Living with psychosis and cognitive impairment: a qualitative study

Cognitive impairment is a major contributor to functional disability in individuals with psychosis. However, there is limited qualitative research on the everyday experience of cognitive impairments in psychosis. Addressing this gap could inform more person-centered care. This study aimed to gain a deeper understanding of how cognitive impairments affect daily life among individuals living with psychosis.

A qualitative phenomenological approach was employed. Data was collected through semi-structured individual interviews with nine participants, aged 30 to 55 years, diagnosed within the psychosis spectrum. Inclusion required evidence of cognitive impairment, operationalized as scoring at least one standard deviation below the normative mean on one or more cognitive domains assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Interviews were transcribed and analyzed using thematic analysis.

Four main themes emerged: (1) Acknowledging and making sense: participants recognized diverse manifestations of cognitive difficulties in their daily life and sought to interpret and contextualize them in order to make sense of their experiences; (2) Navigating the importance and challenges of social life: social interactions were valued but often hindered by sensory overload and feelings of loneliness, and were mostly limited to family; (3) Adjusting to a slow pace: participants described a daily life marked by passivity and difficulties in planning and structuring meaningful activities, leading to lowered expectations for activities and stimulation; and (4) Using everyday workable strategies: coping with cognitive challenges including choosing less crowded environments, engaging in activities requiring short periods of concentration, as well as adopting an accepting attitude towards life.

By exploring participants' lived experiences of cognitive difficulties, this study highlights not only the heterogeneity in how such impairments are manifested, but also the varying degrees of awareness with which they are understood. These insights support the need for individually tailored approaches, both in adapting treatments such as cognitive remediation and in developing interventions that empower individuals to enhance their awareness of their challenges and support strength-based coping strategies.

Clinical trial number: not applicable.