Previous studies suggest that the level of clinical insight in schizophrenia patients is related to working memory functions. However, these studies were not specifically concerned with the components of working memory and had not focused in detail on working memory functions. For this reason, the current study investigated the relationship between clinical insight and working memory components in patients with schizophrenia and schizoaffective disorder. METHOD: The patient group was evaluated by using the Scale for Assessment of Negative Symptoms, the Scale for Assessment of Positive Symptoms, and the Scale to Assess Unawareness of Mental Disorder to measure clinical insight. Moreover, all participants underwent a "Situation Awareness" test in order to measure working memory functions. Based on published data, the first stage of this test was accepted to measure the "visual spatial sketchpad" component of working memory, and the second stage was accepted to measure the "episodic buffer" (bound information storage) component. The functions of these components were measured separately as top-down and bottom-up cognitive processes. RESULTS: The episodic buffer function (managed by the bottom-up cognitive process) was related with clinical insight. This relationship also continued after correcting for the effect of positive symptoms on insight. The patients performed worse than the controls in terms of visual spatial sketchpad function, which was managed by both topdown and bottom-up cognitive processes. The patients performed worse than the controls in terms of both top-down and bottom-up cognitive processes and visual spatial sketchpad function. Furthermore, the patients were also worse than the controls in terms of episodic buffer function (managed by top-down cognitive processes). CONCLUSION: Clinical insight may be associated with binding function (associated with episodic buffer function) managed by bottom-up cognitive processes in patients with schizophrenia and schizoaffective disorder. Further studies are necessary to confirm this novel finding.
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