Impaired cognition

In addition to delusions and disorders of thought form, a wide range of cognitive deficits occur in schizophrenia. These are discussed in Chapter.. This chapter focuses on the relationship between cognitive impairment and other features of the illness.

In the acute phase of the illness, attentional impairment is common and is often associated with psychomotor excitation and/or formal thought disorder. It might also reflect preoccupation with delusions and hallucinations.

During the chronic phase of illness, many schizophrenic patients exhibit persistent cognitive impairments. Longitudinal studies of individuals who subsequently develop schizophrenia reveal that the deficits are discernible during childhood, suggesting that these deficits are an aspect of the redisposition to schizophrenia. The major cognitive impairments are in the realm of executive function, working memory, and long-term memory. Executive dysfunction includes impaired ability to initiate and select self-generated mental activity. Impaired ability to form and initiate plans is associated with chronic poverty of speech, blunted affect, and lack of spontaneous activity, while impaired ability to inhibit inappropriate responses is associated with chronic formal thought disorder. (12>

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