CLINICAL HANDBOOK OF SCHIZOPHRENIA

98 I. CORE SCIENCE AND BACKGROUND INFORMATIONin implementing rehabilitative interventions. With the emergence of newer treatmentsthat have beneficial effects on cognitive deficits, repeated neuropsychological evaluationwill also be important in tracking the effectiveness of such interventions for individualpatients.KEY POINTS• Schizophrenia is commonly, although not always, associated with mild-to-moderate neuropsychologicaldeficits.• The pattern of deficits varies widely among patients, although some of the most commonlyimpaired areas include attention and working memory, episodic learning (but not retention),psychomotor speed, and executive functioning.• The level of neuropsychological deficits varies widely between patients with schizophreniaand has a stronger influence on the level of independent functioning than do the primarypsychopathological symptoms.• Contrary to Kraepelin’s notion of schizophrenia as a dementia praecox, the typical course ofthe cognitive deficits in this disorder is one of remarkable stability, even when psychopathologicalsymptoms fluctuate.• Standard pharmacological treatments for schizophrenia primarily help with the positivesymptoms of this disorder. The influence of even second-generation antipsychotics in termsof yielding functionally relevant relief from neuropsychological deficits is unclear.• Neuropsychological evaluation for schizophrenia is helpful not only to characterize the natureof cognitive deficits but also to identify abilities that are relative strengths in the developmentof plans for treatment and long-term care.REFERENCES AND RECOMMENDED READINGSAmerican Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4thed., text rev.). Washington, DC: Author.Bilder, R. M., Reiter, G., Bates, J., Lencz, T., Szeszko, P., Goldman, R. S., et al. (2006). Cognitive developmentin schizophrenia: Follow-back from the first episode. Journal of Clinical and ExperimentalNeuropsychology, 28, 270–282.Buchanan, R. W., Davis, M., Goff, D., Green, M. F., Keefe, R. S., Leon, A. C., et al. (2005). A summaryof the FDA-NIMH-MATRICS workshop on clinical trial design for neurocognitive drugs forschizophrenia. Schizophrenia Bulletin, 31, 5–19.Cannon, M., Jones, P. B., & Murray, R. M. (2002). Obstetric complications and schizophrenia: Historicaland meta-analytic review. American Journal of Psychiatry, 159, 1080–1092.Feinberg, I. (1982). Schizophrenia: Caused by a fault in programmed synaptic elimination during adolescence?Journal of Psychiatric Research, 17, 319–334.Fey, E. T. (1951). The performance of young schizophrenics and young normals on the WisconsinCard Sorting Test. Journal of Consulting Psychology, 15(4), 311–319.Gold, J. M. (2004). Cognitive deficits as treatment targets in schizophrenia. Schizophrenia Research,72, 21–28.Goldman-Rakic, P.S. (1994). Working memory dysfunction in schizophrenia. Journal of Neuropsychiatryand Clinical Neurosciences, 6, 348–357.Green, M. F. (1996). What are the functional consequences of neurocognitive deficits in schizophrenia?American Journal of Psychiatry, 153, 321–330.Hartwell, C. E. (1996). The schizophrenogenic mother concept in American psychiatry. Psychiatry,Interpersonal and Biological Processes, 59(3), 274–297.Harvey, P. D. (2001). Cognitive impairment in elderly patients with schizophrenia: Age-relatedchanges. International Journal of Geriatric Psychiatry, 16(Suppl. 1), S78–S85.Heaton, R., Paulsen, J. S., McAdams, L. A., Kuck, J., Zisook, S., Braff, D., et al. (1994). Neuropsy-