Do people with schizophrenia who have objective cognitive impairment identify cognitive deficits on a self report measure?

Individuals diagnosed with schizophrenia spectrum disorders have significant neuropsychological deficits that have been linked to poor functional outcome. As more treatments are developed and implemented for cognitive impairments, it will be important to consider whether people with schizophrenia have insight into the neuropsychological symptoms of their illness. Just as insight into psychotic symptoms plays a significant role in treatment compliance, it is likely that insight into neuro-cognitive dysfunction will be associated with compliance with cognitive remediation or cognitive enhancing medications. The objective of this study was to evaluate self reported awareness of cognitive deficit in schizophrenia using the MIC-SR, a new scale, and to compare self report of cognitive deficit with actual neuropsychological performance, and with the MIC-SR performance of Healthy Controls. Patients with schizophrenia reported significantly more cognitive problems as occurring "Almost Daily" than did Healthy Controls. However, Patients were most likely to respond that a cognitive problem "Never" occurred, whereas Healthy Controls most often responded "Once a Week or Less". The Total Score on the MIC-SR did not prove useful in differentiating Healthy Controls from Patients. About one quarter of the cognitively impaired patients with schizophrenia showed no awareness of cognitive deficit on the MIC-SR. This suggests that clinicians must use self report judiciously as an indicator of actual cognitive impairment. The MIC-SR captures a range of awareness of cognitive difficulty. The data indicates that there are many patients who would benefit from psycho-education about the impact of schizophrenia on neuro-cognition.