Neurocognitive functions in schizophrenia: narrative review of cultural-historical versus domain concepts

The narrative review considers the traditional Russian approach to the assessment of cognitive impairment in schizophrenia. The review focuses primarily on impairments of neurocognitive functions, such as thinking, memory, and attention, as the most impaired in schizophrenia. In international psychology it is more likely to talk about mental functions as a whole as it traditionally relies on the psychometric method with its standardized procedures and quantitative assessment of results. In Russian clinical psychology it is common to single out impaired elements of complex cognitive functions with identifying the central core of disorders on the basis of a system approach to the assessment of cognitive function impairments. The core of impairments for schizophrenia is a decrease in motivation, impaired social orientation and regulation of activity, and specific thinking disorders. Studies that have attempted to combine the two approaches have shown that neurocognitive impairments in schizophrenia patients are not unchangeable, and their dynamics are less related to the severity of the disorders and more correlated with the course of the disease. In addition, cognitive functions are not isolated from each other, and in the course of the disease there is not only an impairment of one function, but also a reorganization of connections between all cognitive functions. Combining different approaches to the assessment of cognitive impairment provides opportunities to identify different features of deficits, which may potentially allow for improved methods of preventing relapses and assessing the success of therapy.