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Dr. Strassnig:
This is CME on ReachMD, and I'm Dr. Martin Strassnig. Here with me today is Dr. Philip Harvey.
So let's jump right in, Phil. What is the true impact of CIS?
Dr. Harvey:
Well, cognitive impairment in schizophrenia leads to a number of challenges. What cognitive impairment does is it impairs the ability of people to perform critical functional skills. So, for example, cognitive impairments lead to challenges in the ability to perform activities associated with independence of living, like shopping or travel. It makes it difficult to perform work activities, and so if you’re having a hard time living independently and engaging in work-type activities, there's also a potential economic burden. So the challenge is that it's a multistep process, as well. The cognitive impairments, which originate directly from the illness, impact on people’s ability to perform critical functional skills.
And now the other issue that's involved, and we'll discuss this in another context, is the idea that motivation to perform skills is different from the ability to perform skills. So what we see here is that cognitive impairment impacts on people’s ability to engage in activities that the general population can commonly engage in. So the impact is personal in that it makes it very difficult for people to run their lives and be organized, getting to where they need to get to. It's financial because if you can't work full-time, it causes significant burden on you and your family members. So cognitive impairment is actually a more burdensome factor than the psychotic symptoms of the illness, and the indirect costs of cognitive impairment and disability and schizophrenia probably range from somewhere between 4 to 6 times as great as the direct cost of treating psychosis with medication, hospitalization, and doctor visits. So it's really important not to ignore the economic burden of cognitive impairment and to realize that disability originates from cognitive impairment and it's related to the intrinsic core of the illness, interfering with people’s ability to function from the very earliest stages of their illness over the course of their whole life.
Dr. Strassnig:
I agree. It is, in fact, a very costly illness when you think about it that way with cognition or cognitive impairments being a little bit of a bottleneck to recovery. You don't only get direct costs that is from hospitalizations, doctors’ visits, medications, and what not, but I think the impact on indirect costs is outsized. Right? So lost wages, I'm thinking of, reduced quality of life, decreased life expectancy, right? But also, caregiver costs, right? And it is estimated that, as you said, that those indirect costs are, you know, severalfold higher than the direct costs and they seem to not receive enough attention. Everybody says the healthcare system is expensive and healthcare is expensive and whatnot. The problem is, you know, there are these indirect costs that are not factored in usually when it comes to considering economic impact of schizophrenia and other chronic illnesses, by the way. So in the end, reducing those indirect costs might unlock huge, huge financial benefits. However, the question is how do you do that, right? And the answer obviously lies in treating cognitive symptoms in schizophrenia.
Well, this has been a great micro discussion. Our time is up. Thanks for listening.
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