Introduction: Cognition, Rarely Discussed

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Cognition has historically been the Rodney Dangerfield of psychiatry-it got no respect. Yet mental illness results from neuronal activity in the brain, which is a heavily interconnected processing entity. Furthermore, biological therapies found to be effective in treating mental illness cross the blood-brain barrier and alter chemo-electrical activity. This alters function not only in neural networks involved in the disease process, but also other unaffected networks-resulting in adverse effects.

Psychiatrists traditionally warn patients about effects on attention, alertness, and motor function. Rarely, if ever, do we discuss in detail any negative effects on cognition. The only notable exception to this oversight involves the effects of ECT on memory. Discussions of the risks and benefits of ECT always include some mention of effects on memory. Even here, though, we tend to understate the impact.

Psychiatrists traditionally warn patients about effects on attention, alertness, and motor function. Rarely, if ever, do we discuss in detail any negative effects on cognition.

Kitty Dukakis co-authored an elegant book, Shock: The Healing Power of Electroconvulsive Therapy, which chronicles her very successful experience with ECT. In 2006, Mrs. Dukakis visited our hospital to speak on the subject. She shared with me her frustration with the memory impairments she encounters with her maintenance therapy. While she was informed of this, she did not feel that the description remotely resembled the actual personal experience. She went on to share the experience of another ECT patient:

Her ECT was a triumph and a miscarriage. The treatment was able “to break the stranglehold of a seemingly intractable and severe depression.” It saved her mental health and her very life. But it sliced into the life she had lived starting a full 6 years before her ECT. Memories from the year before treatment have not come back at all, those from 2 to 4 years before are hit-and-miss. [She] is philosophical about the trade-off, comparing herself to a “cancer victim who must choose the horrible side effects of chemotherapy over certain death from the disease.”

The purpose of this Special Report on cognition and cognitive disorders is to raise the consciousness of mental health clinicians to less obvious, but important, effects that illness and treatment have on cognition. It is my hope that more research will be done to delineate specific cognitive effects of psychiatric disorders and cognitive adverse effects of different treatments. With this knowledge, we can strengthen our partnership with patients in shared decision-making and make further advancements in quality of life for people with mental illness.

In this Special Report

Let's Talk About Cognition

Cognitive Enhancers in Children and Adolescents

Lithium Therapy, Bipolar Disorder

Disclosures:

Dr. Campbell is Director Inpatient Psychiatry, Maine Medical Center, Portland, ME. He reports no conflicts of interest concerning the subject matter of this Special Report.