Lack of insight in schizophrenia is a key feature of the illness and is associated with both positive and negative clinical outcomes. Previous research supports that neurocognitive dysfunction is related to lack of insight, but studies have not examined how neurocognition relates to change in insight over time. Therefore, the current study sought to understand how performance on the Wisconsin Card Sorting Test (WCST) differed between participants with varying degrees of change in insight over a 6-month period. Fifty-two patients with schizophrenia or schizoaffective disorder were administered the WCST and Positive and Negative Syndrome Scale (PANSS) at baseline, and the PANSS was again administered at a 6-month follow-up assessment. Results indicated that while neurocognition was related to insight at baseline, it was not related to subsequent change in insight. The implications of findings for conceptualization and assessment of insight are discussed. 1. Introduction Lack of insight into one’s illness has been cited as common among people with psychotic disorders and in particular schizophrenia. Lack of insight can be manifested in the denial or lack of awareness of the presence or impact of symptoms or the need for treatment [1]. Those with schizophrenia have been found to have higher levels of impaired insight in comparison to other psychotic disorders [2–6], with some studies citing this as the most common clinical phenomenon linked with schizophrenia [7, 8]. From a broader perspective, lack of insight reflects not so much the absence of a single piece of knowledge but a failure to construct an adaptive narrative account of the challenges posed by having a psychiatric illness [9, 10]. Although not a diagnostic criterion, lack of insight has become an important topic in the schizophrenia literature due to its utility as a prognosis indicator [11, 12] and potential marker of a subtype of the illness [13]. A better understanding of the etiological correlates of insight could enhance treatment modalities [11], improve prevention, and elucidate the relationship between insight and other clinical symptoms [14]. A number of such associations have already been found, including correlations between poor insight and severity of psychopathology [4, 15, 16], increased number of hospitalizations [4, 15], violent behavior [17, 18], lower treatment adherence [4, 19, 20], and poor premorbid or present adjustment [21]. Despite recognition as an important concept within behavioral science, reaching consensus as to what constitutes insight has proved challenging.
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