Intentionality as a link between the neuropsychology and the symptoms of schizophrenia

Cognitive deficits are an important feature of schizophrenia, particularly in the areas of working memory and executive function. However, their relationship to other clinical dimensions of the illness has remained elusive. We suggest that a phenomenological exploration of disordered intentionality in schizophrenia symptoms might provide us with a framework for understanding the role of cognitive deficits. We propose an understanding of intentionality as having a layered structure, which facilitates a mapping onto neuropsychological concepts. A disturbance of basic intentional processes can explain some of the 'positive' symptoms of schizophrenia. We focus on the temporal aspect of intentionality, which will be related to recent conceptions of prefrontal cortical function as the temporal organization of thought and behavior. A compensation of these basic disturbances leads to a 'minimization of change', which can explain some of the 'negative' symptoms. The compensatory strategies are thought to rely on the higher-order executive functions of the prefrontal cortex. These are also disturbed in schizophrenia, which often renders the process of compensation ineffective, leading to a fragmentation of thought and behavior. Thus the concept of intentionality might help us relate different aspects of prefrontal dysfunction to specific schizophrenic symptom clusters.