Cognitive Dysfunction: A Personal Journey Through Mental Health Challenges

Cognitive function decline issues

Since I experienced severe insomnia at the age of 16, I have struggled to pay attention in class and have found it difficult to concentrate and think clearly.
Even when I am well-rested, I still face the same issues.
Subjects like math suddenly seem very difficult, and I often feel confused by bus routes and other forms of public transportation, requiring others to guide me.
At 18, I consulted a psychiatrist and underwent a psychological evaluation, which indicated that my intelligence is normal.
This was puzzling because I frequently find it hard to keep up with conversations, especially when the information is complex or dense.

At 19, a doctor suggested that I might be in the early stages of schizophrenia, but even now at 23, I have not experienced hallucinations or delusions.
Between the ages of 19 and 23, other doctors have considered that my difficulties with concentration might be related to depression, although my depressive symptoms are not very pronounced.
I have been taking 10 mg of Methylphenidate daily, but my ability to think critically has not improved.
Recently, a physician suggested that my issues might stem from anxiety, and I have been taking a combination of Lurasidone and Divalproex to enhance the medication's efficacy for over a month.
While I feel somewhat less anxious, my cognitive function has not improved.
I have also tried to train my thinking skills, but it seems that once I learn something, I still struggle to learn new concepts at a reasonable pace, indicating a lack of training effectiveness.
I am curious about what this situation might be and whether it is uncommon in psychiatry.
Because of these challenges, I have been unable to attend university and can only manage simple jobs, which I often do not perform well in, making life feel very difficult.
I hope the doctor can seriously address my concerns.
What treatment options do you suggest, or what are your thoughts on my situation?

Chen Yuren, 20~29 year old female. Ask Date: 2021/09/18

Dr. Xue Gengming reply Psychiatry

It is advisable for you to discuss the above situation further with your attending physician.
Thank you, and wishing you good health!

Reply Date: 2021/09/18

More Info

Understanding cognitive dysfunction, especially in the context of mental health challenges, can be a complex and often frustrating journey. Your experience, starting from severe insomnia at age 16, leading to difficulties in concentration and understanding, is not uncommon among individuals facing mental health issues. It’s important to recognize that cognitive dysfunction can manifest in various ways, and it often intertwines with emotional states such as anxiety and depression.

From what you've described, it seems that your cognitive difficulties have persisted despite having normal intelligence test results. This discrepancy can be perplexing, and it's essential to understand that cognitive dysfunction is not solely determined by intelligence. Factors such as anxiety, depression, and even sleep disturbances can significantly impact cognitive functions like attention, memory, and processing speed.
The progression of your symptoms, from difficulties in concentration to the consideration of early-stage schizophrenia, indicates a need for a thorough evaluation of your mental health. While you have not experienced hallucinations or delusions, the cognitive symptoms you describe could be linked to several underlying issues, including anxiety disorders, depressive disorders, or even a form of cognitive impairment that may not fit neatly into a specific diagnostic category.

The fact that you have been prescribed medications such as Methylphenidate (敏特思) and combinations of other medications like Lurasidone (立普能) and Aripiprazole (帝帕克) suggests that your healthcare providers are attempting to address both your cognitive and emotional symptoms. However, it’s crucial to remember that medication alone may not resolve cognitive dysfunction. Cognitive-behavioral therapy (CBT) and other forms of psychotherapy can be beneficial in addressing the underlying anxiety and depression that may be contributing to your cognitive difficulties.

Here are some suggestions that may help you navigate your situation:
1. Continued Medication Management: It’s essential to maintain open communication with your psychiatrist about the effectiveness of your current medications. If you feel that your cognitive symptoms are not improving, discuss this with your doctor. They may consider adjusting your medication regimen or exploring alternative treatments.

2. Cognitive Behavioral Therapy (CBT): Engaging in therapy can provide you with tools to manage anxiety and improve cognitive function. CBT focuses on changing negative thought patterns and behaviors, which can help alleviate some of the cognitive burdens you are experiencing.

3. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, yoga, or deep-breathing exercises can help reduce anxiety and improve focus. These techniques can create a more conducive mental environment for learning and processing information.

4. Structured Learning Approaches: Since you mentioned difficulties in learning new information, consider using structured learning techniques. Breaking down information into smaller, manageable chunks and using visual aids can enhance understanding and retention.

5. Support Groups: Connecting with others who have similar experiences can provide emotional support and practical strategies for coping with cognitive dysfunction. Look for local or online support groups focused on mental health challenges.

6. Healthy Lifestyle Choices: Regular physical activity, a balanced diet, and adequate sleep are crucial for overall mental health. These factors can significantly influence cognitive function and emotional well-being.

7. Patience and Self-Compassion: It’s vital to be patient with yourself as you navigate these challenges. Cognitive recovery can take time, and self-compassion can help alleviate some of the pressure you may feel.

In summary, your situation is not uncommon, and while it may feel isolating, many individuals face similar challenges. The interplay between cognitive dysfunction and mental health is complex, and it often requires a multifaceted approach to treatment. By continuing to seek help, exploring therapy options, and making lifestyle adjustments, you can work towards improving your cognitive function and overall quality of life. Remember, you are not alone in this journey, and there is hope for improvement with the right support and strategies.

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