Recognizing Negative and Cognitive Symptoms in Schizophrenia Care

This episode, "Recognizing Negative and Cognitive Symptoms in Schizophrenia Care," features the panel examining why these symptom domains are so often missed in routine care.

Dr. Hicks opens by stressing the word impact, noting that negative and cognitive symptoms affect patients and families in ways clinicians rarely feel directly. Wearing both a caregiver and provider lens, she argues clinicians must remain curious and keep asking questions rather than assuming they understand a patient's daily experience. Dr. Jackson then asks Spencer Simon how comfortable clinicians are identifying negative and cognitive symptoms and engaging caregivers to track functional change. Spencer explains that uncovering these deficits requires real relationships with siblings, group-home staff, and other stakeholders, since a brief visit cannot capture day-to-day functioning. He uses a cognitive symptom scale covering seven domains, including working memory, reasoning, and processing speed, to gauge whether medication changes are warranted. He adds that building genuine rapport comes first; patients will not disclose struggles like workplace mistakes or mental blocks unless they trust their clinician will act on that information. Dr. Alva reinforces that educating patients on how schizophrenia affects thinking, behavior, and emotion helps them recognize what is faulty and work toward personal goals.

The conversation turns to tardive dyskinesia, which Dr. Jackson notes goes undiagnosed in roughly 85% of cases and untreated in 95%, well below acceptable standards of care. Spencer agrees this gap is unacceptable given available VMAT2 inhibitors with demonstrated efficacy, safety, and tolerability. He argues a simple movement rating score cannot capture the full physical, emotional, and vocational impact of tardive dyskinesia on a patient's life. Dr. Hicks ties this back to rapport, explaining that proactive psychoeducation about potential movement side effects, paired with a concrete plan if they occur, builds the trust needed for patients to raise concerns comfortably rather than hiding them.

Up next, in "Rethinking 'Stable': The Case for Measurement-Based Care in Schizophrenia," the panel challenges what it really means for a patient to be considered stable.