Antipsychotics and Cognitive Functioning: A Critical Review

Paolo      Stratta; Ilaria      Riccardi; Alessandro      Rossi

Abstract

Cognitive dysfunction underpins some of the psychopathology of schizophrenia, as well as contributes to the patient's impaired social and vocational functioning and has now been recognized as an intrinsic dimension linked to functional outcome. Despite a general consensus on the capacity of antipsychotics to improve the psychopathology of schizophrenia, the dispute concerning their impact on cognitive function is constantly open.

We performed a selective review on the possible effects of antipsychotics, both of first and second generation, for a cognitive performance improvement. Other than the strict treatment, pharmacological effect and related aspects, such as dosage and pharmaco-induced brain structure modifications, placebo and practice effect issues have been considered. Interaction with specific cognitive interventions, such as remediation programs and enhancement treatments are discussed.

On the basis of the current evidence-based findings, the hypothesis that cognition could be substantially influenced by antipsychotics has so far been demonstrated. Administering antipsychotic medications in an individually optimized manner seems to have the potential of improving cognitive aspects of schizophrenia, regardless of the kind of antipsychotic medication.

Keywords: Medication management, antipsychotic agents, cognition, placebo, practice effect, cognitive remediation, cognitive enhancement