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MindView Director's Letter Archive
Cognition and Schizophrenia
by Stephen R. Marder, MD
Archived Letters
Spring 2005 - Patients, their family members and mental health advocates
have criticized mental health systems for an excessive
focus on controlling positive symptoms in schizophrenia
and other psychotic illnesses. Many of them believe that
the focus should be on "recovery" rather than stabilization
of psychotic symptoms. Although there are a number of
definitions of recovery, all of them focus on improving
functions, particularly social and work functioning.
The focus on recovery and functioning has also led scientists to re-evaluate the targets for drug treatments. As mentioned in this issue, antipsychotic medications are effective for reducing the severity of symptoms such as hallucinations and delusions. Unfortunately, their effects on neurocognitive impairments and negative symptoms (including loss of motivation, restricted emotional expression, and decreased social interactions) are less established. Moreover, both neurocognition and negative symptoms are strongly related to the impairments in functioning. This suggests that the path to better functioning will involve improving neurocognition, negative symptoms or both.
The MIRECC is attempting to promote drug development in both of these areas although most of our attention has focused on neurocognition. The model for addressing this important issue involves a carefully coordinated research program. Studies in patients with schizophrenia are important for characterizing the impairments. The work of investigators including Michael Green, David Braff, and others has clarified differences between individuals with schizophrenia and those without the illness. These studies have also provided important information regarding differences in how the brain evaluates information. Our Neuroimaging Unit under the leadership of Gregory Brown is studying differences in brain activity as patients and control individuals carry out a cognitive task such as solving a simple problem. The cognitive functions that are impaired in schizophrenia are also studied by the Neuropsychopharmacology Unit which is led by Mark Geyer. This laboratory is able to evaluate the effects of promising new drugs in animal models of impaired cognition.
We believe that this coordinated effort of clinical and basic science researchers has the potential for making substantial contributions to improving the lives of individuals with psychotic illnesses.
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Archived Letters
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