Rafael A. Salas Muriel, PhD in psychology, explains in this article, from a neuropsychological perspective, what schizophrenia is, its symptoms, types, and how clinical neuropsychology and neuropsychological rehabilitation can contribute to the treatment of this clinical condition, as well as improve the quality of life for those who suffer from it.

What is schizophrenia?

Schizophrenia is a chronic and serious mental disorder that affects millions of people worldwide. It is characterized by a combination of psychotic symptoms such as hallucinations and delusions, along with cognitive dysfunctions and problems in social functioning. This disorder can cause significant impairment in a person’s ability to function well in daily life, as well as for the family and friends surrounding the individual.

One of the most prominent aspects of schizophrenia is the psychotic symptoms, which can include visual or auditory hallucinations (American Psychiatric Association, 2022) where the person perceives stimuli that do not exist in reality, and delusions, which are false or irrational beliefs that persist despite contrary evidence. These symptoms can be highly incapacitating and confusing, both for the person experiencing them and for their environment.

In addition to psychotic symptoms, schizophrenia is also associated with a series of cognitive dysfunctions, such as memory impairment, attentional disturbances, and executive dysfunction. These issues can hinder a person’s ability to process information, make decisions, and carry out daily tasks effectively. Later on, we will examine in detail what these symptoms consist of.

Social functioning is also affected by schizophrenia. Difficulties in maintaining interpersonal relationships, participating in social activities, and fulfilling work or academic responsibilities are common among those with this disorder (Belloch et al., 2020). This can lead to social isolation and a deterioration in the quality of life.

Although the exact cause of schizophrenia is still unknown, it is believed to be the result of a combination of genetic, biological, and environmental factors (Gejman and Sanders, 2012). Imbalances in neurotransmitters such as dopamine and serotonin in the brain have also been linked to schizophrenia, as well as certain structural alterations at the neurological level (Ramírez-Jirano et al., 2019).

As for its treatment, it generally involves multiple professionals in a multidisciplinary approach. On one hand, there is pharmacological treatment, which usually consists of antipsychotic medication, along with psychological therapy, social support, and neuropsychological intervention. Medications can help control psychotic symptoms, while therapy can assist the person in learning to manage symptoms, improve their social skills, and regain a certain level of functionality.

However, it is important to highlight that schizophrenia is a complex disorder and treatment may vary according to the individual needs of each person. The support of family, friends, and mental health professionals also plays a crucial role in the recovery and management process of the illness.

Types of schizophrenia

Traditionally, schizophrenia has been classified into several subtypes based on the predominant symptoms presented by the affected individuals. One of the most common subtypes is paranoid schizophrenia, where delusions and hallucinations are prominent, usually of a persecutory or grandiose nature. People with this subtype often have a better prognosis and clinical course compared to other subtypes.

Another important subtype is disorganized schizophrenia, characterized by incoherent speech and behavior, as well as flattened or inappropriate affect. Individuals with this subtype may have difficulties in carrying out daily activities and maintaining significant social relationships due to the lack of organization in their thinking and behavior.

There is also catatonic schizophrenia, which is characterized by the presence of abnormal motor symptoms such as muscular rigidity, immobility, or excessive agitation. People with this subtype may display a variety of strange and repetitive behaviors, such as unusual postures or purposeless repetitive movements. Although less common nowadays due to advances in treatment, catatonic schizophrenia can present a high degree of complexity in clinical management and requires specialized interventions.

On the other hand, there is undifferentiated schizophrenia, a term used to describe cases in which symptoms do not meet clear criteria for any specific subtype of schizophrenia. In these cases, clinical presentation may be variable and does not fit a distinctive profile.

Lastly, unspecified schizophrenia is used when the clinical presentation does not clearly match any of the established subtypes of schizophrenia, but still meets the general diagnostic criteria for the disorder. This category is used when available information is not sufficient for a more specific diagnosis or when symptoms are atypical or fluctuating.

However, it is also necessary to note that current nosological systems (DSM-5-TR and ICD-11) advocate for not differentiating between these types and indicate a single typology where there may be a predominance of certain characteristics (Valle, 2020).

