Insight in Schizophrenia: Its Relationship to Measures of Executive Functions

Abstract

Lack of awareness of specific symptoms among persons with schizophrenia has not been adequately studied in the context of neuropsychological function. The purpose of this study is to investigate whether poor insight as measured by the Scale to Assess Unawareness of Mental Disorder is empirically related to performance measures having a known association with executive functions in a group of individuals with chronic schizophrenia. The results showed that unawareness and misattribution of negative symptoms are significantly associated with deficits in some aspects of executive functioning even after a test of general intelligence had been partialed from the analyses. We conclude that unawareness of negative symptoms is associated with executive functioning in individuals with chronic schizophrenia. Unawareness of other symptoms (i.e., positive symptoms) may reflect dysfunction in other types of neuropsychological processes, or it may reflect motivation to deceive oneself or others.

Insight, Global Functioning and Psychopathology Amongst In-patient Clients with Schizophrenia

“…This is consistent with a number of earlier studies showing that lack of insight is not determined by neurocognitive disturbances; [19,39,45,47,54], suggesting therefore that insight and intellectual performance are somehow independent domains of psychopathology regarding schizophrenic symptomatology [45,47]. However, due to the lack of substantiated results focused on the relationship between insight and IQ, [6,27,43,55], it would seem that the relationship between clinical and cognitive domains may be too complex to be reduced to a single direct association [22,45,47,56]. Furthermore, confounding effects of length of illness over IQ and insight were not explored in all studies; given the complexity of the relationship between the two variables, additional empirical research in this area is warranted.…”

“…For instance, weak to modest relationships have been reported between insight and anxiety [23,39,40] or depressive symptomatology [32,41,42]. Finally, significant but weak to modest relationships have been found between insight and general cognitive functioning [19,23,43,44] although results appear inconsistent [45][46][47][48].…”

Exploratory Study of the Association Between Insight and Theory of Mind (Tom) in Stable Schizophrenia Patients

“…Además fueron comparables a los resultados obtenidos con muestras de similares característi-cas [35][36][37][38] . Por otra parte, las subescalas de conciencia y atribución, aunque parcialmente dependientes, no se correlacionaron entre ellas, corroborando la idea de que las dos subescalas están valorando fenómenos al menos parcialmente independientes.…”

“…Así, se ha observado que la conciencia evoluciona de forma diferenciada para ambos tipos de síntomas y que se correlacionan también de forma diferenciada con los déficit de funciones ejecutivas 36,43 .…”

Los trastornos cognitivos de la esquizofrenia

“…Desde un punto de vista clínico, se ha sugerido que las anormalidades de las funciones ejecutivas se asociarían con una pobre o reducida conciencia de enfermedad (36) . Sin embargo, varios estudios no han apoyado dicha asociación (37)(38)(39) y en otro estudio la asociación se presentaba en el caso de síntomas negativos pero no en los sínto-mas positivos (40) . Recientemente, un estudio logró establecer dos grupos de pacientes con esquizofrenia y pobre insight: uno con función ejecutiva anormal y otro grupo con función ejecutiva normal pero que usaba la negación como estrategia preferida de afrontamiento (41) .…”