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Insight in schizophrenia: Its relationship to frontal lobe function
Abstract
Previous research has suggested that insight may have considerable power in predicting the long-term course of chronic mental disorders and an impact on patient's compliance with treatment plans. Poor insight observed in schizophrenia is of diagnostic significance and is indispensable in guiding treatment decisions. Anosognosia in neurological disorders bears a striking resemblance to poor insight in schizophrenia. Although there has been a plethora of work in neurological disorders, there have been very few studies of the organic origin of anosognosia in schizophrenia. As with unawareness of illness in schizophrenia, anosognosia is most often distinguished from motivational denial in that it is thought to stem from a brain deficit that leaves patients unable to become aware of the signs of their illness. Lack of awareness of illness and it's specific symptoms among schizophrenics, has not been adequately studied in the context of neuropsychological function as they may both be expressions of a certain brain dysfunction. The mechanism responsible for both unawareness of deficits and poor performance in executive functions measures is likely to be some nervous system disease process that affects the frontal lobe. The purpose of this study is to investigate whether poor insight as measured by The Scale to Assess Unawareness of Mental Disorder is empirically associated with performance measures having a known association with frontal lobe functions in a group of stable chronic schizophrenic subjects. This is viewed as a first step in articulating a neuropsychological account of anosognosia in schizophrenia. If a relationship between neuropsychological measures and unawareness exists, this could be construed as an indirect disconfirmatory evidence for a defensive denial account of anosognosia in schizophrenia. The principal finding of the present study is that unawareness and misattribution of negative symptoms is significantly associated with deficits in some aspects of executive dysfunction even after the test of general intelligence had been partialled out from the executive cognitive measures. We conclude that anosognosia for negative symptoms is associated with frontal lobe dysfunction in individuals suffering from schizophrenia. This could be construed as indirect disconfirmatory evidence for a defensive denial account of anosognosia at least for negative symptoms. Unawareness of other symptoms (e.g., positive symptoms) may reflect dysfunction in a different area of the brain or it may reflect motivation to deceive oneself or others. Future research should investigate whether the cognitive functions tapped by neuropsychological measures have some causal role in producing anosognosia in schizophrenia. Implications for rehabilitative efforts are discussed.
Subject Area
Psychotherapy|Cognitive therapy
Recommended Citation
Mohamed, Somaia, "Insight in schizophrenia: Its relationship to frontal lobe function" (1997). ETD collection for University of Nebraska-Lincoln. AAI9805518.
https://digitalcommons.unl.edu/dissertations/AAI9805518