Schizophrenia is a chronic disorder marked not only by positive and negative symptoms but also by core cognitive and social cognitive impairments, which often begin before the onset of psychosis and persist long-term. These deficits—affecting memory, attention, processing speed, and social understanding—are major contributors to disability and poor functional outcomes. Risk factors include early onset, metabolic issues, inactivity, and certain medications. While second-generation antipsychotics are somewhat better for cognition than first-generation drugs, their benefits are modest. Some agents like minocycline and pregnenolone show limited promise, while others, such as anticholinergics and benzodiazepines, may worsen impairment.

Effective management requires early assessment and a comprehensive, multi-strategy approach. Tools like the Measurement and Treatment to Improve Cognition in Schizophrenia test and Brief Assessment of Cognition in Schizophrenia test help monitor cognitive function, while non-drug interventions—especially cognitive remediation therapy (CRT), exercise, and supported employment—are key to improving outcomes. CRT, when delivered by trained professionals and combined with rehabilitation, enhances both cognitive performance and daily functioning. Psychoeducation also plays a vital role in promoting adherence, healthy habits, and awareness of cognitive challenges. Though brain stimulation techniques show some potential, more evidence is needed. Integrating cognitive care into routine schizophrenia management is essential to support recovery and improve quality of life.

Reference: Grover S, Mohapatra D, Vaitheswaran S, et al. Clinical practice guidelines for assessment and management of cognitive impairment in schizophrenia. Indian J Psychiatry. 2025;67(1):65-83. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_690_24.