How Cognitive Deficits in Schizophrenia Can Interfere With Real-World Functioning

Schizophrenia is a serious mental illness with symptoms including hallucinations, delusions, social withdrawal, apathy, and disorganized thinking and behavior. “Schizophrenia is a psychosis,” wrote the late Colorado Recovery founder Richard Warner, MD, in his influential book The Environment of Schizophrenia. “It is a severe mental disorder in which the person’s emotions, thinking, judgment, and grasp of reality are so disturbed that his or her functioning is seriously impaired.”

One of the functions seriously impaired by schizophrenia is cognitive control. “Cognitive deficits associated with schizophrenia include difficulties with attention, working memory, learning, and processing speed,” explained psychiatry professor Eugene Rubin in Psychology Today. “These deficits interfere with real-world functioning. They are associated with increased hospitalization, longer hospital stays, and decreased compliance with treatment.”

It has been known for over half a century that people with schizophrenia often perform poorly on most cognitive tests. “Significant cognitive impairment is common in schizophrenia, affecting up to 75 percent of patients,” wrote  Talreja, Shah, and Kataria in their 2013 study of cognitive function in schizophrenia. “A wide range of cognitive functions are affected; particularly memory, attention, motor skills, executive function, and intelligence.”

If untreated, cognitive impairment presents “a major contributor to illness-related disability, defined as an inability to work productively and/or live independently,” wrote Professor Rubin. “Psychiatric illnesses, including schizophrenia, are among the leading causes of disability across the human lifespan.”

A 2019 study by Zanelli, Mollon, et al. published in the American Journal of Psychiatry suggests “that while a substantial proportion of the cognitive impairment seen in adult patients with schizophrenia, as well as in other psychoses, is already present at the first episode, these patients continue to experience cognitive decline after illness onset.”

Effective treatment needs to work against this decline. “Knowing which specific cognitive deficits an individual with schizophrenia is experiencing can assist caregivers in tailoring psychosocial management,” wrote Rubin who expects that advances in neuroscience will eventually result in an improved understanding of the nature and causes of schizophrenia. “This should lead to advances in novel drug development. Together with increased attention to psychosocial interventions, these advances should aid the development of integrated, personalized treatment approaches to improve the everyday functioning and life satisfaction of those suffering from this devastating psychiatric disorder.”

Personalized therapy to improve everyday functioning and life satisfaction as well as fewer and shorter hospitalizations are hallmarks of the treatment philosophy at Colorado Recovery. Dr. Warner considered schizophrenia a bio-psycho-social disorder significantly affected by the environment surrounding the person with the mental health condition on multiple levels.

Colorado Recovery approaches care for mental health based on a path of self-reliance through developed practiced skills. This non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

How Art Can Harness the Healing Power Within Us

“Art can harness the healing power within each of us and help bring us into community with one another,” wrote educator Jackie Armstrong in the magazine of the Museum of Modern Art (MoMA) in New York City. “When in front of an artwork, we are connected to the artist and to others who have experienced it. And connection, to ourselves and others, is at the core of art and healing. Healing isn’t a destination with a fixed timeline or endpoint but rather a path—or many paths. Just like each visit with a favorite work of art is a new experience with new insights, healing is a journey with possibilities stretching out in all directions.”

Art is also part of the healing process facilitated by the treatment team at Colorado Recovery. After initially working in transitional housing at Colorado Recovery, Peter Kamback, MFA, had the opportunity to lead an art group before taking on his current role as a vocational rehabilitation specialist. He feels art is too often sidelined in our society and delights in allowing mental health patients to express themselves through art. Kamback likes to incorporate his art background in his current role and build on his experience with groups.

Colorado Recovery’s approach to treatment is about nurturing an environment of inclusivity, socialization, and community building. Clients are encouraged to take part in activities out in the community and within our own community as well.

A recent trip to the Boulder Museum of Contemporary Art is a good example. “It’s a great opportunity to see clients in a more natural setting and get a better sense of them as persons rather than patients,” said Kamback. “You experience them as people in a public location and also note how they interact with each other.”

