Neuropsychological and psychopathological variables modulating cognitive insight in people with schizophrenia
Abstract
Cognitive insight is the capacity of patients with schizophrenia to evaluate their psychotic experiences and respond to the corrective feedback. The relationship with their neuropsychological functions and the modulation exercised by mood and anxiety are still not clear. To make advances and deepen our knowledge would have an important impact on our understanding of the cognitive mechanisms and intervention programmes. Two samples were chosen, one clinical with persons suffering from schizophrenia (n = 43) and another with healthy individuals (n = 50). The Cognitive Insight Scale (BCIS), a neuropsychological battery and questionnaire concerning depression and anxiety, was applied to them. The results suggest an influence of anxiety and the deficits in cognitive flexibility on the development of the mechanisms of Self-Reflection in persons with schizophrenia, with a different pattern to that found in healthy individuals. The results are discussed with respect to the intervention programmes.
Downloads
References
Amador, X. F., & David, A. (1998). Insight and psychosis. Oxford University Press.
Beck, A. T., Baruch, E., Balter, J. M., Steer, R. A., & Warman, D. M. (2004). A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophrenia Research, 68(2–3), 319-329. https://doi.org/10.1016/S0920-9964(03)00189-0
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893. https://doi.org/10.1037/0022-006X.56.6.893
Beck, A. T., Steer, R., & Brown, G. (1996). Beck Depression Inventory second edition Mannual. San Antonio, TX: The Psychological Corporation.
Beck, A. T., & Warman, D. M. (2004). Cognitive insight: Theory and assessment. In X. Amador & A. David (Eds.), Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders (2nd Ed.) (79-87). Oxford University Press.
Benedet, M. J., y Alejandre, M. A. (1998). TAVEC: Test de Aprendizaje Verbal España-Complutense. TEA.
Birulés, I., López-Carrilero, R., Cuadras, D., Pousa, E., Barrigón, M. L., Barajas, A., Lorente-Rovira, E., González-Higueras, F., Grasa, E., Ruiz-Delgado, I., Cid, J., de Apraiz, A., Montserrat, R., Peláez, T., Moritz, S., The Spanish Metacognition Study Group, & Ochoa, S. (2020). Cognitive Insight in First-Episode Psychosis: Changes during Metacognitive Training. Journal of Personalized Medicine, 10(4), 253. https://doi.org/10.3390/jpm10040253
Buchy, L., Czechowska, Y., Chochol, C., Malla, A., Joober, R., Pruessner, J., & Lepage, M. (2010). Toward a model of cognitive insight in first-episode psychosis: Verbal memory and hippocampal structure. Schizophrenia Bulletin, 36(5), 1040-1049. https://doi.org/10.1093/schbul/sbp015
Buchy, L., Hawco, C., Joober, R., Malla, A., & Lepage, M. (2015). Cognitive insight in first-episode schizophrenia: Further evidence for a role of the ventrolateral prefrontal cortex. Schizophrenia Research, 166(1-3), 65-68. https://doi.org/10.1016/j.schres.2015.05.009
Carse, T., & Langdon, R. (2013). Delusion proneness in nonclinical individuals and cognitive insight the contributions of rumination and reflection. Journal of Nervous and Mental Disease, 201(8), 659-664. https://doi.org/10.1097/NMD.0b013e31829c4fe7
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd. ed.). New York: Lawrence Earlbaum.
Colis, M. J., Steer, R. A., & Beck, A. T. (2006). Cognitive insight in inpatients with psychotic, bipolar, and major depressive disorders. Journal of Psychopathology and Behavioral Assessment, 28(4), 242-249. https://doi.org/10.1007/s10862-005-9012-7
Dimaggio, G., Vanheule, S., Lysaker, P. H., Carcione, A., & Nicolò, G. (2009). Impaired self-reflection in psychiatric disorders among adults: A proposal for the existence of a network of semi-independent functions. Consciousness and Cognition, 18(3), 653-664. https://doi.org/10.1016/j.concog.2009.06.003
Drake, R. J., Dunn, G., Tarrier, N., Bentall, R. P., Haddock, G., & Lewis, S. W. (2007). Insight as a predictor of the outcome of first-episode nonaffective psychosis in a prospective cohort study in England. The Journal of Clinical Psychiatry, 68(1), 81-86. https://doi.org/10.4088/JCP.v68n0111
Engh, J. A., Sundet, K., Simonsen, C., Vaskinn, A., Lagerberg, T. V., Opjordsmoen, S., Friis, S. & Andreassen, O. A. (2011). Verbal learning contributes to cognitive insight in schizophrenia independently of affective and psychotic symptoms. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35(4), 1059-1063. https://doi.org/10.1016/j.pnpbp.2011.02.021
Frith, C. D. (1995). La esquizofrenia: Un enfoque neuropsicológico cognitivo [Schizophrenia: A Cognitive Neuropsychological Approach]. Ariel.
