Stimulating the development of drug treatments to improve cognition in schizophrenia

Cognitive impairment in schizophrenia is a core feature of the illness (i.e., not a result of clinical symptoms or drug treatments) that is related to the daily functioning of patients. Because schizophrenia is associated with poor community functioning, there is considerable interest in finding treatments to improve cognition in schizophrenia in the hopes that such improvement will yield functional benefits. Before the U.S. Food and Drug Administration could consider granting approval to any new drug for improving cognition in schizophrenia, it was first necessary to achieve consensus on the measurements and methods that would be used in clinical trials, as well as neuropharmacological targets. The U.S. National Institute of Mental Health launched an initiative to help address these obstacles to drug approval (MATRICS). This initiative has generated several additional follow-up initiatives including a clinical trial network and consensus projects for other clinical targets, such as negative symptoms. This review describes how an area that was primarily of academic interest (cognition in schizophrenia) became a focus of public health concerns and drug-development policy.