Assessing the relationship between insight and everyday executive deficits in schizophrenia: a pilot study

Past research has found that deficits in insight into illness are related to executive deficits in schizophrenia. This study further explores this relationship with the utilization of an ecologically-valid battery of executive tests. The study included 21 patients with schizophrenia who were administered the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and the first three items of the Scale to Assess Unawareness of Mental Disorder. Patients were found to be impaired on the BADS and most had insight into their illness. Lack of illness awareness was not significantly correlated with all of the BADS subtests with the exception of Rule Shift Cards, a measure of cognitive flexibility. The relationship between some measures of unawareness and Rule Shift Cards was still significant or approaching significance when the effects of IQ were partialled out. These findings add to previous research by demonstrating that cognitive flexibility, specifically involving the ability to shift set, is associated with awareness of illness in schizophrenia. On the other hand, it is proposed that most of the other BADS subtests are more complex and multifactorial, thereby making it difficult to find any associations that may exist between a specific subdimension of executive function and insight into illness.