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What is learning in schizophrenia? 

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 found medium to large effects of poorer verbal learning, verbal memory, verbal paired associate learning, verbal recognition, and Serial Reaction Time performance in people with schizophrenia. There were small to medium-sized associations between more severe negative and disorganised symptoms and poorer visual and verbal learning.

Compared to people with bipolar disorder, moderate to high quality evidence found medium-sized effects suggesting people with schizophrenia show impaired performance on verbal and visual learning tasks. There was a medium-sized effect suggesting people with schizoaffective disorder also show impaired performance on verbal learning tasks compared to people with bipolar disorder. Small effects suggest people with schizophrenia show impaired performance on verbal and visuospatial learning tasks compared to people with schizoaffective disorder.

Overall, moderate to high quality evidence found greater improvements in explicit learning, but not implicit learning, with second-generation antipsychotics than with first-generation antipsychotics. Specifically, treatment with second-generation olanzapine, clozapine and risperidone, and first-generation haloperidol, result in improvements in explicit learning. There were small associations between better verbal learning and better community functioning, social behaviour, social skills, and problem-solving. Moderate to low quality evidence found better verbal learning is also associated with better work capacity.

In people at clinical high-risk of psychosis, moderate to high quality evidence found medium-sized effects of poorer verbal and visual learning compared to controls. Moderate quality evidence found small to medium-sized effects of poorer visual learning, with no differences in verbal learning, in people at clinical high-risk of psychosis who transitioned to psychosis compared to people at clinical high-risk of psychosis who did not transition to psychosis.

High quality evidence found a small impairment in learning in smokers vs. non-smokers with schizophrenia.  Moderate to high quality evidence found 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.

March 2022

Image: ©Julien Eichinger – stock.adobe.com

Last updated at: 11:22 am, 29th March 2022
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