Green Michael F, Horan William P, Lee Junghee
Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
World Psychiatry. 2019 Jun;18(2):146-161. doi: 10.1002/wps.20624.
Cognitive impairment in schizophrenia involves a broad array of nonsocial and social cognitive domains. It is a core feature of the illness, and one with substantial implications for treatment and prognosis. Our understanding of the causes, consequences and interventions for cognitive impairment in schizophrenia has grown substantially in recent years. Here we review a range of topics, including: a) the types of nonsocial cognitive, social cognitive, and perceptual deficits in schizophrenia; b) how deficits in schizophrenia are similar or different from those in other disorders; c) cognitive impairments in the prodromal period and over the lifespan in schizophrenia; d) neuroimaging of the neural substrates of nonsocial and social cognition, and e) relationships of nonsocial and social cognition to functional outcome. The paper also reviews the considerable efforts that have been directed to improve cognitive impairments in schizophrenia through novel psychopharmacology, cognitive remediation, social cognitive training, and alternative approaches. In the final section, we consider areas that are emerging and have the potential to provide future insights, including the interface of motivation and cognition, the influence of childhood adversity, metacognition, the role of neuroinflammation, computational modelling, the application of remote digital technology, and novel methods to evaluate brain network organization. The study of cognitive impairment has provided a way to approach, examine and comprehend a wide range of features of schizophrenia, and it may ultimately affect how we define and diagnose this complex disorder.
精神分裂症中的认知障碍涉及广泛的非社会性和社会性认知领域。它是该疾病的一个核心特征，对治疗和预后具有重大影响。近年来，我们对精神分裂症认知障碍的病因、后果及干预措施的理解有了显著进展。在此，我们综述一系列主题，包括：a）精神分裂症中非社会性认知、社会性认知及感知缺陷的类型；b）精神分裂症中的缺陷与其他疾病中的缺陷有何异同；c）精神分裂症前驱期及整个病程中的认知障碍；d）非社会性和社会性认知神经基质的神经影像学；以及e）非社会性和社会性认知与功能结局的关系。本文还综述了通过新型精神药理学、认知康复、社会认知训练及其他方法来改善精神分裂症认知障碍所做的大量努力。在最后一部分，我们探讨正在出现且有可能提供未来见解的领域，包括动机与认知的界面、童年逆境的影响、元认知、神经炎症的作用、计算建模、远程数字技术的应用以及评估脑网络组织的新方法。对认知障碍的研究为理解、审视和领会精神分裂症的广泛特征提供了一种途径，并且最终可能影响我们对这一复杂疾病的定义和诊断方式。
