Abstract
Cognitive impairments are present in patients with severe mental illness (SMI) at the time of the first psychotic episode. People with schizophrenia are more impaired across the lifespan compared to bipolar patients or patients with major depression. Although schizophrenia patients appear to generally function on a lower level than bipolar patients, the functional correlates of cognitive impairment are similar. There is much less research on cognition and its functional impact in depression, with the depression literature largely focusing on the impact of symptoms and only some recent studies examining cognition and functional capacity. Complicating both bipolar and major depressive disorders is the influence of mood states on cognition. Moreover, patients with SMI are often medically compromised, with higher rates of obesity and related comorbidities as well as poor lifestyles, which add further cognitive and functional implications. Cognitive impairments are known determinants of disability in SMI and a rate-limiting step in recovering from mental illness. Treatment options are reviewed in this chapter, and potential ways forward are discussed.