Awareness of cognitive dysfunction in patients with schizophrenia

Abstract

Insight into illness, which has traditionally referred to knowledge and understanding of one's psychotic symptoms, has been found to be poor among individuals with schizophrenia. Less is known about insight into the neuropsychological deficits, which are associated with schizophrenia. Evidence suggests that neuropsychological performance is linked to functional outcome and treatment regimens are currently being created to address these cognitive deficits. Awareness is an important factor in treatment compliance and treatment outcome, however, it is not known if patients are aware of their cognitive dysfunction. In order to assess insight into cognitive dysfunction, as distinct from insight into psychotic symptoms, 75 subjects were administered the PANSS (Positive and Negative Syndrome Scale) to assess symptom severity, the SUMD (Scale to assess Unawareness of Mental Disorder) and the IS (Insight Scale) to examine insight into illness and the MIC-CR (Measure of Insight into Cognition - Clinician Rated) and the MIC-SR (Measure of Insight into Cognition - Self Report), two novel measures, to assesses awareness of cognitive impairment. Subjects were also administered the BACS (Brief Assessment of Cognition in Schizophrenia) and ILS-PS (Independent Living Scale - Problem Solving) to objectively assess neuropsychological status. The WRAT-3 (Wide Range Achievement Test - Third Edition) reading subtest and the vocabulary subtest from the WAIS-III (Wechsler Adult Intelligence Scale - 3rd Edition) were administered to assess premorbid status. Results demonstrated that virtually all subjects had cognitive impairment, yet insight into their cognitive symptoms was poor. Demographic variables, symptom severity, functional and neuropsychological status did not appear to influence awareness of cognitive deficits. Subjects demonstrated greater insight into their psychotic symptoms than cognitive symptoms (t(74)=10.20, p<0.001).