When you think of schizophrenia, you probably think of symptoms like paranoia and hallucinations. But as many as 3 in 4 people with the condition also live with limited learning and thinking skills, also called cognitive impairment.
If you’re a caregiver for someone with schizophrenia, it’s important to understand the cognitive challenges they might face. It’ll give you a better idea of how well your loved one functions and what they can do on their own.
Schizophrenia and Thinking Skills
Up to 75% of people with schizophrenia score below average on tests of their thinking skills. The specific areas affected by schizophrenia include:
- Processing speed, or how fast the brain takes in, understands, and responds to information
- Working memory, or the ability to hold on to a bit of information for a short period while using it (such as a few numbers)
- Attention
- Learning and memory
- Problem solving
Schizophrenia can also take a toll on executive function, which relies on many of these thinking skills combined. It’s the ability to plan, focus attention, and remember. Along with following instructions and managing multiple tasks at once.
Cognitive problems from schizophrenia seem to happen separately from psychotic symptoms like hallucinations and delusions. In other words, even when psychotic symptoms aren’t there or are well controlled with medication, your loved one may still have problems with thinking and learning. In fact, people with schizophrenia seem to already have cognitive symptoms, at least to some degree, before their first schizophrenic episode. Some research finds that kids who go on to develop schizophrenia later in life already have the related thinking and learning problems in childhood.
Why Schizophrenia Affects Thinking Skills
It’s not that cognitive problems are just another symptom of schizophrenia. Instead, research suggests it’s more likely that factors that raise your risk for schizophrenia seem to boost a person’s odds of having these other problems, too.
For starters, there seem to be genes that can both lead to schizophrenia and cause learning challenges. Research shows that people with schizophrenia often have relatives who have cognitive problems even though those relatives don’t have schizophrenia.
But genes alone don’t cause schizophrenia or cognitive impairment. It’s likely that circumstances in a person’s life and the world around them contribute.
For example, pregnancy complications raise the odds that a child will have schizophrenia later in life. These same problems are a risk factor for cognitive problems both in people with and without schizophrenia.
People who grow up in urban settings seem to be more likely to have schizophrenia. Several issues often tied to living in urban areas – poverty and air pollution – might also be linked to low educational achievements and low IQ.
These are just a few examples of life circumstances that might both add to risk for schizophrenia and learning difficulties. Overall, it’s most likely a combination of genes and circumstances that cause these problems.
Thinking Skills and Everyday Living
Thinking and learning difficulties in people with schizophrenia can be a major barrier to getting or keeping a job, having good personal relationships, and living on your own. Some people with schizophrenia do well in one of these areas, but very few do well in all three areas. People with cognitive impairment struggle to fully function even when their psychotic symptoms are well controlled with medicine.
One major challenge for people with schizophrenia-related cognitive problems is following their doctor’s recommended treatment plan. The people who have these thinking and learning struggles are less likely to take their medicine and follow other treatment instructions as they should. They are also more likely to go to the hospital than other people with schizophrenia. And when they do go to the hospital, they tend to need to stay longer.
Cognitive Remediation for Schizophrenia
Medicine for schizophrenia helps with hallucinations and delusions, but it has little or no effect on thinking skills. Some antipsychotic drugs can even cloud your thinking. That’s why cognitive problems seem to go on even when psychotic symptoms clear up. But a program called cognitive remediation may help.
In this therapy, a trained specialist takes you through exercises and drills aimed at strengthening the thinking skills that can be weak in people with schizophrenia. You also come up with strategies to help you function better in day-to-day life.
People seem to get the most benefit from cognitive remediation when they do it in combination with standard psychotherapy and medication. Research shows that it can affect targeted thinking skills and quality of life in general. People who go through the program may also have less need for social and assistive services.
The best way to preserve the improvements in quality of life, studies suggest, is to continue with standard psychotherapy for the long term after you complete the cognitive program. If you stop all therapy after the program, symptoms and challenges living daily life may come back after a year or so. People who stay with standard therapy may hold on to the benefits of cognitive remediation for 10 or more years.
Treating Other Symptoms That May Cloud Thinking
These other health problems or unhealthy habits can also take a toll on thinking and memory and may be more common in people with schizophrenia:
- Smoking
- Poor sleep
- Metabolic problems, including being overweight, obesity, diabetes, and high blood pressure
- Lack of social interaction
Working on these problems may help with thinking skills and shore up the benefits you get from therapy.
How to Help Your Loved One With Schizophrenia
Whether you live with a loved one with schizophrenia or offer help from time to time as needed, there are things you can do to give them the best care.
Educate yourself. Now that you know about the cognitive problems that can come with schizophrenia, you have a better idea of what parts of daily life and self-care might be hard for your loved one. Keep learning about the condition so you know what to expect and what might be needed from you.
Offer help where needed. You might notice tasks of daily living that are a struggle for your loved one. Now you understand why. Discuss ways that you can help or that you can get help for them, whether that means pitching in around the house a few days a week or helping find a better living situation with more support.
Partner in health care. Encourage your loved one to get care and stick with it. Offer to help them remember to take medication or get to therapy sessions. You might offer to attend doctor’s appointments with them, where you can help take notes and ask questions.
Don’t bulldoze. Your loved one is more likely to feel invested in their care and recovery when they have a say in the decisions. Encourage them to get care and offer help at home, but don’t take over. Instead, offer the kind of assistance that would help keep them as independent as possible.
Show Sources
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SOURCES:
Sage Journals: “Prediction of disability in schizophrenia: Symptoms, cognition, and self-assessment.”
Educational Psychology Review: “Working Memory Underpins Cognitive Development, Learning, and Education.”
Schizophrenia Research: Cognition: “Cognitive dysfunction in schizophrenia: An expert group paper on the current state of the art.”
Harvard Center on the Developing Child: “Executive function & self-regulation.”
Molecular Psychiatry: “Cognitive impairment in schizophrenia: aetiology, pathophysiology, and treatment.”
HelpGuide: “Helping Someone with Schizophrenia.”
