{"id":39563,"date":"2013-08-29T23:20:10","date_gmt":"2013-08-30T03:20:10","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=39563"},"modified":"2013-08-29T23:20:10","modified_gmt":"2013-08-30T03:20:10","slug":"onto-something","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/08\/29\/onto-something\/","title":{"rendered":"onto something…"},"content":{"rendered":"
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Schizophrenia Is a Cognitive Illness: Time for a Change in Focus.<\/a><\/div>\n
by Kahn RS and Keefe RS.<\/div>\n
JAMA Psychiatry.<\/font><\/strong> 2013 Aug 7. doi: 10.1001\/jamapsychiatry.2013.155.<\/div>\n
[Epub ahead of print]<\/div>\n

<\/p>\n

Schizophrenia is currently classified as a psychotic disorder. This article posits that this emphasis on psychosis is a conceptual fallacy that has greatly contributed to the lack of progress in our understanding of this illness and hence has hampered the development of adequate treatments. Not only have cognitive and intellectual underperformance consistently been shown to be risk factors for schizophrenia, several studies have found that a decline in cognitive functioning precedes the onset of psychosis by almost a decade. Although the question of whether cognitive function continues to decline after psychosis onset is still debated, it is clear that cognitive function in schizophrenia is related to outcome and little influenced by antipsychotic treatment. Thus, our focus on defining [and preventing] the disorder on the basis of psychotic symptoms may be too narrow. Not only should cognition be recognized as the core component of the disorder, our diagnostic efforts should emphasize the changes in cognitive function that occur earlier in development. Putting the focus back on cognition may facilitate finding treatments for the illness before psychosis ever emerges.<\/div>\n<\/blockquote>\n
Sometimes you run across something that’s just interesting in its own right. I found this piece in JAMA Psychiatry and it set me thinking. In my own speculating about schiziphrenia, over the years I’ve concluded as I’ve said here that the public marker, psychosis, doesn’t seem primary to me. In chronic patients, it seems to me that psychosis intervenes in response to things that happen in the world, situations the patient doesn’t understand in some way – not out of the blue. The better you know the patient, the easier it is to know the "triggers." That’s an opinion from my own patients, but also from seeing a lot of patients in emergency rooms or outreach situations. <\/div>\n

My other impression from this same patient base is that the concreteness, literalness, difficulty with abstraction, whatever-you-want-to-call-it is always there – psychosis or not. So experience has primed me to find this article interesting. And I know when I read the "pre-psychotic" literature like the studies of Patrick McGorry, I often think they’re on the wrong track – looking for too many psychotic-like symptoms and not paying enough attention to concrete thinking. <\/p>\n

This article addresses those points. They don’t talk about the qualitative aspects of schizophrenic thought so much, but stick to a quantitative fall in cognitive abilities. But it feels to me like they’re onto something important. We could certainly use some "onto something important" in schizophrenia research… <\/div>\n","protected":false},"excerpt":{"rendered":"

Schizophrenia Is a Cognitive Illness: Time for a Change in Focus. by Kahn RS and Keefe RS. JAMA Psychiatry. 2013 Aug 7. doi: 10.1001\/jamapsychiatry.2013.155. [Epub ahead of print] Schizophrenia is currently classified as a psychotic disorder. This article posits that this emphasis on psychosis is a conceptual fallacy that has greatly contributed to the lack […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-39563","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/39563","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=39563"}],"version-history":[{"count":12,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/39563\/revisions"}],"predecessor-version":[{"id":39575,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/39563\/revisions\/39575"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=39563"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=39563"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=39563"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}