Neurocognitive insight, treatment utilization, and cognitive training outcomes in schizophrenia

The degree to which people with schizophrenia show awareness of cognitive dysfunction and whether this neurocognitive insight affects treatment use or outcome is understudied. We aimed to examine neurocognitive insight among a treatment-seeking sample of patients with psychotic disorders, and whether neurocognitive insight affected treatment utilization or outcome.

69 individuals with schizophrenia-spectrum disorders enrolled in a trial comparing Compensatory Cognitive Training (CCT) to standard pharmacotherapy. Participants with objective cognitive impairment were identified and grouped into "intact" vs. "impaired" neurocognitive insight groups. These groups were then compared via ANCOVA on three treatment utilization variables and six post-treatment cognitive/functional variables.

43 participants demonstrated objective cognitive impairment. Among those individuals, 31 were considered to have intact neurocognitive insight and 12 showed impaired neurocognitive insight. These two groups did not differ on CCT attendance, satisfaction with the intervention, or self-reported cognitive strategy use at post-treatment. There were significant treatment group by neurocognitive insight group interactions for verbal memory and functional capacity outcomes, such that individuals with impaired neurocognitive insight who received treatment performed better than those who did not receive treatment.

Even among individuals who self-select into a cognitive treatment study, many show minimal awareness of cognitive dysfunction. Impaired neurocognitive insight, however, was not associated with decreased treatment utilization, and was associated with positive treatment outcomes in some cognitive domains as well as functional capacity. As cognitive training treatments become increasingly available, impaired neurocognitive insight need not be a barrier to participation.