Insight, symptoms, and neurocognition in schizophrenia and schizoaffective disorder.

There are conflicting reports in the literature regarding the relationships among impaired insight, symptoms, and neurocognition in schizophrenia. The inconsistent findings likely reflect the multidimensionality of insight in this population, along with variations in study design. We examined 46 individuals with chronic schizophrenia or schizoaffective disorder who were recently discharged from an inpatient unit. Insight was operationalized as awareness of having a mental disorder and awareness and attribution of both current and past symptoms. Positive, negative, disorganized, and depression symptoms were rated, and a neurocognition battery, including measures of visual processing, memory, visuo-spatial ability, and executive functions, was administered. Poor awareness of symptoms was moderately associated with core schizophrenia symptoms, and higher levels of depression were strongly associated with good awareness. Symptom misattribution, more so than symptom unawareness, was associated with deficits in frontal lobe functioning. Finally, different patterns of associations between symptoms, neurocognition, and insight were noted for current symptoms versus past symptoms. The data suggest that insight deficits in schizophrenia are multidimensional, and that investigators should pay careful attention to the choice of measures as well as to phase of illness characteristics in future studies.