Cognitive difficulties have been recognized as a component of psychotic disorders since the early twentieth century. Deficits in the areas of verbal learning and memory, attention/concentration, speed of thinking and executive functions (eg., concept formation and abstraction) have been reported. The demonstrated prevalence of these cognitive problems among persons with psychosis and the recent relationships reported between level of cognitive functioning and prognosis or outcome, both provide a rationale for assessment of this area as an important part of our PEPP protocol.
Recent research has found strong evidence that such cognitive deficits have important implications for the community functioning of those with psychotic disorders, independently of clinical symptoms. Recognition of the importance of cognitive deficits has also resulted in increased focus on reduction of such deficits as an important clinical outcome. Given the age of the patient population in this program (late adolescent/early adulthood), many of the functional issues arising at the time of initial treatment also relate to reintegration into and completion of high school or college/university studies. Assessment of cognitive functioning is an important and necessary part of addressing these issues.
The data gathered by our baseline and follow-up cognitive assessments are used to address a number of concerns and/or objectives for patients in the program.
Immediate Functional Issues: the baseline results are typically utilized to answer questions related to activities of daily living, educational, and vocational concerns (eg., what does the patient’s level of functioning dictate regarding an appropriate vocational setting, course load, academic modifications or accommodations, etc.).
Long-Term Issues: the follow-up assessment results are often utilized to answer questions related to the possibility of change in cognitive functioning over time and the course of such change among our patients; after one year of treatment patients are often making important decisions regarding their future and cognitive data can be an important component of this (i.e., have they improved over the past year and in what areas, and whether these changes now dictate commencement of new academic or vocational activities, eg., full-time versus part-time work or school).
Applied Research Issues: last, but not least, the results of these assessments can be used to address research questions related to the relationship between cognitive functioning and prognosis, patterns of functioning in persons with psychosis, gender differences in cognitive functioning, etc.; the answers to these questions can then be used to inform clinical practices with our patients.
