Self-awareness of cognitive functioning in schizophrenia

Poor awareness of psychiatric symptoms is associated with schizophrenia. It is unclear whether this lack of insight extends to the cognitive impairment that affects at least 85% of people with schizophrenia. Given the increasing efforts to develop treatments for cognitive impairment, and the link between awareness of disability and treatment compliance, it is important to understand whether people with schizophrenia have awareness of their cognitive deficits. Ratings of cognitive functioning from 185 outpatients diagnosed with schizophrenia, their clinicians' ratings and objective neuropsychological test results were compared in the following cognitive domains: attention, nonverbal memory, and verbal memory. The results indicated that there was poor concordance among the three assessments. Patients did not agree with their clinician's assessments and did a very poor job of accurately classifying their cognitive status. However, clinicians were also poor at classifying cognitive status consistent with neuropsychological test results. The implications of these findings for understanding insight in schizophrenia are discussed.