Neuropsychological symptoms of schizophrenia

As we have seen, schizophrenia is not only manifested through psychotic symptoms such as hallucinations and delusions but also presents a variety of cognitive dysfunctions that affect the thinking, attention, and memory capabilities of those who suffer from it. These neuropsychological symptoms are essential for understanding the complexity of the illness and its impact on the daily lives of affected individuals.

One of the most prominent neuropsychological symptoms in schizophrenia is memory impairment. Patients may experience difficulties in remembering recent information or retrieving long-term memories (Henry et al., 2019). This deficit can manifest in everyday situations, such as forgetting important tasks or having difficulty following conversations.

Attention is another cognitive function affected in schizophrenia. Patients may have difficulties maintaining focus on a task or filtering out irrelevant stimuli from the environment (Hare, 2021). This can lead to a decrease in academic or work performance, as well as problems in social interactions due to a lack of attention towards others.

Executive dysfunction is a common neuropsychological symptom in schizophrenia. This refers to difficulties in planning, organizing, decision-making, and problem-solving (Sheffield et al., 2018). Patients may struggle to establish realistic goals or efficiently carry out complex tasks, which affects their ability to function independently in daily life.

Thought disorders, such as disorganized thinking or a lack of verbal fluency, are distinctive features of schizophrenia. These neuropsychological symptoms are manifested in the way patients process and express information, which can hinder effective communication and understanding of abstract ideas (Ojeda, 2018).

In addition to affecting cognitive functions, the neuropsychological symptoms of schizophrenia also have a significant impact on the social functioning of individuals. Difficulties in remembering past conversations, maintaining attention during social interactions, and processing social information can hinder the establishment and maintenance of meaningful relationships.

Neuropsychological Intervention

In the field of clinical neuropsychology, various strategies are used to address the symptoms of schizophrenia. These may include cognitive-behavioral therapies, social skills training, and cognitive rehabilitation programs.

It is necessary to note that neuropsychological intervention in schizophrenia is an integral part of treatment. This therapeutic modality, let’s remember, focuses on understanding and addressing the cognitive deficits associated with schizophrenia, as seen in the previous section.

Neuropsychological intervention is adapted to the individual needs of each patient, using techniques and strategies designed to improve cognitive function and, ultimately, the quality of life of the patient and their family members.

An important focus in neuropsychological intervention is cognitive rehabilitation, which seeks to improve compromised cognitive skills through repeated and structured practice of specific tasks (Skokou et al., 2023). These tasks may include memory exercises, attention, and problem-solving, adapted to the abilities and goals of each individual.

Such cognitive rehabilitation helps individuals with schizophrenia recover or improve their cognitive functioning, which in turn can have a positive impact on their ability to carry out daily activities and participate in society.

In addition to traditional cognitive rehabilitation, the use of digital tools and programs can be beneficial in neuropsychological intervention in schizophrenia. In this way, NeuronUP represents a platform that offers a wide range of activities specifically designed for cognitive rehabilitation, including exercises to improve memory, attention, concentration, and other cognitive functions. These digital tools can be particularly useful in providing personalized and scalable intervention, allowing neuropsychologists to adapt treatment to the specific needs of each patient and properly monitor their progress over time.

Finally, in the entire intervention process, it is very convenient to involve the patient’s family, both in the initial stages to provide proper psychoeducation about the disorder and associated deficits, and to ensure good patient adherence to treatment throughout the intervention.

Future Perspectives

Future perspectives in the neuropsychological treatment of schizophrenia are marked by an increasingly personalized and neuroscience-based approach. Advances in understanding the neurobiological mechanisms underlying the disease are expected to lead to more specific and effective therapies targeting the cognitive deficits characteristic of schizophrenia.

One promising area is the development of pharmacological and non-pharmacological interventions aimed at modulating brain function in individuals with schizophrenia. New classes of drugs that act on neurotransmitter systems involved in the cognitive symptoms of the disease, such as dopamine, glutamate, and acetylcholine, are being investigated. Additionally, emerging neuromodulation therapies such as deep brain stimulation and transcranial magnetic stimulation (Mehta et al., 2019) are being explored as ways to modulate brain activity and improve cognitive function in schizophrenia.

