Cognitive deficits among functionally psychotic patients: A rehabilitative perspective

Abstract

Psychological and neuropsychological assessments of psychiatric patients are usually designed to contribute to or document psychiatric diagnoses. The present article suggests that reframing the task to focus on cognitive rehabilitation issues can contribute significantly to the treatment of the chronic patient. A test protocol is proposed and exemplary tests suggested.

Cognitive Functioning in Schizophrenia: Implications for Psychiatric Rehabilitation

“…New roles for cognitive psychopathology suggest new applications for a number of familiar clinical technologies in the domain of psychological and neuropsychological assessment. For example, analysis of performance deficits on laboratory tasks can contribute to treatment planning, individual and family counseling, and staff consultation, much like it does in cases of brain injury and other types of central nervous system neuropathology (Erickson and Binder 1986;Erickson 1988Erickson , 1994. Similarly, recognition of the nature of schizophrenic cognitive impairments can inform design of psychosocial techniques such as social and living skills training (Liberman et al 1982;Kern and Green 1994).…”

Neuropsychological assessment and the rehabilitation of persons with severe psychiatric disabilities.

“…Fewer think to call upon neuropsychologists to map patients' cognitive strengths and weaknesses and relate them to the challenges of daily living. Clinical applications of those approaches to persons with severe psychiatric disability appear to be most recent (Diamant, 1981(Diamant, , 1985Diamant & Huijsman, 1982;Erickson & Binder, 1986;Spaulding, Storms, Goodrich, & Sullivan, 1986;Townes et al, 1985;Yozawitz, 1986).…”

“…More recently, psychological assessments have contributed to a better understanding of functional skills and deficits relative to community living (Anthony, 1980;Erickson, 1984;Wallace, 1986). In this article, I would like to take the discussion one step further by describing attempts to identify and address those cognitive deficits that undermine rehabilitation efforts with persons with severe psychiatric problems.A number of persons with psychiatric disability suffer from cognitive deficits comparable to those found among persons who are brain-injured (Erickson & Binder, 1986;Goldstein, 1978). First, cognitive deficits are particularly noteworthy among persons diagnosed as schizophrenic whose clinical pictures are dominated by "negative symptoms" such as impoverished speech and affect, attentional impairment, severe withdrawal, and lack of motivation (Andreason & Olsen, 1982).…”

“…A number of persons with psychiatric disability suffer from cognitive deficits comparable to those found among persons who are brain-injured (Erickson & Binder, 1986;Goldstein, 1978). First, cognitive deficits are particularly noteworthy among persons diagnosed as schizophrenic whose clinical pictures are dominated by "negative symptoms" such as impoverished speech and affect, attentional impairment, severe withdrawal, and lack of motivation (Andreason & Olsen, 1982).…”

Cognitive rehabilitation of social deficits in schizophrenia: A direction of promise or following a primrose path.

“…Within the last decade, the cognitive rehabilitation model has emerged as a paradigm in treating individuals with a chronic mental illness (CMI) (Erickson, 1988;Erickson &c Binder, 1986;Erickson &c Burton, 1986). The rehabilitation approach, in contrast to the medical model, tends to be more idiographic, focuses on the patient's competencies and weaknesses, and applies intervention strategies often directly derived from the measures used for assessment (e.g., an individual with memory im pairment training on tasks adapted from the WMS-R).…”