Schizophrenia Is a Cognitive Illness Time for a Change in Focus
Schizophrenia Is a Cognitive Illness Time for a Change in Focus
复制标题
DOI：
10.1001/jamapsychiatry.2013.155
复制
发表时间：
2013-10-01
期刊：
影响因子：
25.8
通讯作者：
Keefe, Richard S. E.
中科院分区：
文献类型：
--
作者：
Kahn, Rene S.;Keefe, Richard S. E.
精神分裂症目前被归类为精神障碍。本文认为，这种强调精神病是一种概念上的谬误，极大地促进了我们对这种疾病的理解缺乏进展，因此阻碍了适当治疗的发展。不仅认知和智力表现不佳一直被证明是精神分裂症的危险因素，一些研究发现，认知功能的下降早于精神病发作近十年。虽然精神病发作后认知功能是否继续下降的问题仍有争议，但很明显，精神分裂症的认知功能与结果有关，抗精神病药物治疗对其影响不大。因此，我们专注于根据精神病症状来定义（和预防）这种障碍可能过于狭隘。不仅认知应该被认为是疾病的核心组成部分，我们的诊断工作应该强调在发育早期发生的认知功能的变化。将重点重新放在认知上可能有助于在精神病出现之前找到疾病的治疗方法。
Schizophrenia is currently classified as a psychotic disorder. This article posits that this emphasis on psychosis is a conceptual fallacy that has greatly contributed to the lack of progress in our understanding of this illness and hence has hampered the development of adequate treatments. Not only have cognitive and intellectual underperformance consistently been shown to be risk factors for schizophrenia, several studies have found that a decline in cognitive functioning precedes the onset of psychosis by almost a decade. Although the question of whether cognitive function continues to decline after psychosis onset is still debated, it is clear that cognitive function in schizophrenia is related to outcome and little influenced by antipsychotic treatment. Thus, our focus on defining ( and preventing) the disorder on the basis of psychotic symptoms may be too narrow. Not only should cognition be recognized as the core component of the disorder, our diagnostic efforts should emphasize the changes in cognitive function that occur earlier in development. Putting the focus back on cognition may facilitate finding treatments for the illness before psychosis ever emerges.