Recent, while talking to a young client, who is diagnosed with schizoaffective disorder, they reported noticeable changes in their memory and ability to read/fill out necessary paperwork (e.g. legal, housing, doctor’s forms). This particular client observed a decline in their memory and reading comprehension over the past several years, shortly after receiving their schizoaffective diagnosis. He theorized the various psychiatric medications impacted his thinking and asked my opinion. My heart broke a little as I recalled various research studies about the link between schizophrenia spectrum disorders and decreases in IQ due to structural changes in the brain. However, I didn’t say anything to my client in the moment because I did not want give a grim pronouncement, “Your brain is structurally changing, and your IQ (aka thinking power) is going to decline over time,” without reading up on the topic and getting my research related “ducks in a row.”
What I learned, after a brief review of current research is this: Yes, folks with schizophrenia and other psychoses experience a cognitive decline (e.g., decreased IQ) over time. However, researchers found IQ decline was most pronounced in areas of verbal knowledge and memory (Zanelli, et. al, 2019). What I did not know, but learned from the current research (Zanelli, et. al, 2019) is the development of cognitive decline (decreased verbal skills, memory, visual/spatial reasoning, and processing speed) occurs around the onset of first episode symptoms.
As I later shared this with my client, who initial got me thinking about cognitive issues and schizophrenia, in his true stoic fashion, laughed, shook his head and said, “Well THAT sucks!” This led me to look up what can be done for individuals and their loved ones, who live with schizophrenia.
One approach would be to have proper cognitive assessment completed by a psychologist to identify a baseline of functioning. This allows the individual, who is exhibiting cognitive deficits, where their difficulties lie. If cognitive deficits are apparent, enroll the individual in a cognitive rehabilitation programs. This behavioral intervention can be conducted 1:1 or in a group setting and is meant to improve memory, attention, social skills, planning, organizational, impulse control, and emotional control (Mihaljević-Peleš, et al., 2019). Researchers have noted this approach has two models: compensatory and restorative. Compensatory approaches work to bypass or remove specific deficits which impact functioning. Restorative approaches are based upon correcting the specific deficits through repetition of tasks and strategy acquisition (Kidd, et. al., 2020). Several notable programs include: Cognitive Adaptation Training (CAT), Individual Resiliency Training (IRT), and Action Based Cognitive Remediation (ABCR) (Browne, et. al., 2019; Kidd, et. al., 2020). These types of programs are typically offered through First Episode Psychosis clinics, which can be found by a quick internet search in your area. If cognitive remediation programs for psychosis are not specifically available in your area, ask about community focused treatment groups (aka mental health day treatment programs). These programs are developed and run with remediation in mind.
It is also important to note that IQ decline is not inevitable in schizophrenia. Many people with schizophrenia are able to maintain their cognitive function throughout the course of the illness. However, for those who do experience IQ decline, appropriate assessment and cognitive remediation programming can be effective and can offer individuals living with schizophrenia hope and guidance.
Browne, J., Mueser, K. T., Meyer-Kalos, P., Gottlieb, J. D., Estroff, S. E., & Penn, D. L. (2019). The therapeutic alliance in individual resiliency training for first episode psychosis: Relationship with treatment outcomes and therapy participation. Journal of Consulting and Clinical Psychology, 87(8), 734.
Kidd, S. A., Herman, Y., Virdee, G., Bowie, C. R., Velligan, D., Plagiannakos, C., & Voineskos, A. (2020). A comparison of compensatory and restorative cognitive interventions in early psychosis. Schizophrenia Research: Cognition, 19, 100157.
Mihaljević-Peleš, A., Bajs Janović, M., Šagud, M., Živković, M., Janović, Š., & Jevtović, S. (2019). Cognitive deficit in schizophrenia: an overview. Psychiatria Danubina, 31(suppl 2), 139-142.
Zanelli, J., Mollon, J., Sandin, S., Morgan, C., Dazzan, P., Pilecka, I., … & Reichenberg, A. (2019). Cognitive change in schizophrenia and other psychoses in the decade following the first episode. American Journal of Psychiatry, 176(10), 811-819.