Another important approach is the integration of digital technology in cognitive rehabilitation. The development of more sophisticated applications and software programs specifically tailored to the individual needs of patients is expected to enhance the accessibility and effectiveness of neuropsychological intervention. These tools can provide a scalable and cost-effective way to deliver personalized therapies, allowing patients to engage in cognitive rehabilitation from the comfort of their homes and facilitating remote monitoring by healthcare professionals.

Furthermore, ongoing research on cognitive and neurobiological biomarkers in schizophrenia may facilitate the development of more precise and early treatment approaches (Perkovic et al., 2017). The identification of specific biological markers that predict the progression of cognitive symptoms could enable targeted preventive interventions to preserve brain function and prevent long-term cognitive impairment in individuals at risk of developing schizophrenia or in the early stages of the disease.

In summary, these future perspectives in the neuropsychological treatment of schizophrenia offer a broad scenario, filled with significant advances in understanding and managing the cognitive deficits associated with this disease. With a multidisciplinary approach that integrates the latest advancements in neuroscience, pharmacology, and digital technology, it is possible that more effective and personalized therapeutic options will be available in the future to improve the quality of life of individuals affected by schizophrenia.

In conclusion, neuropsychology offers a highly enriching – and often necessary – perspective for understanding and treating schizophrenia. By addressing the cognitive and emotional problems associated with this disease, neuropsychologists can enhance the quality of life of affected individuals and make progress in the field of mental health.

References

• American Psychiatric Association (APA) (2022). Diagnostic and Statistical Manual of Mental Disorders (5th Edition, Revised Text) (DSM-5-TR). Panamericana Medical Publishing.
• Belloch, A., Sandín, B., and Ramos, F. (2020). Manual of Psychopathology. Volume II (3rd Edition). McGrawHill Publishing.
• Gejman, P. V., and Sanders, A. R. (2012). The etiology of schizophrenia. Medicine, 72(3), 227–234.
• Hare S. M. (2021). Hallucinations: A Functional Network Model of How Sensory Representations Become Selected for Conscious Awareness in Schizophrenia. Frontiers in neuroscience, 15, 733038. https://doi.org/10.3389/fnins.2021.733038
• Ojeda, N. (2018). Neuropsychology of schizophrenia. Síntesis Publishing.
• Henry, J. D., Moore, P., Terrett, G., Rendell, P. G., & Scott, J. G. (2019). A comparison of different types of prospective memory reminders in schizophrenia. Schizophrenia research, 210, 89–93. https://doi.org/10.1016/j.schres.2019.06.002
• Mehta, U. M., Naik, S. S., Thanki, M. V., & Thirthalli, J. (2019). Investigational and Therapeutic Applications of Transcranial Magnetic Stimulation in Schizophrenia. Current psychiatry reports, 21(9), 89. https://doi.org/10.1007/s11920-019-1076-2
• Perkovic, M. N., Erjavec, G. N., Strac, D. S., Uzun, S., Kozumplik, O., & Pivac, N. (2017). Theranostic Biomarkers for Schizophrenia. International journal of molecular sciences, 18(4), 733. https://doi.org/10.3390/ijms18040733
• Ramírez-Jirano, L. J., Velasco-Ramírez, S. F., Pérez-Carranza, G. A., Domínguez-Díaz, C., & Bitzer-Quintero, O. K. (2019). Cytokines and the nervous system: relationship with schizophrenia. Revista médica del Instituto Mexicano del Seguro Social, 57(2), 107–112.
• Sheffield, J. M., Karcher, N. R., & Barch, D. M. (2018). Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective. Neuropsychology review, 28(4), 509–533. https://doi.org/10.1007/s11065-018-9388-2
• Skokou, M., Messinis, L., Nasios, G., Gourzis, P., & Dardiotis, E. (2023). Cognitive Rehabilitation for Patients with Schizophrenia: A Narrative Review of Moderating Factors, Strategies, and Outcomes. Advances in experimental medicine and biology, 1423, 193–199. https://doi.org/10.1007/978-3-031-31978-5_17
• Valle R. (2020). Schizophrenia in ICD-11: Comparison of ICD-10 and DSM-5. Schizophrenia in ICD-11: comparison with ICD-10 and DSM-5. Revista de psiquiatría y salud mental, 13(2), 95–104. https://doi.org/10.1016/j.rpsm.2020.01.001

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