Cognitive symptoms in psychosis

When we talk about psychosis, we often focus on the most visible or distressing aspects, such as hallucinations and delusions. However, there is another crucial aspect that deserves our attention: cognitive symptoms . These symptoms, although less obvious, play a fundamental role in the experience of people with psychosis.

We're referring to the memory, attention, thinking, and problem-solving difficulties that may arise after a psychotic episode. These can be subtle, such as difficulty concentrating, or more pronounced, such as short-term or long-term memory problems.

Cognitive symptoms are often underestimated or mistaken for simple forgetfulness, but they can have a significant impact on a person's daily life. They can also cause confusion for the family, who may think the person isn't trying hard enough or has become clumsy, and this can affect their self-esteem and mood.

People with psychosis may experience difficulties they did not previously have in areas such as memory, attention, information processing, and decision-making.

We know that these symptoms are related to changes in brain activation and connectivity , primarily in the frontal and temporal lobes, which occur during psychosis. We also know that these symptoms sometimes appear in people months before the psychotic episode and that they could be considered prodromal symptoms (signs of distress that precede an illness).

Studies have shown that people with psychosis have lower cognitive performance compared to those without the disorder, and this performance is also lower compared to their premorbid functioning (before the onset of psychosis symptoms). This means they may experience difficulties they didn't previously have in areas such as memory, attention, information processing, and decision-making. Therefore, they often feel and express that they used to be able to study more easily or that they find it increasingly difficult to concentrate, for example.

Understanding the impact of this condition on people's lives is essential for providing them with effective treatment and support. By addressing both cognitive and psychotic symptoms, we can help people live fuller, more meaningful lives, despite the challenges they face.

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What are the most common cognitive symptoms?

The most common cognitive symptoms include:

• Memory difficulties : People with psychosis may experience problems remembering recent information, such as names, dates, or important events.
• Impaired attention : The ability to maintain concentration on a specific task may be compromised, making it difficult to perform everyday activities that require sustained attention, such as reading a book or studying for an exam.
• Information processing problems : There may be difficulties in processing information efficiently, which may manifest as slowness in understanding instructions or problems following complex and fast-paced conversations.
• Disorganization of thought : Thoughts may become disordered or confused, making it difficult to communicate coherently and express ideas logically.
• Difficulties in planning and problem-solving : The ability to solve problems and make decisions may be compromised, and this can affect the ability to handle everyday situations (making a decision, planning a trip, or resolving conflicts, among others).

These cognitive symptoms can vary in severity from person to person and can affect different areas of daily life in different ways. Some people experience subtle cognitive symptoms that only bother them with more demanding tasks, while others experience more severe cognitive symptoms that significantly interfere with their daily lives. It is important to address these symptoms alongside other symptoms of psychosis to provide comprehensive treatment and improve the quality of life for those affected.

Alice

Person with personal experience of psychosis

"I had to build a new version of myself"

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What can we do if we have cognitive problems?

Reducing cognitive symptoms in psychosis may require a comprehensive approach that combines different strategies.

• Appropriate medication . Some psychotropic medications can help improve cognitive symptoms in some people with psychosis. It is important to work with a mental health professional to find the right medication and adjust the dosage as needed. Adjusting the dosage is crucial, as poorly tolerated or incorrectly adjusted medications can produce bothersome side effects, but at the right dose, they are key to improving clinical and cognitive symptoms.
• Psychoeducation and training . Participating in education and training programs specifically designed for people with psychosis can provide additional skills and resources for managing cognitive symptoms and other challenges associated with psychosis. These can range from strategies for managing distressing symptoms to compensatory programs for improving organization. They are often helpful in empowering the individual. In addition, targeted cognitive training programs, at an appropriate intensity, have demonstrated a mild to moderate impact on improving cognitive symptoms in psychosis.
• Cognitive stimulation . Participating in activities that challenge the brain, such as solving puzzles, learning a new language, or playing a musical instrument, can help maintain and improve cognitive function. The activities can be very varied, but the important thing is that they interest and motivate the person (learning to play the drums, playing chess, studying Japanese, etc.).
• Regular physical exercise . Regular exercise is not only beneficial for physical health, but it also has a positive impact on cognitive and psychological function. Aerobic exercise, such as walking, running, or swimming, has been shown to improve memory and executive function in people with psychosis. Furthermore, it plays a role in stress management by reducing cortisol levels.
• Healthy lifestyle : Maintaining a healthy lifestyle that includes a balanced diet, sufficient rest, and stress management can help improve overall cognitive function. Getting seven to eight hours of sleep per day is essential for good cognitive function. Along these lines, it is key to reduce or eliminate the consumption of substances that can interfere with cognition, such as alcohol and cannabis.
• Psychosocial support . The support of friends, family, and support groups can be invaluable for people with psychosis. Feeling understood and supported can reduce stress and improve emotional well-being, which in turn can have a positive impact on cognitive function. It is crucial that family and friends are understanding and empathetic, and that they understand the origin of any cognitive difficulties, in order to provide the support each person needs.

It is important to remember that everyone's needs are unique, so it may be necessary to try different approaches and tailor treatment to individual circumstances. Working collaboratively with a team of mental health professionals, along with the affected person and their support network, can help identify the most effective strategies for reducing cognitive symptoms and improving overall quality of life.