Schizophrenia Case Series, Part 5: Addressing Residual Cognitive Deficits in Patients with Schizophrenia
neuroscienceCME Medical Simulation
 | Patient Info: Allen, a 22-year-old male with schizophrenia, has been responding well to treatment with a long-acting injectable antipsychotic, but complains that he continues to experience problems with his memory and cognition that interfere with his ability to function independently. |
This activity offers CE credit for:
- Physicians (ACCME/AMA PRA Category 1)
- Pharmacists (ACPE)
Credit Expiration Date:
Saturday, April 3, 2010
 | Rakesh Jain, MD, MPH Director, Adult and Child Psychopharmacology Research R/D Clinical Research, Inc. Lake Jackson, TX |
The majority of people with schizophrenia have global cognitive deficits, some of which are evident
during the prodromal period. The specific domains that are impaired vary among individuals,(1,2) but
cognitive deficits as a group are among the most robust predictors of overall functional outcome.(3,4)
Although second-generation antipsychotics (SGAs) have been shown to produce clinically significant
improvements in cognitive functioning, some residual cognitive deficits may remain and can impede
functional recovery. Compared to first-generation antipsychotics, SGAs show a generally higher level
of efficacy in improving cognitive function; however, no one SGA stands out over another in this area.(7)
Cognitive symptoms also are related to medication adherence, which in turn affects long-term outcome.
Improvement in cognitive functioning is better in those who adhere to their medication regimens,(5) and
lower levels of cognitive functioning can be correlated with non- or partial adherence.(6) Appropriate
assessment of cognitive deficits is vital to optimizing functional outcome, and clinicians need to be
aware of available cognitive test batteries and their use in this patient population. Once affected
cognitive domains are identified, interventions to improve cognitive functioning should be evaluated,
and an individualized regimen should be implemented. In this interactive, case-based medical simulation,
participants will be presented with a realistic patient with cognitive deficits and will use problem-solving
and clinical evidence to assess and manage the patient.
- Bozikas VP, Kosmidis MH, Kiosseoglou G, Karavatos A. Neuropsychological profile of cognitively impaired patients with schizophrenia. Compr Psychiatry 2006;47:136-143.
- Meltzer HY, McGurk SR. The effects of clozapine, risperidone, and olanzapine on cognitive function in schizophrenia. Schizophr Bull 1999;25:233-255.
- Keefe RS, Goldberg TE, Harvey PD, Gold JM, Poe MP, Coughenour L. The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophr Res 2004;68:283-297.
- Bilder RM, Goldman RS, Robinson D, et al. Neuropsychology of first-episode schizophrenia: initial characterization and clinical correlates. Am J Psychiatry 2000;157:549-559.
- Woodward ND, Purdon SE, Meltzer HY, Zald DH. A meta-analysis of neuropsychological change to clozapine, olanzapine, quetiapine, and risperidone in schizophrenia. Int J Neuropsychopharmacol 2005;8:457-472.
- Keith SJ, Kane JM. Partial compliance and patient consequences in schizophrenia: our patients can do better. J Clin Psychiatry 2003;64:1308-1315.
- Reed RA, Harrow M, Herbener ES, Martin EM. Executive function in schizophrenia: is it linked to psychosis and poor life functioning? J Nerv Ment Dis 2002;190:725-732.
To provide mental healthcare practitioners with strategies drawn from the evidence base for assessment and management of cognitive deficits in patients with schizophrenia.
At the end of this CE activity, participants should be able to:
- Compare and contrast cognitive domains impacted by schizophrenia and treatment with second-generation antipsychotics.
- Identify appropriate tests batteries for assessing particular cognitive domains.
- Develop an individualized treatment plan for managing cognitive deficits in patients with schizophrenia.
Physicians, physician assistants, and other healthcare professionals with an interest in mental health.
CME Outfitters, LLC, gratefully acknowledges an educational grant from Wyeth Pharmaceuticals and Solvay Pharmaceuticals in support of this CE activity.
CME Credit (Physicians):
CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. CME Outfitters, LLC, designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Note to Physician Assistants: AAPA accepts Category I credit from AOACCME, Prescribed credit from AAFP, and AMA Category I CME credit for the PRA from organizations accredited by ACCME.
CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 0.5 contact hours (0.05 CEUs)
Universal Program Number: 376-000-09-013-H01-P
Activity Type: knowledge-based
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Rakesh Jain, MD, MPH
Rakesh Jain, MD, MPH, is Director of Psychiatric Drug Research for the R/D Clinical
Research Center at Lake Jackson, Texas.
Dr. Jain attended medical school at the University of Calcutta in India. He then attended
graduate school at the University of Texas School of Public Health in Houston, where
he was awarded a National Institute/Center for Disease Control Competitive
Traineeship. His research thesis focused on alcohol abuse issues. He graduated from
the School of Public Health in 1987 with a Masters of Public Health (MPH) degree.
After graduate school, Dr. Jain completed a postdoctoral fellowship in Research
Psychiatry with the Gerontology Center of the University of Texas Mental Sciences
Institute in Houston. He received the National Research Service Award for the support
of the postdoctoral fellowship. After this, he served a three-year residency in Psychiatry
at the Department of Psychiatry and Behavioral Sciences at the University of Texas
Medical School at Houston as well as a two-year fellowship in Child and Adolescent
Psychiatry.
Dr. Jain is currently involved in multiple research projects studying the effects of
medications on short-term and long-term treatment of depression, anxiety, pain/mood
overlap disorders, and psychosis in adult and child/adolescent populations. He is the
author of several articles on the issue of mood and pain conditions. He serves on
several Boards focusing on drug development and disease state education. He was
recently named “Public Citizen of the Year” by the National Association of Social
Workers, Gulf Coast Chapter, in recognition of community and peer education and
championing of mental health issues. He was also recently awarded the “Extra Mile
Award” by the local school district, in recognition of the service to the children of the
school district and consultation to the teachers and counselors.
Disclosure Declaration
It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all its CE activities. Faculty must disclose to the participants any significant relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.
Dr. Jain has disclosed that he receives research support from Abbott Laboratories, Addrenex Pharmaceuticals, Inc., Aspect Medical Systems, Inc., Forest Laboratories, Inc., Eli Lilly and Company, and Pfizer Inc. He is on the speakers bureaus of Cyberonics, Inc., GlaxoSmithKline, Jazz Pharmaceuticals, Eli Lilly and Company, Pfizer Inc., Shire Pharmaceuticals, and Takeda Pharmaceuticals North America, Inc. Dr. Jain serves as a consultant to Addrenex Pharmaceuticals, Inc., IMPAX Laboratories, Inc., Eli Lilly and Company, and Shire Pharmaceuticals.
Unlabeled Use Disclosure
Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.
CME Outfitters, LLC, the faculty, Wyeth Pharmaceuticals, and Solvay Pharmaceuticals do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.
Questions about this activity? Call us at 877.CME.PROS (877.263.7767).
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