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What is learning? 

Learning is the ability to acquire, or change, existing knowledge, behaviours or skills. There are two distinct forms of learning: explicit (or declarative) learning occurs during a high level of consciousness regarding specific learnt content, for example, memorising information for an exam. Implicit (or procedural) learning is less conscious and refers to learning which is gained from task performance, for example, juggling. Explicit verbal learning can be measured with the Hopkins Verbal Learning test, the California Verbal Learning test and verbal list-learning. The Brief Visuospatial memory test, the Rey design learning test, the Rey complex figure test, and visual reproduction all measure explicit visual learning. Implicit learning can be measured using the Serial Reaction Time task where learning is inferred from reduced reaction time to stimuli.

What is the evidence for learning?

Compared to people without schizophrenia, moderate to high quality evidence suggests a medium to large effect of poor performance in people with schizophrenia in verbal learning cued and free recall, verbal memory span, verbal paired associate learning, verbal recognition, and Serial Reaction Time. Compared to people with affective psychosis (e.g. bipolar disorder), high quality evidence shows a small effect of poor performance in people with schizophrenia on the California Verbal Learning Test total free recall subscale, but not on the long delayed free recall or recognition hits subscales.

High quality evidence suggests a small to medium-sized association between more severe negative or disorganised symptoms and poor visual and verbal learning. In general, moderate to high quality evidence suggests greater improvements in explicit learning but not implicit learning in people with schizophrenia taking second generation antipsychotics compared to people taking first generation antipsychotics. Specifically, people taking second generation olanzapine, clozapine or risperidone, or first generation haloperidol, show improvements, but patients receiving second generation quetiapine show no improvements in learning.

High quality evidence shows better community functioning, social behaviour and problem solving ability are associated with better verbal learning, while lower work capacity is associated with poor verbal learning. There is a small effect of better verbal learning and memory in people with a psychotic disorder and a substance use disorder than in people with a psychotic disorder and no substance use disorder.Moderate quality evidence suggests small to medium-sized effects of poorer visual learning in people at clinical high risk for psychosis who transitioned to psychosis compared to people at clinical high risk for psychosis who did not transition to psychosis, with no differences in verbal learning.


April 2016

Page last updated: 4:35  6 September 2017

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