Cognitive, negative, and positive are the three types of schizophrenia symptoms. Cognitive symptoms affect how you think and remember.

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Negative symptoms represent a decrease in something, such as reduced energy or social withdrawal. Positive symptoms are those that are new or increased experiences, like delusions or hearing voices.

Doctors also recognize cognitive symptoms as a third category. Any symptom that affects your thought process is included in this category.

Schizophrenia is chronic and lifelong, but treatable. The earlier treatment is started, the easier it is to manage symptoms.

Doctors identify cognitive symptoms of schizophrenia using neurocognitive tests, which are tests to identify your capabilities across different areas of mental functioning.

Examples of cognitive symptoms of schizophrenia include:

  • processing speed
  • working memory
  • attention and vigilance
  • verbal learning
  • reasoning and problem solving
  • social cognition

The cognitive symptoms of schizophrenia are usually present at the first onset of psychosis, so they’re not a side effect of antipsychotic medication.

The cognitive symptoms of schizophrenia may, in part, be related to changes in the brain. Research, including a 2021 study, shows that people with schizophrenia have reduced cortical thickness, which may contribute to changes in thinking and memory.

The cortex is the outer surface of your brain, with gray matter on the outside and white matter underneath. Gray and white matter support cognitive functions like attention, memory, and language.

A 2019 study reported that people with schizophrenia had less brain matter in several areas, including gray matter in the cortex, than people without schizophrenia.

Some people with schizophrenia don’t experience changes in cognitive domains. A 2011 study showed that the people with no cognitive symptoms had a brain cortex similar to people without schizophrenia.

The rate at which you receive, assess, and respond to new information is called your processing speed. This cognitive quality impacts how quickly you think, learn, and respond to your environment.

The volume of white matter in the brain affects processing speed. White matter contains nerve cell axons, which transmit signals through brain cells.

Axons are covered with a substance called myelin, which helps to speed up the transmission of signals. Schizophrenia is associated with disruptions in myelin, resulting in less white matter and a slower processing speed.

If you have slow processing speed, you may need extra time to respond to questions. You might feel overwhelmed with too much information at once, and you might need instructions or information repeated.

Working memory is the information you retain to complete an immediate task. Examples of what you might hold in your working memory include:

  • multistep instructions
  • a short shopping list
  • a new phone number you don’t already have memorized
  • mental math

Impaired working memory is a common characteristic of schizophrenia. It’s linked to lower levels of activity in an area of the brain called the prefrontal cortex.

If you have trouble repeating something you’ve just heard or remembering directions, this might indicate difficulties with your working memory.

Attention and vigilance both mean to focus on something. With attention, you focus on a task or something that is happening, whereas vigilance means to focus on watching for something that might happen.

If you have schizophrenia, you may have reduced attention and vigilance ability regardless of whether you’re experiencing psychosis.

Verbal learning is based on verbal elements like:

  • words
  • syllables
  • letters
  • digits

A verbal learner is someone who remembers what they’ve heard and read, and who expresses themselves well using language.

A 2018 review of 17 studies linked immediate and delayed verbal learning to reductions in the volume of the brain region called the hippocampus — a key area for memory. Dysfunction in this area, resulting in reduced verbal learning, is one of the cognitive symptoms of schizophrenia.

In addition, a 2000 study shows that decreases in brain activity — specifically in the prefrontal cortex — is associated with verbal memory abilities.

Executive functioning includes higher level cognitive abilities like reasoning and problem solving, a complex skill with multiple steps. To solve a problem you must first identify and analyze it, and ultimately find a solution.

Reasoning stems from perception. A person with schizophrenia who experiences psychosis may have trouble identifying the truth from their hallucinations and delusions. This makes it difficult to perform reasoning tasks.

When we interact with people, our brains process and store information about them. We then use this information to understand others and to decide how to interact with them. This is called social cognition.

For example, social cognition is how we understand another person’s beliefs and attitudes about us and the world. It’s also how we let others know about our emotions, and how we communicate our emotions to others.

Social cognitive impairment can cause issues with daily functioning. If you have schizophrenia, you may have difficulties in social cognition areas that make it difficult to interact with others, like:

  • regulating your emotions
  • understanding the feelings of others, known as mentalizing
  • noticing emotions and social signals in other people’s faces and voices

Schizophrenia is a complex condition with treatments that aim to help with positive, negative, and cognitive symptoms.

Medication and therapy are common treatment strategies. For cognitive symptoms, executive function training may also help, though it usually takes several months to take effect.


Unlike the positive and negative symptoms, the cognitive symptoms of schizophrenia are less responsive to antipsychotic medications.

However, some newer antipsychotic medications may be helpful in treating the cognitive impairment caused by schizophrenia. These include:

  • Paliperidrone
  • Lurasidone
  • Aripiprazole
  • Ziprasidone
  • BL-1020

Research is ongoing, with other medications emerging as potential cognitive symptom treatments. These include:

  • Varenicline
  • Encenicline
  • D-serine
  • Sodium benzoate
  • L-carnosine
  • Raloxifene

Sex differences exist in schizophrenia, with males developing the condition younger than females. 2017 research suggests that estrogen might have a neuroprotective (brain-based) effect against cognitive symptoms.


Cognitive enhancement therapy

Cognitive enhancement therapy (CET) works toward the goal of improving the functioning of the prefrontal brain. This is one of the areas that causes cognitive symptoms because of reduced function.

A small 18-month randomized trial showed improvements to the prefrontal cortex, limbic, and striatal brain regions in participants with schizophrenia who underwent CET.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is effective for supporting people with many mental health issues. Your therapist helps you identify thoughts and patterns of thought that lead to distress and counterproductive behavior. You then work with your therapist to reshape those thoughts into those that create a positive and proactive mindset.

Social cognitive training

Many people with schizophrenia report a need for more social interaction. Social cognitive training aims to improve social cognition and social abilities in people with schizophrenia.

This therapy helps you understand and perceive the emotions of others, figure out social situations, and then helps you put this into practice.

Family support and education

With support and education, family members and caregivers are better equipped to navigate the landscape of a schizophrenia diagnosis. Learning to recognize symptoms, combined with strategies that are proven to help, can reduce the stress of managing schizophrenia.

Schizophrenia is a serious and complex condition, but there is treatment and support available.

If you or someone you know is newly diagnosed and is looking for a treatment facility, the Substance Abuse and Mental Health Services Administration (SAMHSA) has a treatment locator directory and a behavioral health services locator you can try.

SAMHSA also has a national helpline at 800-662-HELP (4357).

The Schizophrenia and Psychosis Action Alliance has a support group finder tool where you can join a group via conference call or in person.

The National Suicide Prevention Lifeline at 800-273-8255 is available 24/7 with free confidential support for anyone in distress. Text HOME to 741741 to reach the Crisis Text Line where you can speak to a crisis counselor 24/7.