the pattern of deficits in schizophrenia tends to be reduced rates of learning over multiple exposure trials and poor recall of learned information” (Bowie and Harvey, 2006). So basically it takes a while for us to learn something but once we do we have good recognition memory. Now, recognition memory is the ability to recall something when you’ve seen it before, so I think what happens is if you’re able to process the information into long term memory you’ll be able to recall when you encounter that information again. Maybe I’m totally wrong, I don’t know.

Executive functioning

Now most schizophrenics have difficulties with most of all of the processes involved with executive dysfunction. Bowie and Harvey (2006) say that “schizophrenia patients have trouble adapting to changes in the environment that require different behavioral responses” which is directly due to issues with executive dysfunction. Furthermore, this “inflexibility” is highly associated with what Bowie and Harvey call “occupational difficulties.” This makes sense, when someone can’t plan, practice self-care, engage in social and interpersonal matters or participate in community functions, it’s gonna take a toll on your work life.

Treatment

Atypical antipsychotics seem to be the best treatment for cognitive impairments, though the results are sorta weak, Bowie and Harvey (2006) admit that “they have had very limited, if any, success in producing cognitive improvements. However, the search for new compounds designed specifically for cognitive enhancement in schizophrenia continues to be a promising area for future research.”

However there is also behavioural treatments, but there isn’t a lot of research on this topic. On the other hand, what little research there is, is very promising. “These strategies include training on computerized tasks similar to existing cognitive tests, teaching new learning strategies, training on novel tasks, and/or performing tasks repetitively” (Bowie and Harvey, 2006).

In the end, it seems that a combination of medication and therapy is the key. On the other hand, research by Everding (2005) states that “memory problems in schizophrenia can indeed be reduced and suggests that helping people use the right memorization strategy is critical to success.” The right strategies seem to be to remember more ‘deeply’ or according to Jantzi, Mengi, Serfaty, et al., (2019) to engage in retrieval practice, also Antzi, Mengi, Serfaty, et al.’s (2019) study is “the first to demonstrate that retrieval practice is also superior to restudy in improving later recall in patients with schizophrenia presenting with episodic memory impairment.” This is great news for us because it presents a real way of improving our memories, which apparently most of us need.

REFERENCES

Study finds brain marker of poor memory in schizophrenia patients: possible key to understanding and treating cognitive symptoms of the disease, (2016). Columbia University. Retrieved from https://www.cuimc.columbia.edu/news/study-finds-brain-marker-poor-memory-schizophrenia-patients

Bowie, C. R., & Harvey, P. D. (2006). Cognitive deficits and functional outcome in schizophrenia. Neuropsychiatric disease and treatment, 2(4), 531–536. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671937/

Černis ,E,. Vassos, E,. Brébion, G,. McKenna, PJ,. Murray, RM,. David, AS,. MacCabe, JH. (2015). Schizophrenia patients with high intelligence: A clinically distinct sub-type of schizophrenia? Eur Psychiatry. (5):628-32. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25752725/

Gerry Everding (2005). Memory study shows brain function in schizophrenia can improve with support, holds promise for cognitive rehabilitation: need cues, memory aids. Washington University. Retrieved from https://source.wustl.edu/2005/07/memory-study-shows-brain-function-in-schizophrenia-can-improve-with-support-holds-promise-for-cognitive-rehabilitation/

Jantzi, C., Mengin, A., Serfaty, D. et al. (2019). Retrieval practice improves memory in patients with schizophrenia: new perspectives for cognitive remediation. BMC Psychiatry 19, 355. Retrieved from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2341-y#citeas

Goodman, B. (2021). Executive function and executive dysfunction disorders. WebMD. Retrieved from https://www.webmd.com/add-adhd/executive-function

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Keeping things clean

Hygiene is a difficult topic for most people with a mental illness, for example depression, anxiety or PTSD, although I will be focussing on people with schizophrenia. Decline in hygiene also happens to be one of the signs that you may have this disorder. You may find yourself not showering, brushing your teeth, using deodorant or the likes, and you may not care either. While you can live without taking a shower or using deodorant you really need to take care of your teeth. Dental procedures are incredibly expensive and dental issues can be extremely painful. I will cover different ways to get the motivation the brush your teeth regularly. But more on that later.

Lack of good hygiene is heavily stigmatized by society, which means there are often feelings of guilt or disgust when we lose that standard of living. Despite that fact we may not feel motivated to clean our homes and our bodies and obviously this can be very distressing. I always say a messy home is a messy mind, in fact it might bring up your anxiety or push you farther into a depressive state, living in a bad environment can do a number on you psychologically. According to WebMD, clutter can lead to higher cortisol levels and causes embarrassment over living in a messy environment which can then lead to self isolation.

Disorganized behaviour may be another reason a person can’t keep themselves and their surroundings clean. Disorganized behaviour (and speech but that’s not relevant here) is a huge red flag for schizophrenia, but it can be overcome with some therapy and medication. You will always hear me advocate for medication and therapy, partly because that’s what I learned in psychology and also because it’s worked wonders for me. In particular, cognitive behavioural therapy, or CBT, is shown to produce good results in changing behaviour. Therefore it can aid one to change the behaviour of poor hygiene into one of good hygiene.