García Guerrero, A., & Lysaker, P. H. (2013). Socially naive self-appraisal moderates the relationship between cognitive insight and positive symptoms in schizophrenia. Schizophrenia Research, 143(1), 97-101. https://doi.org/10.1016/j.schres.2012.10.037
Giusti, L., Mazza, M., Pollice, R., Casacchia, M., & Roncone, R. (2013). Relationship between self‐reflectivity, theory of mind, neurocognition, and global functioning: An investigation of schizophrenic disorder. Clinical Psychologist, 17, 67-76. https://doi.org/10.1111/cp.12006
González-Blanch, C., Álvarez-Jiménez, M., Ayesa-Arriola, R., Martínez-García, O., Pardo-García, G., Balanzá-Martínez, V., Suárez-Pinilla, P. & Crespo-Facorro, B. (2014). Differential associations of cognitive insight components with pretreatment characteristics in first-episode psychosis. Psychiatry Research, 215(2), 308-313. https://doi.org/10.1016/j.psychres.2013.12.003
Granholm, E., McQuaid, J.R., McClure, F.S., Auslander, L.A., Perivoliotis, D., Pedrelli, P., Patterson, T., & Jeste, D. V. (2005). A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. American Journal of Psychiatry, 162(3), 520-529. https://doi.org/10.1176/appi.ajp.162.3.520. PMID: 15741469
Gutiérrez-Zotes, J. A., Valero, J., Cortés, M. J., Labad, A., Ochoa, S., Ahuir, M., Carlson, J., Bernardo, M., Cañizares, S., Escartín, G., Cañete, J., Gallo, P., & Salamero, M. (2012). Spanish adaptation of the Beck Cognitive Insight Scale (BCIS) for schizophrenia. Actas Españolas de Psiquiatría, 40(1), 2-9.
Heaton, R., Chelune, G., Talley, J. L., Kay, G., & Curtiss, G. (Eds.). (1993). Wisconsin Card Sorting Test Manual (revised and expanded). Odessa: Psychological assessment resources. Odessa, Florida: Psychological Assessment Resources.
Johns, L. C., & van Os, J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21(8), 1125-1141. https://doi.org/10.1016/s0272-7358(01)00103-9
Lezak, M. (1995). Neuropsychological assessment (3rd ed.). Oxford University Press.
Lincoln, T. M., Möbius, C., Huber, M. T., Nagel, M., & Moritz, S. (2014). Frequency and correlates of maladaptive responses to paranoid thoughts in patients with psychosis compared to a population sample. Cognitive Neuropsychiatry, 19(6), 509-526. https://doi.org/10.1080/13546805.2014.931220
Lysaker, P. H., & Buck, K. D. (2008). Insight and schizophrenia: Correlates, etiology and treatment. Clinical Schizophrenia & Related Psychoses, 2(2), 147-154.
