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Mike Barber: Hello and welcome to today's masterclass entitled. How cognitive impairment affects daily functioning in patients with schizophrenia and bipolar disorder. I'm Mike Barber and I'm a medical science liaison with Sunovian Pharmaceuticals. With me today is Dr. Philip Harvey, professor of psychiatry and behavioral sciences at the University of Miami's Miller School of Medicine in Miami, Florida. Dr. Harvey is a consultant of Sunovian. In today's program we'll be discussing how cognitive dysfunction impacts everyday functioning in patients with schizophrenia and bipolar disorder, so let's get started. Dr. Harvey, thank you for being with us today.
Dr. Philip Harvey: Well, thanks for inviting me.
Mike: You're welcome. This is a very complex area of mental healthcare and in our session, we're only going to be able to focus on a few aspects of this topic, given the wide breadth of the information that exists. That said, Dr. Harvey let's get started by discussing the major cognitive domains and how each are affected in patients with schizophrenia and bipolar disorder.
Harvey: Sure. Historically, people have thought about cognition being organized into different types of functional domains. On the next slide, you'll be able to see that these domains include perceptual-motor function, language, learning and memory, complex attention, executive functioning, and social cognition. Within each of these areas, they're subdomains and so for example, there are variable impairments that are seen across people with schizophrenia across these different domains. The biggest impairments are in processing speed and attention and working memory, the smallest impairments tend to be in things like delayed recognition, memory, and semantic memory, and old learning.
Mike: As you discuss those, what I find really intriguing is recognition of emotions and a lot of things may come to mind. Can you explain a little more in some patients with schizophrenia, for example?
Harvey: Sure. What we see in people with schizophrenia is they have challenges in recognizing emotions. They don't have challenges in recognizing what the emotions are, they can tell a sad face from a happy face but what they tend to do is have an exaggerated response to negative emotions, and they tend to see negative emotional expressions as much more negative than healthy people would looking at the same picture of the same face.
Mike: Can you tell us about what we know about the underlying mechanisms implicated in cognitive dysfunction?
Harvey: Sure. cognitive impairment is definitely originating from the brain. Cognitive impairment has a very similar signature across people with bipolar disorders, schizophrenia, and major depression. As you see on the slide, there are some more global domains of cognitive functioning, some basic things such as sensory and perceptual operations but also higher-level functions, executive functioning, reasoning, and problem-solving, encoding complex verbal material. Now the origin of these impairments probably is coming from impairments in certain types of brain structures, in certain brain circuits, and originating from abnormalities in neurotransmitter systems.
One of the common hypotheses that we have right now is that abnormalities in the glutamatergic system are associated with some of these cognitive challenges but we've also seen that the serotonergic system, particularly the serotonergic seven receptor may actually be implicated in encoding and memory as well. There's a lot of different possible causes originating in multiple parts of the brain transmitter systems, circuits, et cetera.
Mike: Wonderful.
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