Cognitive decline in schizophrenia

[valid username]

This question is for some of the more experienced people here: if a person's schizophrenia is well-controlled (excellent social support, compliance, no illicit drug use), how much cognitive decline is there on average as compared to poorly controlled (same, slightly less, much less, barely there)?

How do you explain people like Elyn Saks? I know one of her videos showed her rx botles and she is on clozapine. Is that part of it? She had her share of poor compliance though. Or was her baseline so high that the decline not as noticeable?
For anyone not familiar with her: Elyn Saks - Wikipedia

Is schizophrenia decline like seizure-related decline? Meaning, if we minimize the episodes is the long term damage is reduced? Or do we even know? Unless we are only studying injectables, it seems nearly impossible to know about medication compliance amongst large groups of higher functioning patients?

Thank you in advance for sharing your wisdom.

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[FlowRate]

We had a really great grand rounds on this recently. (In the context of a particular, large research study.) It turns out there's three groups of patients in BPAD and two or three in schizophrenia with regard to cognitive performance.

With regard to BPAD, there's a group with stable and often above-average cognitive performance who tend to be the CEO's and lawyers and such who might have 6-7 lifetime manic episodes, if that. There's another group who start out with approximately normal cognitive function, but they seem to have decline with each passing manic/depressive cycle (life-long cognitive decline). That group has the most poorly controlled BPAD and may have 20-25 combined manic or major depressive episodes over like 18 years. The final group looks a lot like the typical schizophrenic, with poor premorbid cognitive function who have a fast drop in cognitive performance that ends up being stable (not progressive) and low. That group of patients with BPAD are somewhat better controlled as far as episodes of care as compared to the prior group.

The presenter didn't go into it as much, but I believe she mentioned that there's another group in schizophrenia who have relatively normal cognitive function that is usually stable. This group tends to have more issues compared to the BPAD group, despite similar function on cognitive tests, thought likely due to the burden of negative symptoms.

 

[valid username]

So this is what it feels like to get sucked into research?

 

[NickNaylor]

We had a really great grand rounds on this recently. (In the context of a particular, large research study.) It turns out there's three groups of patients in BPAD and two or three in schizophrenia with regard to cognitive performance.

With regard to BPAD, there's a group with stable and often above-average cognitive performance who tend to be the CEO's and lawyers and such who might have 6-7 lifetime manic episodes, if that. There's another group who start out with approximately normal cognitive function, but they seem to have decline with each passing manic/depressive cycle (life-long cognitive decline). That group has the most poorly controlled BPAD and may have 20-25 combined manic or major depressive episodes over like 18 years. The final group looks a lot like the typical schizophrenic, with poor premorbid cognitive function who have a fast drop in cognitive performance that ends up being stable (not progressive) and low. That group of patients with BPAD are somewhat better controlled as far as episodes of care as compared to the prior group.

The presenter didn't go into it as much, but I believe she mentioned that there's another group in schizophrenia who have relatively normal cognitive function that is usually stable. This group tends to have more issues compared to the BPAD group, despite similar function on cognitive tests, thought likely due to the burden of negative symptoms.

Any chance you have any information on that paper that you referred to?

 

[valid username]

Or even the name of the speaker? (I am seriously trying to focus on something besides match.)

 

[FlowRate]

Her name is Katherine E. Burdick, PhD. A lot of what she was talking about was prelim data for some upcoming papers. Of her current work, I think "Burdick KE, Goldberg JF, Harrow M. Neurocognitive dysfunction and psychosocial outcome in patients with bipolar I disorder at 15-year follow-up. Acta psychiatrica Scandinavica 2010 Dec; 122(6)." and "Harvey PD, Wingo AP, Burdick KE, Baldessarini RJ. Cognition and disability in bipolar disorder: lessons from schizophrenia research. Bipolar disorders 2010 Jun; 12(4)." would be the most relevant.

 

[NickNaylor]

Her name is Katherine E. Burdick, PhD. A lot of what she was talking about was prelim data for some upcoming papers. Of her current work, I think "Burdick KE, Goldberg JF, Harrow M. Neurocognitive dysfunction and psychosocial outcome in patients with bipolar I disorder at 15-year follow-up. Acta psychiatrica Scandinavica 2010 Dec; 122(6)." and "Harvey PD, Wingo AP, Burdick KE, Baldessarini RJ. Cognition and disability in bipolar disorder: lessons from schizophrenia research. Bipolar disorders 2010 Jun; 12(4)." would be the most relevant.

Awesome, thanks.