title: Neurocognitive insight and objective cognitive functioning in schizophrenia.
abstract: Neurocognitive impairment is a core component of schizophrenia affecting everyday functioning; the extent to which individuals with schizophrenia show awareness of neurocognitive impairment (neurocognitive insight) is unclear. This study investigated neurocognitive insight and examined the cross-sectional relationships between neurocognitive insight and objective neurocognition and functional capacity performance in a large outpatient sample. 214 participants with schizophrenia-spectrum disorders completed measures of neurocognition, functional capacity, and self-reported neurocognitive problems. Latent profile analysis classified participants with regard to neuropsychological performance and self-report of neurocognitive problems. The resulting classes were then compared on executive functioning performance, functional capacity performance, and psychiatric symptom severity. More than three quarters of the sample demonstrated objective neurocognitive impairment (global deficit score≥0.50). Among the participants with neurocognitive impairment, 54% were classified as having "impaired" neurocognitive insight (i.e., reporting few neurocognitive problems despite having objective neurocognitive impairment). Participants with impaired vs. intact neurocognitive insight did not differ on executive functioning measures or measures of functional capacity or negative symptom severity, but those with intact neurocognitive insight reported higher levels of positive and depressive symptoms. A substantial portion of individuals with schizophrenia and objectively measured neurocognitive dysfunction appear unaware of their deficits. Patient self-report of neurocognitive problems, therefore, is not likely to reliably assess neurocognition. Difficulty self-identifying neurocognitive impairment appears to be unrelated to executive functioning, negative symptoms, and functional capacity. For those with intact neurocognitive insight, improving depressive and psychotic symptoms may be a valuable target to reduce illness burden.
authors.affiliation: SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, San Diego, CA 92120, USA. Electronic address: czburton@ucsd.edu.
authors.forename: Cynthia Z
authors.initials: CZ
authors.lastname: Burton
authors.affiliation: University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, 1120 NW 14th Street, Suite 1450, Miami, FL 33136, USA; Miami VA Healthcare System, Research Service, 1201 NW 16th Street, Miami, FL 33125, USA. Electronic address: philipdharvey1@cs.com.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Harvey
authors.affiliation: University of California, San Diego Department of Psychiatry, 9500 Gilman Drive, MC: 0603, La Jolla, CA 92093, USA. Electronic address: tpatterson@ucsd.edu.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.affiliation: University of California, San Diego Department of Psychiatry, 9500 Gilman Drive, MC: 0603, La Jolla, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161, USA. Electronic address: etwamley@ucsd.edu.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Twamley
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D021641:Recognition, Psychology / Q000502:physiology*; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology
keywords: Awareness; Cognition; Functional capacity; Psychosis
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