CLINICAL HANDBOOK OF SCHIZOPHRENIA

10. Cognitive Functioning in Schizophrenia 97in Schizophrenia (MATRICS) and Treatment Units for Research on Neurocognition andSchizophrenia (TURNS) are ongoing NIMH-sponsored efforts that aim to foster the developmentof cognition-enhancing medications for schizophrenia (Buchanan et al., 2005).Psychosocial TreatmentsIn recent years, there has been an increasing recognition of the need for psychosocial rehabilitativeinterventions for schizophrenia. Cognitive Training, originating in neurorehabilitationresearch in traumatic brain injury, targets neurocognitive abilities such as attention,learning and memory, and executive functioning. Cognitive Training is not arestorative intervention (i.e., it does not reverse lost functions); rather, it is compensatoryin nature (i.e., it teaches patients, via strategy coaching and task practice, to use externalaids or to modify their environments to make up for deficit areas).CLINICAL IMPLICATIONSCognitive functioning is a core dimension of schizophrenia that has been traditionally ignoredin treatment contexts. Given the considerable heterogeneity in the level of deficitsamong patients, the remarkable stability of these deficits within patients, and the strongrelationship between such deficits and everyday functioning, clinical attention to the leveland pattern of cognitive deficits in individual patients with schizophrenia is clearly warrantedas part of treatment planning. In that regard, we offer the following recommendations.Neuropsychological assessment is generally provided and interpreted by a licenseddoctoral-level clinical psychologist with specific training in neuropsychological principles.The evaluation generally includes administration of a battery of standardized tests tomeasure a range of cognitive functions. However, neuropsychological assessment involvesmore than mere testing; it involves synthesizing the standardized test results with otherinformation, including clinical history, behavioral observations, medical and neurologicaldata, as well as information about the patient’s premorbid and current psychosocial functioning.Because such an evaluation requires some cooperation on the part of the patientto attend to the neuropsychological tests, the actual evaluation may be most useful afterthe most acute symptoms have been stabilized, but briefer testing may be helpful in documentingwhat a patient is able to attend to and understand, even when in more acutelypsychotic states. After stabilization, comprehensive assessment should be considered partof the overall treatment planning for patients with schizophrenia.Neuropsychological evaluation can be helpful in the clinical care of patients withschizophrenia in a number of important ways. For instance, having schizophrenia doesnot make one immune to other neurological conditions. Neuropsychological assessmentcan be helpful in evaluating the possible presence of secondary neurological conditions.For instance, as noted earlier, patients with schizophrenia frequently have difficulty withinitial acquisition of information but generally show adequate retention of informationonce learned (at least if evaluated through cued recall or recognition methods). Thus,presence of “rapid forgetting” in a patient with schizophrenia may be an indication of thepresence of a secondary condition; therefore, such persons should receive further, morecomprehensive cognitive evaluation.Neuropsychological evaluation of patients with schizophrenia is generally more usefulin determining not only areas and levels of cognitive limitations/deficits but also, importantly,the presence and degree of spared cognitive capacities that may be drawn upon