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BOOK REVIEW
Year : 2014  |  Volume : 139  |  Issue : 5  |  Page : 789-790

Neurocognition and social cognition in schizophrenia patients: Basic concepts and treatment


Advanced Centre for Yoga - Mental Health & Neuro Sciences, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560 029, India

Date of Web Publication9-Jul-2014

Correspondence Address:
B N Gangadhar
Advanced Centre for Yoga - Mental Health & Neuro Sciences, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560 029
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Gangadhar B N. Neurocognition and social cognition in schizophrenia patients: Basic concepts and treatment. Indian J Med Res 2014;139:789-90

How to cite this URL:
Gangadhar B N. Neurocognition and social cognition in schizophrenia patients: Basic concepts and treatment. Indian J Med Res [serial online] 2014 [cited 2019 Jul 20];139:789-90. Available from: http://www.ijmr.org.in/text.asp?2014/139/5/789/136463

Neurocognition and social cognition in schizophrenia patients: Basic concepts and treatment, V. Roder, A. Medalia, editors (Karger, Basel, Switzerland). 178 pages. Price: US$ 79.00, CHF 67.00 ISBN 978-3-8055-9338-0

Despite descriptions of cognitive deficits in schizophrenia nearly a century ago, the advent of antipsychotics in 1950s and the evolving diagnostic schema for schizophrenia in the 1970s laid prominent emphasis on delusions and hallucinations. Though this approach yielded effective pharmacological therapies, a substantial proportion of patients continued to experience difficulties in returning to their social and occupational functional roles. It was at the turn of the 21 st century that the clinical significance of cognitive deficits in predicting functional disability in schizophrenia gained firm recognition.

Over the last two decades, a rapidly growing body of research has not only helped us define different cognitive domains and measure them reliably, but also device innovative cognitive and social therapies for patients with schizophrenia. It is with this renewed philosophy of striving not just for symptom relief, but also towards attainment of functional stability of schizophrenia patients, the authors have conceptualized this book. It provides state of the art theoretical concepts and empirical evidence on neurocognition as well as social cognition in schizophrenia. There is also information on the diverse methods of treating them, with the intention of helping mental health professionals in providing comprehensive and holistic care for schizophrenia patients.

The book has seven chapters and a range of themes spanning from definitions, measurement and clinical relevance of social and neurocognition, to specific and combined treatment approaches to improve these cognitive deficits that is backed with empirical evidence. Cognitive deficit is a relatively nascent and rapidly expanding dimension of symptoms in schizophrenia. Knowledge in this area would gain from theoretically grounded standard and uniform nomenclature, definitions as well as methods of measurement. This would provide a strong foundation for research into the clinical significance of cognitive deficits and novel therapeutic strategies used to treat them. The first chapter addresses these felt needs. It further discusses the sub-domains, frequency, course, and magnitude of cognitive deficits, and their relationship with symptoms as well as antipsychotic medications. A brief overview of the philosophy and development of the Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery is presented. The seven cognitive domains identified for use in clinical trials for new cognitive enhancers are also described. Attention is drawn to the complexities in methods used to measure these cognitive functions, influence of confounding factors such as order of administration and fatigue, and the inadequacies in the psychometric properties of tests (especially those used to assess social cognition sub-domains). However, emerging evidence on pathoplastic and pathoreactive effects of cultural factors on cognition (social cognition in particular) in schizophrenia could have also been discussed.

The dynamic interactions between symptoms and environmental determinants in affecting functional recovery have been pointed out in the second chapter. A critical synthesis of different cognitive remediation strategies (new-learning, compensation and environmental modification) targeting elementary neurocognitive abilities (chapter 3), and social cognitive abilities (chapter 4) follows. Modes of applying cognitive remediation, its active ingredients, mechanisms of action and evidence for generalisability to changes in psychosocial functioning are summarized in the fifth chapter. Cognitive remediation must be combined with psychosocial intervention for optimal benefit. Detailed examples of some manual-based remediation programmes are provided for better understanding of both social and neurocognitive remediation processes. Critical evaluation of the durability of effects, the cortical structural/functional changes after cognitive remediation and examples of translational application of these treatment modalities in clinical settings would have been useful.

Given the complex nature of cognitive deficits in schizophrenia, approaches to solve the problem need to be comprehensive. Several treatment methods need to be considered, and a chapter on pharmacological interventions has been rightly included. Essentially the remediation programmes would address deficits both in social field and neurocognition. Such combined efforts as treatment strategies have shown promise. Modest effect size for changes/improvements in different cognitive functions measured before and after these interventions vindicate their effectiveness. Such therapies have effects in 'correcting' not only the addressed cognitive function but also the psychosocial functioning as well as psychopathology. Cognitive deficits occur in schizophrenia and in other psychiatric conditions as well. Specifically, among patients who lack social skills, educating them in certain skills such as the cognition being remedied would be appropriate. One such application, NEAR (Neuropsychological Educational Approach to Cognitive Remediation) is discussed. Remedying here is process driven. It utilizes psychological concepts from different schools; behavioural, educational and rehabilitation. The essential target is to enhance functional outcome instead of merely a test-measured outcome.

Motivation is the key to success and more so when there is cognitive deficit. Unfortunately, the latter also lowers motivation and hence the 'destructive vicious circle'. There is a need to enhance motivation for optimal benefits of cognitive remediation. Motivation is also determined by the inherent pathology of the disease as well as the interaction of the resultant behaviour with the environment. The therapist's influence cannot be underestimated. This topic is dealt with in the last chapter of the book.

Doctors, as psychiatrists are tempted to use pharmacological approaches in correcting any symptom in patients. The topic of the book is relevant to psychiatrists too and not just to other players in the arena of cognitive remediation. It is, therefore, appropriate that drug management of cognitive dysfunction in schizophrenia is covered in this book. Each of the neurotransmitter-related pharmacological approach has been addressed. It is known that antipsychotic therapy partly 'corrects' cognitive dysfunction. At the same time, these agents are implicated in contributing to deficits as well. Role for other (non-antipsychotic) drugs needs exploration. Theoretical support exists for their use if properly researched. Authors point to several potential approaches in this regard. There is a need for basic research to find pharmacological remedies for cognitive deficits in schizophrenia.

To summarize, this book is a much-needed compilation of concepts and evidence in the rapidly evolving field of cognitive dysfunction and its treatment in schizophrenia. The readability of individual chapters is pleasant and easy. However, the progress from one chapter to the next at times becomes lengthy with overlapping content. Nevertheless, this book is a useful resource book for early researchers in this field. Clinicians and other mental health professionals involved in rehabilitation services for patients with schizophrenia would also benefit from this book.




 

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