The Challenges of Living With Schizophrenia
Video Transcript
Dr Andrew Cutler: Hello. I am Dr Andrew Cutler, clinical associate professor of psychiatry at SUNY Upstate Medical University in Syracuse, New York, and I am the Chief Medical Officer for the Neuroscience Education Institute in Carlsbad, California. And my practice is actually based in Lakewood Ranch, Florida.
Amber Hoberg: I'm Amber Hoberg. I'm a psychiatric mental health nurse practitioner. I practice at Baptist Healthcare System and Morningstar Family Medicine in San Antonio, Texas.
Dr Andrew Cutler: So, Amber, as we know, schizophrenia has a very heterogeneous clinical presentation, and of course, we know it also has a heterogeneous neurobiological underpinning. When we talk about the symptoms of schizophrenia, we tend to divide them into a couple of categories. We talk about the positive symptoms, which most people think about when they think of psychosis, and this is hallucinations, delusions, which are false beliefs, hallucinations are false perceptions, and then disorganized thoughts. Next category are negative symptoms, and this can be very impairing to patients. These are things that include alogia, not talking; blunted affect is not showing much expression; not having a lot of social interaction; not having a lot of motivation, which is avolition; and not really being able to express pleasure. Then we have the cognitive symptoms, and of the three domains here, we think cognitive impairment, clearly the most associated with functional impairment. So we look at cognition in seven key domains that can have impairment: Attention and vigilance; reasoning and problem solving, which is part of executive function; social cognition, very important to read social cues; speed of processing, and that's both mental—it's a combination really of mental and physical speed; verbal learning; and memory; and then there's visual learning and memory; and then working memory, which is kind of a shorter term memory to hold something in your memory while you're going to information you want to use soon.
The positive symptoms, as you can see here, tend to be more overt, and those are the things that get people into trouble acutely. That's, of course, what can lead to hospitalization and so on. However, as we said, our medications can be very effective for the positive symptoms. Unfortunately, the current medications are not as effective for negative symptoms and cognitive impairment. And interestingly, there's similar underlying neurobiology in both the pathways for negative symptoms and cognitive symptoms. And it's not only a similar neurobiological structure, but also similar circuitry and similar neurotransmitters may be involved.
Amber Hoberg: The interesting thing is a lot of my patients, we can treat the positive symptoms, but negative and cognitive symptoms tend to be a lot harder and something that the patients tend to struggle with that cause a lot of functional problems.
Dr Andrew Cutler: Well, absolutely. Our current medicines—we all know, we've had a patient or two, we've had some patients who do have some improvement in negative symptoms and cognition, but on average, unfortunately, not enough people are helped.
Amber Hoberg: Thank you so much for joining and watching today.
Dr Andrew Cutler: And for more information, please check out Psych Congress Network.
