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Nora Eldasher

Self Awareness in Schizophrenics
Schizophrenia is a chronic psychiatric illness characterized by excessive dopamine activity in the mesolimbic tract and mesocortical tract leading to symptoms of psychosis along with poor cognition in socialization. Under the DSM-V, schizophrenics have a combination of positive, negative and psychomotor symptoms. These cognitive disturbances involve rare beliefs and/or thoughts of a distorted reality that creates an abnormal pattern of functioning for the patient. Multiple studies have investigated this issue. Although it has been studied and proven that schizophrenia is hereditary, most patients that inherit this gene are not self-aware of their disorder, regardless of their family history. The level of self-awareness among patients with schizophrenia is a heavily studied topic.

Schizophrenia as a disease state is characterized by severe cognitive dysfunction and it is uncertain to what extent patients are aware of this deficiency. In a study published in Schizophrenia Research by Medalia and Lim (2004), researchers investigated patients’ awareness of their cognitive deficit in the areas of attention, nonverbal memory, and verbal memory. Results from this study (N=185) revealed large discrepancy in patients’ assessment of their cognitive functioning relative to the assessment of their clinicians. Though it is impossible to access ones’ consciousness and truly understand what a schizophrenic believes, regardless in this study, patients were not aware of their cognitive dysfunctional reasoning. In the DSM-V, to properly diagnose a schizophrenic, they must have two or more of the following symptoms in the duration of one month: delusions*, hallucinations*, disorganized speech*, grossly disorganized/catatonic behavior and negative symptoms (*these three symptoms above all other symptoms must be present to correctly diagnose a patient.) Sometimes these symptoms are very prominent and are treated with a combination of antipsychotics (i.e. haloperidol, loxapine), atypical antipsychotics (such as clozapine and risperdone) and psychosocial therapies that include family interventions and socials skills. When a patient is undergoing treatment and recovering from the disorder, the memory of their behavior is present in a diminutive amount; thus, self awareness of diagnoses of schizophrenia after treatment is rare, as well as subsequent to onset and prevalence in the patient.

The above findings are further supported by a study conducted in The American Journal of Psychiatry in 1993 by Amador, et al (N=43). The study suggests a correlation exists between patient insight, compliance and disease progression. Investigators assess insight of illness was assessed via Scale to Assess Unawareness of Mental Disorder and was used along with rating of psychopathology, course of illness, and compliance with treatments in a sample of 43 patients. Patients with poor insight are less likely to be compliant with treatment and are more likely to have a poorer prognosis. Patients with hallucinations sometimes experience positive symptoms, which can include delusions of reference, thought insertion/withdrawal, thought broadcast, delusions of persecution, grandiosity and many more. These psychoses skew the patient’s perspectives of reality in ways in which they truly believe are really happening. For instance, a patient that is experiencing delusions of reference may believe while watching the weather forecast that when the weatherman says it will rain, he is really sending a message to the patient in which rain symbolizes a specific warning completely irrelevant to what the weather is. Another example would be thought broadcast, which is when a patient believes that everyone can hear their thoughts. These positive symptoms sometimes are so severe to where the schizophrenic believes that something is crawling on them or smelling something that is not there in reality. These strong hallucinations are intense and difficult to convince the patient that they do not exist outside of their cognitive beliefs, making it extremely difficult for a patient to understand and become self-aware that what they are experiencing is in fact not there.

Furthermore, a study by Bedford and Davis (2013) was conducted to look at the association of denial vs. acceptance of multiple facets of schizophrenia (self reflection, self perception and insight) and its effect on self-reflection (N=26). Study results suggest patients with increased disease denial have lower recollection for self evaluated mental illnesses. Disease denial, to a great extent, creates a hardship for patients to undergo recovery because their feelings and sensations are intensely outstanding. But just as this and the above studies imply, a large proportion of schizophrenics do not have self awareness of their illness for many factors and severity of reasoning of their diagnoses.