title: Neurocognition, insight and medication nonadherence in schizophrenia: a structural equation modeling approach.
abstract: OBJECTIVE
  The aim of this study was to examine the complex relationships among neurocognition, insight and nonadherence in patients with schizophrenia.
  
  
  METHODS
  
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Diagnosis of schizophrenia according to the DSM-IV-TR criteria.
  
  
  METHODS
  Neurocognition was assessed using a global approach that addressed memory, attention, and executive functions; insight was analyzed using the multidimensional 'Scale to assess Unawareness of Mental Disorder;' and nonadherence was measured using the multidimensional 'Medication Adherence Rating Scale.'
  
  
  METHODS
  Structural equation modeling (SEM) was applied to examine the non-straightforward relationships among the following latent variables: neurocognition, 'awareness of positive symptoms' and 'negative symptoms', 'awareness of mental disorder' and nonadherence.
  
  
  RESULTS
  One hundred and sixty-nine patients were enrolled. The final testing model showed good fit, with normed χ(2) = 1.67, RMSEA = 0.063, CFI = 0.94, and SRMR = 0.092. The SEM revealed significant associations between (1) neurocognition and 'awareness of symptoms,' (2) 'awareness of symptoms' and 'awareness of mental disorder' and (3) 'awareness of mental disorder' and nonadherence, mainly in the 'attitude toward taking medication' dimension. In contrast, there were no significant links between neurocognition and nonadherence, neurocognition and 'awareness of mental disorder,' and 'awareness of symptoms' and nonadherence.
  
  
  CONCLUSIONS
  Our findings support the hypothesis that neurocognition influences 'awareness of symptoms,' which must be integrated into a higher level of insight (i.e., the 'awareness of mental disorder') to have an impact on nonadherence. These findings have important implications for the development of effective strategies to enhance medication adherence.
authors.affiliation: Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France. laurent.boyer@ap-hm.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Boyer
authors.forename: Michel
authors.initials: M
authors.lastname: Cermolacce
authors.forename: Daniel
authors.initials: D
authors.lastname: Dassa
authors.forename: Jessica
authors.initials: J
authors.lastname: Fernandez
authors.forename: Mohamed
authors.initials: M
authors.lastname: Boucekine
authors.forename: Raphaelle
authors.initials: R
authors.lastname: Richieri
authors.forename: Florence
authors.initials: F
authors.lastname: Vaillant
authors.forename: Remy
authors.initials: R
authors.lastname: Dumas
authors.forename: Pascal
authors.initials: P
authors.lastname: Auquier
authors.forename: Christophe
authors.initials: C
authors.lastname: Lancon
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology; D001364:Awareness / Q000502:physiology*; D003071:Cognition / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D008960:Models, Psychological; D010045:Outpatients / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000188:drug therapy / Q000503:physiopathology*; D012565:Schizophrenic Psychology; D055815:Young Adult