LACK OF INSIGHT IN SCHIZOPHRENIA

A neuropsychological etiology has been suggested for lack of insight i n schizophrenia patients, mainly based on frontal, right parietal, rig ht hemisphere, or diffuse cerebral dysfunctions. The aim of this study was to investigate the neuropsychological pathogeny of lack of insigh t in schizophrenia patients. We examined a sample of 40 DSM-III-R schi zophrenia inpatients admitted because of a recrudescence of symptoms. Schizophrenic symptoms were evaluated through the Scale for the Assess ment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms. Neurologic explorations included an assessment of frontal n eurologic signs, abnormal involuntary movements, and soft neurologic s igns. Lack of insight was assessed through three items from the Manual for the Assessment and Documentation of Psychopathology (AMDP). A glo bal index from these three items (lack of feeling ill, lack of insight , and uncooperativeness) was obtained. A neuropsychological battery co mposed of tests involving many functional areas of the brain was used. No correlation between bad performance and lack of insight was found on any test. On the contrary, lack of insight was associated with bett er performance on immediate verbal, immediate visual, and delayed visu al memory tasks. Moreover, the three components of lack of insight wer e extracted as an independent factor when they were included together with the positive and negative symptoms, neurologic abnormalities (fro ntal and soft neurologic signs, and abnormal movements), and a global measure of cognitive performance. The results of the study do not supp ort the neuropsychological hypothesis of lack of insight. However, the se results are inconclusive because of inadequate statistical power. N onetheless, the absence of correlation between lack of insight and cog nitive disturbances and independence of lack of insight from the clini cal symptoms, neurologic signs, and cognitive disturbances suggest tha t lack of insight could be a primary symptom resulting directly from t he schizophrenic process.