Patterns of neurocognitive deficits and unawareness of illness in schizophrenia

It has been alternately theorized that poor insight in patients with schizophrenia results from deficits in executive function and a preference for denial as a coping strategy. One possibility is there are two distinct groups of persons with poor insight: those with impairments in executive function and those with a generally avoidant coping style. To examine this question, the authors performed a cluster analysis on 64 persons with schizophrenia spectrum disorders on the basis of the PANSS insight and judgment item and executive function assessed with the Wisconsin Card Sorting Test. As predicted, three groups were found: good insight-average executive function (N = 28), poor insight-average executive function (N = 13), and poor insight-poor executive function (N = 23). When self-reported coping styles were compared among groups, as predicted, the poor insight-average executive function group endorsed a significantly greater preference for denial as a coping strategy than the poor insight-poor executive function group, even after controlling for differences in executive function. The coping scores of the good insight group did not differ significantly from either poor insight group. Results suggest that denial may play a role in the unawareness of illness in some persons with schizophrenia who have average executive function.