Cognition

One of the original (Krapelinian) descriptions of the illness we now recognize as schizophrenia was 'dementia praecox'; in other words, presenile dementia. The patient would display a gradual onset of symptoms, characterized by loss of initiative, lack of interest in self-care, and general social withdrawal; delusions and hallucinations, although often present, were not the dominant part of the clinical picture. Stereotyped behaviour was common. These patients often ended up in long-stay care in institutions, and undoubtedly would show impairments on cognitive testing. However, such cases would be unusual in general psychiatric practice nowadays.

Regarding cognitive testing in patients with schizophrenia today, if they were in remission, it would be expected that 'bedside' tests of orientation, concentration, and memory would be roughly normal, although, if more subtle tests were done, it would be expected that they would underperform in comparison with control subjects.

As regards patients with current acute psychosis, obviously, it would not be expected that they would be unimpaired in such tests. The key point to remember, however, is that in most cases of schizophrenia, there is no substantial cognitive impairment, and there is no process of cognitive deterioration such as would be seen in presenile dementia due to cerebral pathology such as Alzheimer's disease.

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