A Case Study of Clozapine and Cognition: Friend or Foe?

27 Mar 2018

Cognitive dysfunction is a hallmark feature of schizophrenia, often presenting in patients with psychotic disorders since the first episode (1) or earlier (2). Antipsychotic medication is effective for treating the positive symptoms of psychosis, but their potential for therapeutic effects on cognition continues to divide researchers (3). Acute psychotic symptoms impair several cognitive domains, and medication (or lack of) in turn impacts the degree of psychosis. Improvements in clinical symptoms can occur independently of cognitive functioning, whereby typical antipsychotics improve different clinical domains, but have little or no efficacy for improving primary cognitive functions. However, it has been suggested that the second-generation antipsychotic clozapine can improve cognition in schizophrenia (4, 5). Unusual cases, such as remitted patients who decide to stop taking clozapine, thus represent a unique opportunity to understand the effect of antipsychotic medication on cognition, as described in the case study below.