Too often with schizophrenia,

This is what stable looks like.

Even when stabilized with antipsychotics, people living with schizophrenia can still struggle with basic daily tasks, such as cleaning and organizing their home. That's because managing schizophrenia is more than just managing positive symptoms. Negative and cognitive symptoms are also core aspects of the condition. Many people still face issues with problem solving, attention, and memory, known as cognitive impairment associated with schizophrenia, or CIAS.¹ Scroll down to learn more

Watch what "stable" really means for many patients

SYMPTOM DOMAINS

Recognizing the full spectrum of symptoms

For people with schizophrenia, it’s critical to get their positive symptoms under control. Unfortunately, it’s usually not enough. Other symptoms can hold them back from living full, independent lives—and even hinder stabilization efforts.²

The 3 core symptom domains to address³

Positive Symptoms¹

Symptoms that are not normally experienced but are present during a psychotic episode: Delusions Hallucinations Abnormal behavior

Negative Symptoms¹

A lessening or absence of interest in daily life: Decreased motivation or ability to complete tasks (avolition) Decreased ability to experience joy (anhedonia) Social isolation

Cognitive Symptoms⁴

When cognition is impaired, people with schizophrenia often have trouble with: Attention and memory Problem-solving and reasoning Social situations

CIAS and negative symptoms may appear before the onset of positive symptoms, and remain
over the course of the disease. Current treatments do not specifically address CIAS and have at most
a modest effect on negative symptoms. Clinically meaningful improvements in functioning are not seen.⁴

Scroll down to uncover the importance of CIAS

I could no longer think on the fly. People started telling me I was becoming forgetful.
-Patient

COGNITIVE IMPAIRMENT

Understanding cognitive impairment

CIAS causes a significant reduction in your patients’ ability to independently complete activities of daily living. These deficits can also limit how well they follow their treatment plan, which creates an additional burden for the patient, their caregivers, and their healthcare provider.⁴

85% to 98% of people living with schizophrenia will face problem-solving, memory, and attention issues caused by CIAS.⁹

Significant deficits found across multiple cognitive sub-domains⁴

Researchers* have identified at least 7 key cognitive functions impaired in schizophrenia⁶:

Attention and vigilance
Working Memory
Reasoning and problem-solving
Verbal Learning

Verbal Learning
Speed of Processing
Social cognition

*Established by the NIMH MATRICS™ to support the development of CIAS therapies.

A closer look at the pathophysiology of schizophrenia symptoms

NMDA receptors in the brain play a critical role in learning and memory. But the chronic blockage of glutamate can lead to NMDA receptor hypofunction, which is implicated in the cognitive deficits and negative symptoms seen in schizophrenia.⁷

Hypofunctioning NMDA receptors are implicated in cognitive deficits in schizophrenia.

NMDA= N-methyl-D-aspartate.

Negative symptoms and CIAS: Related, yet distinct

Negative symptoms and CIAS have similar characteristics. They can even influence each other; for example, reduced executive functioning from CIAS can lead to reduced goal-directed behavior that results in avolition. Nonetheless, these 2 core symptom domains are distinct, and each must be addressed when managing schizophrenia.¹

CIAS can make it hard to do simple tasks, like preparing a meal.

Scroll down to see the impact on patients and caregivers

DAILY IMPACT

CIAS and negative symptoms take an enormous toll on patients— and their loved ones⁸

Imagine not being able to find your way home. Prepare a simple meal. Count change at the store. Or even feel motivated to get out of bed. Those are just a few ways that CIAS and negative symptoms can turn someone’s life upside down.⁶

CIAS and negative symptoms are among the strongest correlates of real-world functioning among people with schizophrenia, impacting their ability to work, study, and live independently.¹

The impact of CIAS

CIAS can lead to a decreased ability to perform activities of daily living (ADL), and even to homelessness. People with CIAS may become more dependent on friends, family, and institutions for everyday needs.⁴

CIAS makes it hard to carry out many basic, but essential, daily activities, including⁴:

Caring for personal hygiene

Following bus or train schedules

Going shopping

Preparing a meal

Managing finances

Remembering conversations

Keeping medical appointments

Following a psychiatrist’s treatment plan

The impact of negative symptoms

Negative symptoms persist throughout the course of schizophrenia and tend to become more prominent over time, taking away a person’s ability to thrive.¹

Negative symptoms can interfere with¹:

The motivation to perform routine tasks

The ability to experience joy

Being socially active and maintaining relationships

CIAS CAN MAKE IT HARD FOR PATIENTS TO GET AROUND, CAUSING THEM TO MISS DOCTOR APPOINTMENTS.

Scroll down to see what you can do today for your patients

RETHINK STABLE

Let’s rethink stable

Stabilizing patients is important. But often, it’s just the start. Recognizing and addressing CIAS, in addition to negative symptoms, can help more people living with schizophrenia have a more autonomous and fulfilling life.⁴

Higher cognitive performance is strongly associated with improved outcomes, including improved treatment adherence.⁴

What you can do today to help

Although no medications currently provide clinically meaningful relief for negative and cognitive symptoms, there are actions you can take right now³:

Proactively assess cognitive symptoms

Don’t rely on patients to tell you about their cognitive symptoms, because they may not be aware of them⁴

There are many validated screening tools available, with some assessments taking as little as 15 minutes.²

Evaluate negative symptoms

Make sure to differentiate between primary and secondary negative symptoms

Primary negative symptoms are caused by schizophrenia, but secondary negative symptoms are caused by other factors, such as isolation or extrapyramidal effects, and may be treated by addressing the underlying cause.¹

Educate patients and caregivers about CIAS

Let them know what to look for

Ask caregivers if they notice symptoms in their loved ones, such as difficulty completing simple chores, following conversations, or getting around on their own.⁴

References

Correll CU, Schooler NR. Negative symptoms in schizophrenia: a review and clinical guide for recognition, assessment, and treatment. Neuropsychiatr Dis Treat. 2020;16:519-534.
Keefe RS, Poe M, Walker TM, Kang JW, Harvey PD. The Schizophrenia cognition rating scale: an interview-based assessment and its relationship to cognition, real-world functioning, and functional capacity. Am J Psychiatry. 2006;163(3):426-432.
Kitchen H, Rofail D, Heron L, Sacco P. Cognitive impairment associated with schizophrenia: a review of the humanistic burden. Adv Ther. 2012;29(2):148-162.
Bowie CR, Harvey PD. Cognitive deficits and functional outcome in schizophrenia. Neuropsychiatr Dis Treat. 2006;2(4):531-536.
Keefe RS, Eesley CE, Poe MP. Defining a cognitive function decrement in schizophrenia. Biol Psychiatry. 2005;57(6):688-691.
García-Laredo, E. Cognitive impairment in schizophrenia: description and cognitive familiar endophenotypes. A review of the literature. In Irtelli F. Psychosis - Biopsychosocial and Relational Perspectives. doi: 10.5772/intechopen.78948
Yu A, Lau AY. Glutamate and Glycine Binding to the NMDA Receptor. Structure. 2018;26(7):1035-1043.e2. doi:10.1016/j.str.2018.05.004
Caqueo-Urízar A, Urzúa A, Boyer L. Caregivers' perception of patients' cognitive deficit in schizophrenia and its influence on their quality of life. Psicothema. 2016;28(2):150-155.
Mosiołek A, Gierus J, Koweszko T, Szulc A. Cognitive impairment in schizophrenia across age groups: a case-control study. BMC Psychiatry. 2016;16:37.

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This is what stable looks like.