How should DSM-V criteria for schizophrenia include cognitive impairment?
Open accessAbstract
Neurocognitive impairment is considered a core component of schizophrenia and is increasingly under investigation as a potential treatment target. On average, cognitive impairment is severe to moderately severe compared with healthy controls, and almost all patients with schizophrenia demonstrate cognitive decrements compared with their expected level if they had not developed the illness. Compared with patients with affective disorders, cognitive impairment in schizophrenia appears earlier, is more severe, and tends to be more independent of clinical symptoms. While the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, description of schizophrenia includes several references to cognitive impairment, neither the diagnostic criteria nor the subtypology of schizophrenia include a requirement of cognitive impairment. We forward for consideration a proposal that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria include a specific criterion of "a level of cognitive functioning suggesting a consistent severe impairment and/or a significant decline from premorbid levels considering the patient's educational, familial, and socioeconomic background." The inclusion of this criterion may increase the "point of rarity" with affective psychoses and may increase clinicians' awareness of cognitive impairment, potentially leading to more accurate prognosis and better treatment outcomes. Future research will need to address the validity of these possibilities. The reliable determination of cognitive impairment as part of a standard diagnostic evaluation may present challenges to diagnosticians with limited resources or insufficient expertise. Various cognitive assessment methods for clinicians, including brief assessments and interview-based assessments, are discussed. Given the current emphasis on the development of cognitive treatments, the evaluation of cognition in schizophrenia is an essential component of mental health education.
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Neurocognitive impairments in schizophrenia include significant deficits in memory, attention, working memory, problem solving, processing speed, and social cognition.
“They include significant deficits in memory, attention, working memory, problem solving, processing speed, and social cognition.1–3”
From Clinical trials of potential cognitive-enhancing drugs in schizophrenia: what have we learned so far? (2013) · cites this paper as [1]
Neurocognitive impairments are a core component of schizophrenia.
“Neurocognitive impairments are a core component of schizophrenia.”
From Clinical trials of potential cognitive-enhancing drugs in schizophrenia: what have we learned so far? (2013) · cites this paper as [1]
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- Authors
- Keefe, R. S. E., & Fenton, W. S.
- Affiliations
- Duke University (US)
- National Institute of Mental Health (US)
- ORCID
- Keefe, R. S. E.
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-03-15
- Volume
- 33
- Issue
- 4
- Pages
- 912-920
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC2632322
- OpenAlex
- W2102864354
- Cited by
- 394
- References
- 48
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 18 · 2023: 18 · 2022: 21 · 2021: 24 · 2020: 15 · 2019: 25 · 2018: 24 · 2017: 19 · 2016: 20 · 2015: 16 · 2014: 23 · 2013: 34 · 2012: 32
- FWCI
- 2.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Schizophrenia Bulletin (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- schizophrenia, cognitive impairment
- MeSH terms
- Cognition Disorders, Educational Status, Humans, Schizophrenia, Severity of Illness Index, Reproducibility of Results, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders
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