BMoCA in downtown Boulder is easily accessible for Colorado Recovery patients. “It’s a small building but they utilize the space well,” Kamback remembered. “They featured three different artists that none of us—myself included—were familiar with. It was good to come in fresh and let clients explore the space. The museum wasn’t too busy so they were really comfortable with that. On this particular excursion, I specifically encouraged them to wander around and look at all the art on display, and then choose a favorite.”

After they got back to the campus, they got together and discussed the artwork they had viewed and which one they liked the best. “We had a sort of debriefing: ‘What drew you to this particular piece?’ and then others could chime in and we talked about feelings and emotions—what it was like to be at the museum.”

Because of his art background, Kamback excels at organizing and processing this kind of outing. He knows where to draw the line and not exhaust clients too much and make them lose interest. “We had a good time on this trip. This was a great opportunity for them to be in a public space. We used public transport to get there and they had good interactions the whole way. The whole trip is the experience, not just the museum visit.”

Trips to the art museum, hikes, game and movie nights, and other socializing activities are all part of the groundbreaking approach to mental health treatment pioneered by Colorado Recovery founder Richard Warner.

Recovery from serious mental illness requires that people with such a condition retain a sense of empowerment—a belief in their ability to take charge of their lives and manage the complex challenges of their illness.

At Colorado Recovery it is our mission to help adults with serious mental health issues stabilize their illness, minimize symptoms, improve functioning, and enhance each person’s social inclusion, quality of life, and sense of meaning in life.

If you have questions about our recovery model or our services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.

How Bipolar Disorder Affects Body Image

Bipolar disorder (BD) is a mental illness characterized by psychosis in which a person’s ability to recognize reality and emotional responses, thinking processes, judgment, and ability to communicate are so affected that their functioning is seriously impaired. Hallucinations and delusions are common features of psychosis.

Bipolar disorder caused extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When people with BD (formerly called manic depression) become depressed, they may feel sad or hopeless and lose interest or pleasure in most activities. When their mood shifts to mania they may feel euphoric, full of energy, or irritable. These mood swings can affect sleep, energy, activity, judgment, behavior, and the ability to think clearly.

But bipolar disorder affects more than the psyche of the patient. People with BD also face elevated physical health risks. According to a study published last year in Psychosomatic Medicine, they are more likely than other people to experience a major adverse cardiac event, for example. Another common side effect of BD is weight gain.

“Nearly 70 percent of people who seek treatment for bipolar disorder are overweight or have obesity,” reported Stephanie Watson on PsychCentral in March. “Weight gain is a side effect of many medications that treat bipolar disorder. Other factors related to having bipolar disorder, like depression and substance use, also can lead to excess eating and weight gain.”

Managing the psychiatric symptoms of bipolar disorder with appropriate medications is very important, of course, but so is maintaining a healthy body weight. A 2017 study indicated that an elevated body mass index (BMI) may impact brain chemistry in ways that could worsen bipolar disorder symptoms.

And it may have a negative effect on body image, i.e. the impression a person has of their physical appearance. BD “symptoms and the possible weight gain related to treatment often affect body image,” Watson wrote. “For example, if you notice a major change in your body size after starting treatment, this might change the way you feel about or perceive your body. Obesity is linked to more body dissatisfaction, worse self-esteem, and greater rates of depression.”

Which in turn does not exactly help to counteract the symptoms of bipolar disorder. Body dissatisfaction is a major driver of eating disorders and many BD patients also have an eating disorder. As Watson explained in her article, “eating disorders can look very different among individuals with bipolar disorder. Mania and depression can fuel various features of eating disorders, such as restrictive diets or overeating. Binge eating disorder and bulimia may be more likely to coexist with bipolar disorder than anorexia nervosa.”

An eating disorder can obviously complicate BD management and should be addressed as part of a comprehensive treatment plan. The Colorado Recovery treatment model created by our founder Richard Warner is based on a warmer and more human familial setting, as well as  comprehensive levels of care that result in a path of self-reliance, improved self-esteem, and community engagement for connection and a feeling of contribution.

Since Dr. Warner’s passing in 2015, we have continued to innovate based on these core principles. It is our mission to help adults with serious mental health issues stabilize their illness, minimize symptoms, improve functioning, and enhance each person’s social inclusion, quality of life, and sense of meaning in life.

If you have questions about our recovery model or our services to treat schizophrenia, bipolar disorder, and similar mental illnesses, call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.