Missing the sweet spot disengagement in schizophrenia.
The extent to which an individual engages in a cognitive task is associated with performance in laboratory settings(1) and a variety of domains of functioning, such as athletic activity and artistic expression.(2) The neural circuitry associated with task engagement is in the process of being elucidated by cognitive neuroscience investigations. These newly acquired data provide an opportunity to understand the cognitive, social, and functional disabilities that lie at the core of dysfunction in patients with schizophrenia. This article describes the importance of task engagement in human functioning, its impairment in schizophrenia, and the possibility that disengagement during late adolescence may herald future development of schizophrenia.(3,4) Since treatment studies suggest that improvement in this aspect of cognitive functioning has the potential to improve the functioning of patients with schizophrenia in various domains, it is possible that these improvements may be mediated by improved engagement with external processes, including social processes and patient-clinician relationships, leading to improved therapeutic alliance and increased treatment adherence.
Dr. Keefe is Associate Professor of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
Richard S E
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Keefe