The contribution of depression and denial towards understanding the unawareness of symptoms in schizophrenic out-patients

Abstract

Objectives: Unawareness of schizophrenic symptoms was postulated to be partially attributable to patients denying symptoms in order to avoid depression.

Method: The 24-item version of the Brief Psychiatric Rating Scale (BPRS) was administered to 41 schizophrenic patients (chart diagnoses were validated by a DSM-III-R checklist). The first 14 of these items were then used to gather information about patients' symptomatology from 55 relatives of patients. Unawareness of symptoms was calculated by subtracting patients' total for these 14 items from parents' totals. Two measures of depression were obtained. Subjective depression was the score on the depression item based on patients responses to interview questions, objective depression was the score based on interviews with relatives about their ill family member. Family functioning was also assessed by administering patients' relatives the Camberwell Family Interview and the FACES III.

Results: Hierarchical regression analyses revealed that both subjective and objective measures of depression were significantly related to unawareness; subjective depression was negatively related, and objective depression was positively related. The employed measures of family functioning were unrelated to unawareness of symptomatology.

Conclusion: This opposing pattern of subjective and objective depression was interpreted as evidence of the self-deception which characterizes all defence mechanisms including denial.