Cognitive rehabilitation for schizophrenia: Problems, prospects, and strategies

Increasing awareness of the importance of neurocognitive impairments in sch izophrenia has fostered considerable interest in the prospects for cognitiv e rehabilitation. Nevertheless, optimism has outpaced progress, We first re view recent literature on the central assumptions that underlie cognitive r ehabilitation, including the hypothesis that cognitive deficits play a cent ral role in social disability and other problems schizophrenia patients exp erience in daily living, and that these impairments must be rectified if we are to achieve effective rehabilitation. We next discuss developments in k nowledge about the neurobiology of schizophrenia that bear on the potential for cognitive rehabilitation and the selection of appropriate targets for intervention, Third, we propose a new research strategy for investigating c ognitive functioning in schizophrenia and for examining the relationship of cognitive deficits to role functioning in the community: examining patient s who have good vocational outcomes in order to identify strengths or compe nsatory factors that compensate for core deficits. We present new data that lend support to our proposed approach. We next discuss putative limits to cognitive rehabilitation based on data documenting cognitive deficits in he althy siblings and parents. Finally, we briefly describe an interim rehabil itation strategy that minimizes the load on cognitive processes rather than attempting to improve cognitive functioning.