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Schizophrenia is a cognitive illness: time for a change in focus
René S Kahn1, Richard S E Keefe
1Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, UMC Utrecht, Utrecht, the Netherlands.
JAMA Psychiatry
|August 9, 2013
Summary
Schizophrenia research should shift focus from psychosis to cognitive decline. Recognizing cognitive changes earlier could lead to better treatments before psychosis emerges.
Area of Science:
- Neuroscience
- Psychiatry
- Cognitive Psychology
Background:
- Schizophrenia is currently classified as a psychotic disorder.
- This classification has hindered progress in understanding and treating the illness.
- Cognitive and intellectual deficits are established risk factors for schizophrenia.
Purpose of the Study:
- To challenge the psychosis-centric view of schizophrenia.
- To advocate for recognizing cognitive function as the core component of schizophrenia.
- To propose a shift in diagnostic focus towards early developmental cognitive changes.
Main Methods:
- Review of existing literature on schizophrenia, cognitive function, and psychosis.
- Analysis of studies demonstrating the predictive value of cognitive decline.
- Examination of the relationship between cognitive function, treatment outcomes, and antipsychotic medication.
Main Results:
- Cognitive decline often precedes psychosis onset by nearly a decade.
- Cognitive function in schizophrenia is linked to patient outcomes.
- Antipsychotic treatments have minimal impact on cognitive function.
Conclusions:
- The emphasis on psychosis in schizophrenia diagnosis is a conceptual fallacy.
- Cognition should be recognized as the central feature of schizophrenia.
- Diagnostic efforts should prioritize identifying early cognitive changes to facilitate timely interventions and potentially prevent psychosis.
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