[Cognitive functioning in psychotic spectrum disorders: current status and clinical implications]

Although cognitive impairments occur in approximately 70% of individuals with a psychotic spectrum disorder (PSS) and have a substantial impact on daily functioning, they are often underrecognized in clinical practice. Due to their limited specificity, they are not included in the DSM classification criteria. Historically, cognitive deficits were already central to the concept of dementia praecox.

To provide an overview of the literature on cognition in psychosis.

This article summarizes the existing literature on cognition in PSS.

Patients with PSS generally score lower than the general population across nearly all cognitive domains, although no specific cognitive deficit is unique to PSS, and variability between patients is considerable. The article further discusses the prevalence and course of cognitive dysfunction, as well as findings from neuroimaging and genetic studies. After a first psychotic episode, it is recommended to screen cognitive functioning, for instance using the MATRICS battery. Pharmacological treatment typically shows only modest positive effects on cognitive impairment. In contrast, cognitive remediation (CR) – aimed at improving or compensating cognitive functions through strategies and training – has shown beneficial effects. Although clinical guidelines recommend CR, its availability in practice remains limited.

Integrating systematic cognitive screening and CR into treatment may contribute to improved functioning and quality of life...