Original article Dissociating self-reported cognitive complaint from clinical insight in schizophrenia Sophie Bayard a, * , Delphine Capdevielle b,c , Jean-Philippe Boulenger b,c , Ste ´phane Raffard b,c,d a Sleep Disorder Unit, University Department of Neurology, University of Montpellier 1, 34295 Montpellier, Cedex 5, France b University Department of adult Psychiatry, University of Montpellier 1, Montpellier, France c INSERM U-888, Montpellier, France d University Department of Clinical Psychology and Neuropsychology, EA 4210, University of Montpellier 3, France Received 24 July 2008; received in revised form 30 November 2008; accepted 27 December 2008 Abstract Whereas new pharmacological treatments are developed for cognitive impairments in schizophrenia, self-assessment of cognitive dys- functioning besides their objective validity could be of interest in evaluating patients’ motivation to engage in rehabilitation program. Never- theless insight into symptoms is severely impaired in schizophrenia and is negatively linked with poor compliance. But it is yet unknown if patients with poor insight into their symptoms could have some insight into their cognitive impairments. The aim of this study was to explore the relationships existing between the cognitive complaint and the level of awareness of the disease in patients with schizophrenia. A total of 101 patients with DSM-IV schizophrenia or schizoaffective disorder and 60 control participants were recruited. Insight was assessed using the Scale to assess Unawareness of Mental Disorder (SUMD) and cognitive complaint intensity was assessed with the Scale to Investigate Cognition in Schizophrenia (SSTICS). Participants with schizophrenia displayed the same level of cognitive complaint when compared to healthy controls. Strong correlations were observed between SSTICS total score and duration of illness, levels of depression and state anxiety. Patients with a good insight into the therapeutic effects achieved with medication expressed a more important cognitive complaint. No correlations were found between the four others SUMD insight dimensions and total SSTICS score. The partial overlap of insight into illness and cognitive complaint suggests that insight is modular in schizophrenia. Assessment of cognitive complaint and awareness of illness need to be assessed before engagement in rehabilitation program. Ó 2009 Elsevier Masson SAS. All rights reserved. Keywords: Schizophrenia; Insight; Cognitive complaint; Scale to Investigate Cognition in Schizophrenia; Scale to assess Unawareness of Mental Disorder 1. Introduction The MATRICS neurocognition committee has recently proposed a consensus cognitive battery for assessing cognitive change in clinical trials of cognition-enhancing drugs for schizophrenia [21,35]. Despite cognitive impairments are a core feature of the disease (for review [42]) no drugs have been approved or have given evidence to be effective cogni- tion-enhancing agents [24,35,47]. Furthermore it seems reasonable to claim that it is also important that patients perceived the pharmacological treatment as effective [47]. It has been showed in several studies that perception of cognitive impairments is a common subjective experience in schizo- phrenia even if cognitive self-reports appears to be inconsis- tent with objective cognitive results [30,31,40]. If objective cognitive testing is an important predictor of the course of schizophrenia, assessment of subjective illness perceptions may be useful in predicting treatment compliance and thera- peutic alliance [20] especially in mental disorder with a high risk of relapses [26,43]. Surprisingly, very few tools have been designed to systematically collect the subjective experiences of patients with schizophrenia [37,48]. More specifically, little attention has been paid to the exploration of patients’ abilities to report * Corresponding author. E-mail address: bayardsophie@yahoo.fr (S. Bayard). 0924-9338/$ - see front matter Ó 2009 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.eurpsy.2008.12.010 ARTICLE IN PRESS Please cite this article in press as: Bayard S et al., Dissociating self-reported cognitive complaint from clinical insight in schizophrenia, European Psychiatry (2009), doi:10.1016/j.eurpsy.2008.12.010 Available online at www.sciencedirect.com European Psychiatry xx (2009) 1e8 + MODEL