My son has been on Antipsychotic meds for 5 months, but i notice a decline in his cognitive functioning. Would like to hear your experience on this. Is this the same for all AS meds? Are there good practices to improve cognitive functioning among people with SMI and on treatment?
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My estimation is it’s tough to tell if cognitive decline is caused by the AP medication or disease progression itself or some combination of the two. The general hypothesis among Psychiatrists, researchers and drug companies is AP medication should decrease brain atrophy and thus cognitive decline, but I haven’t found their arguments particularly convincing. I asked a neuroscientist presenting at a NAMI conference about brain imaging comparisons between identical twins with and without schizophrenia whether the subjects with schizophrenia were medicated, and he rather pointedly said “of course” and seemed confused when I asked him if it was possible that the neuroleptics might be contributing to the brain abnormalities. Of course this was a long time ago back when Dr. Torrey was making a name for himself, and I haven’t kept up with the studies. My intuition is that unmedicated people make such lousy subjects for studies and rarely follow through to the end of studies, so it’s hard to collect useful comparative data aside from placebo trials from a given drug’s initial studies.
Some drugs can and do slow down mental function especially if they target bipolar symptoms. My brother seems to be especially slowed down by Lithium Carbonate, yet we haven’t managed to convince him to take any newer atypical AP medications targeted at bipolar disorders to see if he fares any better.
My guess is the same sorts of preventatives and supportive interventions suggested for dementia might help slow or stop cognitive decline. Physical and mental exercise, and supplements might help. In particular, I took on a myriad of classes and training in music, drama and art and I feel this extra stimulation may have made my brain more resilient and aided recovery.
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I like your final statement here, that you feel the stimulation and focus required for taking classes improved your resilience to cognitive decline. I’ve actually observed this with my MI partner as well. About five years ago he started taking a program in plumbing and also took a different position at his family’s company that required him to have to engage more readily with others (opposed to driving a delivery truck where he was alone and rarely engaged with a living person for days or weeks at a time). In some ways it seems odd or counterintuitive considering when he was in the throes of deep psychosis he could barely communicate in a normal fashion at all.
Sorry if that’s a bit off topic as it doesn’t address the question of decline with AP meds. Clozapine was a life saver for my ex husband who was only able to successfully finish school because of it. I’m not sure I could say I’ve ever seen a cognitive decline in any of my patients due to meds either, though I’d be tempted to consider maybe it’s not necessarily a cognitive decline but maybe something more akin to lethargy. Like when you’re already overtired or have a glass of wine before bed you’re just not as sharp as you were when you were well rested with a cup of coffee in you.
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Unsurprisingly I agree. I’ve been an advocate of employment and advocations with low stakes, low pressure social engagement for some time now. Again this is the sort of thing that’s been linked to cognitive decline in seniors. My father had significant advancing hearing loss that led to social isolation as he aged and probably contributed to or accelerated his mental decline.
I see parallels in the clubhouse model and senior centers, and an emphasis on social “activities” and physical exercise in mental hospitals and senior care facilities, and I can’t help but think these are deliberate and similar for parallel reasons. I don’t recall much of an emphasis on such activities post hospitalization with most psychiatrists. My last one was especially big on supportive supplements like vitamins, antioxidants etc, and we would discuss strategies for maintaining better physical exercise habits as well as language learning etc, but as a whole I’ve seen little emphasis at encouraging cognitive supportive care outside of hospital settings by most professionals.
Per this being off-topic, I tend to disagree. The OP asked for practices to improve cognitive functioning in those under treatment, and I feel supportive care such as this lifts all boats— treated and untreated; diagnosed or undiagnosed. And switching to more appropriate or effective medications probably is the most direct way to improve matters—whether the issues are strictly cognitive or not. Since you mention Clozapine and mild stimulants and depressants, it probably goes without saying discouraging cigarette smoking, cannabis and illegal drugs is probably a good idea. I’ve often counteracted sedation and other perceived medication side-effects with caffeine— probably to excess. Some people also emphasize improved nutrition and hydration. I’ll also mention there’s significant variation in recommendations on timing of taking AP medications. I discovered when switching psychiatrists many having different strategies, so it may help to experiment with timing of maintenance schedules for non-injectable medications.
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Oh I love all of that! As usual MB, all great stuff! Exercise, nutrition, hydration, social exercises, appropriate med timing… all spot on. I think you’re right too in that its so true there seems to be little after-care support that really gets the emphasis it deserves once a person is out of a clinical setting. Thanks again! (You remind me also I need to pick up more fish for dinner this week 
)
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My son has taken antipsychotic medication since 2003. After the first two years, I noticed a decline in his cognitive functioning. I have read that any antipsychotic medication may cause cognitive decline over the years. I am not sure if the other cause is from his mental illness. My son sometimes has dificulty concentrating while listening to someone speak or following complex instructions. He lives with a group of ten people in an independent living facility which keeps him engaged with others and not isolated. This seems to help his cognition.
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My son is on a high dose of APs (quetiapine and olanzapine) and has cognitive problems like memory loss and concentrating. His psychiatrist says it’s both the disease and the APs.