Awareness and unawareness of thought disorder

Objective: There is little systematic evidence to determine if patients wit h thought disorder are aware of their impaired communication. Awareness ver sus unawareness of deficit has important implications for neurocognitive mo dels of thought disorder, The aims of this study were to assess awareness o f impaired communication in patients prone to thought disorder, and to expl ore associations between degree of awareness of thought disorder, objective measurement of thought disorder and performance on tests sensitive to impa ired executive ability. Method: Thirty-one patients with schizophrenia, 16 patients with mania and 20 well controls were included. Subjects completed a new instrument to asse ss awareness of thought disorder, the Communication Awareness Scale (CAS). Thought disorder was rated from free speech samples scored with Andreasen's Scale for the Assessment of Thought Language and Communication. Four tests sensitive to impaired executive ability were administered. Results: Subjects with higher levels of positive thought disorder had signi ficantly higher CAS scores. Unexpectedly, those with lower scores on execut ive ability had significantly higher scores on the GAS. Conclusions: The significant correlation between objective levels of positi ve thought disorder and higher scores on the CAS suggests that, overall, pa tients with thought disorder are aware of their deficit. A neurocognitive m odel of thought disorder is described that involves a dissociation between the ability to monitor errors (required for accurate awareness of deficit) and the ability to correct errors (required for the production of efficient communication).