Recent work has suggested that at least two types of declarative memory can be substituted for each other, and that the brain has two distinct memory access strategies, one for retrieval and one for "Familiarity". Recent personal experience has led me to ask whether Resperidal and it's brethern invagia sustenna act on the strategic choice to favor retrieval over familiarity. If this is true, and experiments that show a different pathway for familiarity strategy from that of retrieval strategy are true, then we should see a rerouting of the pathway from a familiarity strategy to retrieval as a result of treatment with Resperidal. This should clearly show on MRI records that show the chosen memory strategy.
It does occur, but very rarely, and hence the drug is selected weighing the pro's and cons. Also the memory deficit can be part of the cognitive symptom of psychosis
the cognitive deficits in psychosis and schizophrenia are commonly attributed to repeated acute episodes, which can occur when medicament are discontinued. the opposite should happen when patients are in regular therapy should not to have repeated acute episodes, should not be hospitalised, and should not have cognitive defict. since two years I'm measuring the cognitive level of patients with neuropsychological tests. I would like to compare the cognitive data with the clinical (also the different medicaments...) and social outcomes to see what happens. I'm very intrested to see the evolution of the cognitive levels.
best regards
tiberio
Thankyou Tiberio
The assumption that cognitive deficits are caused by acute episodes may not be accurate, What if the cognitive deficits unbalance the patient and cause the accute episodes, treatment might not be the complete answer. I will be glad to see the results of your work.
best regards
Graeme
I'm in the second year of record and I think the time is already too short to have valuable results. how do You measure cognitive deficit in psychosis and/or schizophrenia?
best regards
tiberio
That is an interesting question Tiberio
The short answer is that I don't, I have only my own experience to fall back on, and an idea of how a friends cognitive deficit affected her life.
A friend of mine, was being treated with resperidal and chose not to take the drug under the advisement of a few books that said that the drug was the problem, not the illness. She was doing all right until she got overstressed, and then had an accident involving a broken plant pot in her sink. She washed the soil down the drain, and plugged up the sewer for the whole building. It was while she was being evicted that she had a memory deficit and started hearing voices. She quite literally didn't remember washing the soil down the sink, and the plumbing problems were the result of bad management and she was being unfairly attacked by the management to the point that they were sending her annoying messages over the intercom system.
I think it was loss of memory that triggered the paranoia and hearing of voices, rather than the paranoia and hearing of voices that triggered the memory loss. But she was off her drugs and so either effect could be primary and the accute attack was seen as proof that she should be on drugs. She was unwilling to go back onto them. I have heard from her since, but she still seems somewhat unsettled.
The cognitive deficit that resulted in her blaming the management for a problem that she had created, was I think a direct result of a memory deficit that "forgot" her own culpability. Obviously someone else was at fault, and the active party was the building management which was faced with a difficult client but was otherwise working within the law as far as I can tell. Once the paranoia set in, it was only a matter of time until auditory halucinations joined in. It seems likely that the memory deficit caused the misattribution which was the cognitive deficit.
My Father was paranoid for a while during his senscence, he literally took a hammer to his computer to keep some unknown attacker from being able to break into the computer by creating new accounts in his name.
Again I think it was a memory deficit (they started treating him with aracept and his paranoia damped down) He was confused into opening multiple accounts on the same computer and then saw it as an attack by some hacker. Protective of his life collection of stories he attacked the computer to keep the hacker out. If I am correct a memory deficit is at the bottom of many paranoia episodes.
I have a model of Agency that explains why this might be so.
in essence there are three parts to the attribution of Agency.
1. A log of actions started which can be checked to be sure something was started by the self.
2. A Model of what the self would and would not do
3. a "Self Signal" that indicates that the above two are in agreement and that an action was taken by the self.
A failure of the Log, or the Model to adequately capture what a person would do, results in a reduction in the strength of the "Self Signal" which draws into question whether the action was taken by the self, or by another.
Paranoia is AFAIK essentially the missattribution of action to someone else, and the building of a fantasy as to why they did it.
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