Some other ways you can change your behaviour is through operant conditioning, or using rewards to change your behaviour. One example that I do is I write a few things on a whiteboard, such as brushing my teeth, cleaning for half an hour, taking my morning meds, exercising, and I tick one off after I finish that task and once I complete all of them I can drink all the iced coffee I want (hot coffee in the winter). If you feel as though you can’t follow your guidelines ask someone else to uphold them for you. So if you can only play your switch after you brush your teeth ask someone to stop you from playing it until after you’ve done it. And you don’t have to start off with a long list, it really could be as short as brushing your teeth. You can build on it after you set up that particular habit. I use brushing your teeth as the primary example because its the most important habit to build, brushing (and flossing, don’t forget to floss) twice a day is the key to healthy teeth, I also like to use non-alcoholic mouth wash twice a day just for added protection. If you seriously don’t have the energy to brush at least use mouthwash and floss, there are even these plastic flossing tools to make it easier.

The second but not less important thing to remember is to attend to your pets needs. This means feeding and watering them first and taking them for walks or cleaning litter boxes or just general pet cleanliness. Make sure to reward yourself with something after you do so you can build up those habits. If you find you can’t take care of your pets consider finding them a new and loving home.

Now, showering can be tedious if you’re suffering from a mental illness, you have to undress, and then get in the shower which can take a lot of energy, then once you get in you don’t want to leave, and then you have to get dressed which costs even more energy, I’ve been there. But smelling funky can be a serious blow to your self esteem. And if you don’t care, well I’m not sure why you’re reading this. Anyway, if you’re feeling self conscious use that feeling to find the energy to get into that shower or bath. I like to put on my favourite perfume after a shower, it makes me smell even nicer and it’s a little reward so doing it. And again, using rewards is a great way to stay motivated. I will however say that using positive punishment (I’ll list a reference about the types of punishment in the reference page) is actually the worst thing you can do to successfully change behaviour, I mean if you try it and it works for you more power to you. But make sure you don’t harm yourself in any way, that’s not the point of punishment in operant conditioning.

As for keeping your space clean, it’s really really hard to keep a house or even room clean when you have a mental illness like schizophrenia. One trick that I have found is to not wait until you have a sudden burst of energy and try to do it all in one night. Set aside 5, 15 or even 30 minutes per day, and dedicate that time to cleaning. Listen to upbeat music while you do, sing along. And just do that every day and eventually you’ll have a place that doesn’t make you depressed or anxious, which is ideal and what we all really want.

REFERENCES

WebMD (2012). Retrieved from https://www.webmd.com/balance/ss/slideshow-clutter-affects-health

Pietrangelo, A. (2020). What is positive punishment?. Healthline. Retrieved from https://www.healthline.com/health/positive-punishment

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Introduction

Wow, this is exciting, my first youtube video! This one is just an introduction but you can expect more content about mental health and, specifically right now, schizophrenia. I’ll be posting personal essays to this blog that I use as guidelines for the videos so definitely go check those out!

Disclaimer: I am not a mental health professional, I can’t diagnose you. If you think you have a mental illness please reach out to your doctor or a mental health professional.

Hello! I’m NanaPanda and in this video I’m gonna introduce myself as well as explain what this channel is about.

So I’m bran new to YouTube so please bare with me as I learn to navigate it. I’m hoping this channel will help educate people on schizophrenia, as well as uplift those who have it, or any psychotic disorder, I’m not about to alienate people just because they haven’t been diagnosed specifically with schizophrenia. I will be looking at other mental illnesses later, I have a long list of ones I want to cover, but for now I’ll be focusing on what I know best which is schizophrenia.

Now a little bit about my history, I have schizophrenia, it’s been a long road to getting officially diagnosed and a it took a few psychologists and psychiatrists but I got there eventually.

I’ve been to two different psych units, one in a city (as an adolescent) and another in a small town (as an adult) and I’ve been to the hospital about three times if I remember correctly. And I was diagnosed with schizophrenia when I was 17, and I’ve had a few different disorders, ones that I still have are dyscalculia and ADHD (inattentive type) as well as generalize anxiety disorder, and some I no longer have, which are major depressive disorder, and somatic symptom disorder.

I understand not everyone will want to watch my videos, because I’m new at this so I’m not very good, and the production value isn’t great either so I will be providing a link to the personal essays I’ve written for each video (so far only on Tumblr and Twitter but that may change), with mostly academic references attached to it too.

Im also eventually getting better recoding equipment or maybe even a video editing software, but for now I’m going to be staying with the wonderful and completely free OBS.

Now I’m doing this partly for fun (who doesn’t love to write personal essays with APA formatting?) and partly to educate people on mental health issues, this is a topic I’m passionate about and I hope you can learn something along the way.

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The beginning

About to record my first youtube video, I’m so nervous! I hope it turns out good!