Effect of executive functioning on perceived needs in chronic schizophrenia

INTRODUCTION: Recent approaches to needs assessment involve patients in this process; however, little is known of the effects of mental illness on patients' ability to assess their own needs. METHOD: The needs of 26 subjects with schizophrenia were assessed over 22 domains by patients and staff, using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). Patients' executive functioning was assessed using the Wisconsin Card Sorting Test (WCST). RESULTS: Mean discrepancies between ratings by staff and by patients were compared across executive functioning, results showed no effect of executive functioning on the discrepancy between staff and patient ratings. Higher executive functioning was associated with more met needs. Multivariate analysis showed higher executive functioning associated with more needs in some but not all areas. CONCLUSIONS: Results suggest that patients with schizophrenia and impaired executive functioning can validly estimate their needs. Better executive functioning may be associated with the ability to get one's needs met, increased awareness of needs, better ability to communicate needs, or more needs in certain areas. Need is shown to be a complex variable, and not simply an index of functioning. Hospitals and clinics must ensure that patients' views find full expression in ratings. Needs ratings and rehabilitation status should be viewed in the light of neuropsychological functioning.