Handbook Guides Families Through Cognitive Impairment

In recognition of the fact that cognitive dysfunction is a debilitative aspect of mental disorders, the New York State Office of Mental Health has released a handbook on this topic for family and friends of people with serious mental illness.

The handbook is titled Dealing With Cognitive Dysfunction Associated With Psychiatric Disabilities: A Handbook for Families and Friends of Individuals With Psychiatric Disorders.

Authors Alice Medalia, Ph.D., who is director of neuropsychology at Montefiore Medical Center in the Bronx, N.Y., and Nadine Revheim, Ph.D., a research psychologist at the Nathan Kline Institute in Orangeburg, N.Y., tailored the content of the 34-page handbook to families and friends of people who have cognitive problems as a result of mental illness.

The authors begin by correcting commonly held misconceptions about cognitive impairment in this population. For example, many people related to a person with schizophrenia, depression, or bipolar disorder don’t realize that the cognitive difficulties experienced by this person are primary symptoms of the mental disorder and are not secondary to symptoms such as psychosis or unstable mood. They also may not realize that cognitive problems do not end when hallucinations and delusions stop.

Medalia and Revheim strive to teach families how to recognize the signs of cognitive dysfunction, which can affect their family member in just about all aspects of his or her life—in the community, at work, at school, and in relationships with others.

On the job, a person with mental illness may have a difficult time keeping up with the workload because he or she lacks critical thinking or problem-solving skills. In relationships, this person’s ability to listen and pay attention to others may be impaired by the mental illness.

The handbook also delves into common treatment strategies for people experiencing cognitive problems. Just as hallucinations and mood instability can be alleviated with psychotropic medications, clinicians have at their disposal three techniques to target cognitive dysfunction in people with mental illness: remediation techniques, compensatory strategies, and adaptive approaches.

Cognitive remediation techniques seek to build problem-solving skills or attention through specific drills using computer software or paper and pencil. Compensatory strategies use alternative approaches to reach a cognitive goal such as memorizing a grocery list by, for example, sorting the list into food categories. In an adaptive approach, a person might record a grocery list on a cassette recorder and replay it while at the store.

So that family and friends can help a loved one with mental illness understand his or her learning style—and thereby determine the ways in which a person learns most easily—the handbook includes a learning-style checklist.

There are also guidelines for family members to help loved ones with memory and attention problems, for instance, and difficulties with critical thinking.

Toward the end of the handbook, there is a list of resources for families including agencies that offer cognitive remediation strategies, literature on cognitive dysfunction in people with mental illness, and information about educational software.

Copies of the handbook can be obtained by contacting Rami Kaminski, M.D., or Joan Shanebrook, A.C.S.W., at the New York State Office of Mental Health at (518) 474-4888. ▪