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Poor Insight in Schizophrenia: Neuropsychological and Defensive Aspects.

Kasapis C, Amador XF, Yale SA, Strauss D, Gorman JM.

Schizophrenia Research, 20:123,1996.

This paper reports on a replication of the Young et. al., study which implicated frontal lobe dysfunction in the etiology of poor insight in patients with schizophrenia. The study also investigated the extent to which defensiveness might play a role in such unawareness. The authors (XFA) had previously hypothesized that frontal lobe pathology may account for the severe forms of unawareness frequently seen in certain psychotic disorders. This study tested this hypothesis using the same neuropsychological tests and insight scale used by Young and his colleagues. Defensiveness was measured using the Balanced Inventory of Desirable Responding (BIDR). The results indicated that defensiveness was modestly correlated with only a handful of the different measures of poor insight. On the other hand, the neuropsychological test results were nearly identical to that of Young and colleagues, indicating that poor performance on tests of frontal function predicted poor insight independent of other cognitive functions tested including IQ. This independent replication adds further evidence in support of the idea that poor insight into illness and resulting treatment refusal stem from a mental defect rather than defensiveness or informed choice.

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