Pharmacotherapy of Cognition in Schizophrenia
Dr.
Margarita M. Maramis, dr. SpKJ(K), FISCM
SMF/Departemen
Psikiatri, RSUD Dr. Soetomo-FK Universitas Airlangga, Surabaya
Schizophrenia is a chronic, severe and debilitating brain disease, is known as a multilateral condition. The symptoms of schizophrenia are positive symptoms such as delusions like paranoia and the hallucinations like hearing voices, secondly the negative symptoms such as social withdrawal, lack of motivation and apathy. cognitive symptoms such as problems with concentration (inability tn sustain attention), working memory problems (the ability to keep recently learned information in mind and use it right away), poor executive functioning (the ability to absorb and interpret information and make decisions based on that information).Traditionally, significant cognitive impairment was thought to be evident only in elderly deteriorated patients with schizophrenia, though Emil Kraeplin popularized the term dementia precok for Schizophrenia
in 1891. However, over the past 25 years, evidence has accrued to challenge this view. It is becoming evident that marked cognitive impairment is the norm and often pre-dates the illness. Cognitive impairments often interfere with the patient’s ability to lead a normal life and earn a living. They can cause great emotional distress and enduring, significantly negatively affects functional outcome and the ability to live and work Independently.
Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed and can be just as disabling as the other types of symptoms. Unlike the psychotic symptoms, these deficits do not improve during periods of remission and change only minimally with antipsychotic medications.
Cognitive impairment in schizophrenia can be managed by medication and non-medication interventions Several agents i.e. dopaminergic (psychostimulant, D1-gonists), serotonergic (Agents acting at 5HT1A, 5HT2A & 5HT6 receptors), acetylcholinergic (Nicotinic acetylcholine receptors, Muscarinic Agonists, Cholinesterase Inhibitors), glutamatergic (Glycine site agonists, Glycine reuptake inhibitors and AMPA modulators, metabotropic glutamate receptor agonists), GABAergic (GABA-A Agonists), miscellaneous (Modafinil, Pregnenolone), brain stimulation's, cognitive rehabilitations with 2 main techniques: remediation and compensatory approaches.
keyword: schizophrenia, cognitive impairment, medication and non-medication interventions.
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