Neuropsychology forms a bridge between the phenomenology and clinical features of schizophrenia, and the underlying pathology. The cognitive sciences have been increasingly adopted as a framework for discussing such features at the expense of a purely descriptive psychopathology. The advantage of this is that cognitive models strive to be mechanistic and explanatory although, like phenomenology, they sometimes succeed only in displacing one lot of arcane jargon for another. The neuro- prefix is a relatively new addition and simply reflects the often tacit acceptance of a biological basis for the changes observed, but in fact earlier discussions of for instance 'disorders of attention in schizophrenia' which made no reference to the brain, would now be placed under the heading of neuropsychology. (1)

In his description of dementia praecox, Kraepelin emphasized the presence of clear-cut intellectual decline (see Chapter,4:,3.,,1), whereas Bleuler(2) remarked:

It shows a complete misunderstanding of the peculiarities of schizophrenia if one believes that schizophrenic dementia can be proved or excluded by means of an 'intelligence test'...The actual amount of knowledge remains preserved...but it is not always available or it is employed in the wrong way.

Paradoxically, both positions are correct. There are aspects of the neuropsychology of schizophrenia which are akin to a dementia (i.e. an apparent decline in function across several cognitive domains) in conjunction with other aspects most unlike a straightforward dementia, such as the variability of test performance across and within individuals, and lack of inexorable progression. However, attempts to distinguish schizophrenia from neurological disorders on the basis of neuropsychological tests have failed—the overlap in test scores is surprisingly large and classification rates on this basis, no better than chance. (3)

It was previously common for all-embracing psychological theories of schizophrenia to be advanced. This is less common nowadays, where empirical findings outweigh theoretical speculation. This chapter is not intended to be a comprehensive review of the work in this area but rather a brief overview of clinically relevant findings in the neuropsychology of schizophrenia. The approach taken here will be to divide the neuropsychology of schizophrenia into premorbid, illness-related, and symptom-related deficits, with discussion of whether these deficits are generalized or specific.

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