Moritz, S., Woodward, T. S., Whitman, J. C., & Cuttler, C. (2005). Confidence in errors as a possible basis for delusions in schizophrenia. The Journal of Nervous and Mental Disease, 193(1), 9-16. https://doi.org/10.1097/01.nmd.0000149213.10692.00
Moritz, S., y Woodward, T. S. (2006). The contribution of metamemory deficits to schizophrenia. Journal of Abnormal Psychology, 115(1), 15. https://doi.org/10.1037/0021-843X.15.1.15
Moritz, S., & Woodward, T. S. (2007). Metacognitive training in schizophrenia: From basic research to knowledge translation and intervention. Current Opinion in Psychiatry, 20(6), 619-625. https://doi.org/10.1097/YCO.0b013e3282f0b8ed
Nair, A., Palmer, E. C., Aleman, A., & David, A. S. (2014). Relationship between cognition, clinical and cognitive insight in psychotic disorders: A review and meta-analysis. Schizophrenia Research, 152(1), 191-200. https://doi.org/10.1016/j.schres.2013.11.033
Nuechterlein, K. H., Barch, D. M., Gold, J. M., Goldberg, T. E., Green, M. F., & Heaton, R. K. (2004). Identification of separable cognitive factors in schizophrenia. Schizophrenia Research, 72(1), 29-39. https://doi.org/10.1016/j.schres.2004.09.007
Orfei, M. D., Caltagirone, C., Cacciari, C., Assogna, F., & Spalletta, G. (2011). The neuropsychological correlates of cognitive insight in healthy participants. Applied Cognitive Psychology, 25(6), 927-932. https://doi.org/10.1002/acp.1771
Orfei, M. D., Piras, F., Macci, E., Caltagirone, C., & Spalletta, G. (2013). The neuroanatomical correlates of cognitive insight in schizophrenia. Social Cognitive and Affective Neuroscience, 8(4), 418-423. https://doi.org/10.1093/scan/nss016
Orfei, M. D., Spoletini, I., Banfi, G., Caltagirone, C., & Spalletta, G. (2010). Neuropsychological correlates of cognitive insight in schizophrenia. Psychiatry Research, 178(1), 51-56. https://doi.org/10.1016/j.psychres.2009.05.013
Palmer, E. C., Gilleen, J., & David, A. S. (2015). The relationship between cognitive insight and depression in psychosis and schizophrenia: A review and meta-analysis https://doi.org/10.1016/j.schres.2015.05.032
Penney, D., Sauvé, G., Joober, R., Malla, A. K., & Lepage, M. (2018). Establishing clinical cutoff values for the Beck Cognitive Insight Scale. Cognitive Therapy and Research, 1-11. https://doi.org/10.1007/s10608-018-9963-0
Pijnenborg, G. H., Van der Gaag, M., Bockting, C. L., Van der Meer, L., & Aleman, A. (2011). REFLEX, a social-cognitive group treatment to improve insight in schizophrenia: Study protocol of a multi-center RCT. BMC Psychiatry, 11, 161-244X-11-161. https://doi.org/10.1186/1471-244X-11-161
Rathee, R., Luhrmann, T. M., Bhatia, T., & Deshpande, S. N. (2018). Cognitive insight and objective quality of life in people with schizophrenia and auditory hallucinations. Psychiatry Research, 259, 223-228. https://doi.org/10.1016/j.psychres.2017.09.032
Ruiz-Vargas, J. M. (1987). Esquizofrenia: Un enfoque cognitivo. Alianza Editorial.
Sanz, J., Perdigón, A., y Vázquez, C. (2003). Adaptación española del Inventario para la depresión de Beck-II (BDI-II): 2. Propiedades psicométricas en población general. Clínica y Salud, 14(3), 249-280.
Sanz, J., y Navarro, M. E. (2003). Propiedades psicométricas de una versión española del inventario de ansiedad de Beck (BAI) en estudiantes universitarios. Ansiedad y Estrés, 9(1), 59-84.
Segarra, N., Bernardo, M., Gutiérrez, F., Justicia, A., Fernadez-Egea, E., Allas, M., Safont, G., Contreras, F., Gascón, J., Soler-Insa, P. A., Menchón, J. M., Junque, C. & Keefe, R. S. E. (2011). Spanish validation of the brief assessment in cognition in schizophrenia (BACS) in patients with schizophrenia and healthy controls. European Psychiatry, 26(2), 69-73. https://doi.org/10.1016/j.eurpsy.2009.11.001
Autores (2018). Cognitive insight, neurocognition and life skills in patients with schizophrenia. Psicothema, 30(3), 251-256. https://doi.org/10.7334/psicothema2018.12
Autores (2019). Effects of metacognitive training on cognitive insight in a sample of patients with schizophrenia. International Journal of Environmental Research and Public Health, 16(22), 4541. https://doi.org/10.3390/ijerph16224541
Sponheim, S. R., Jung, R. E., Seidman, L. J., Mesholam-Gately, R. I., Manoach, D. S., O’Leary, D. S., Ho, B. C., Andreasen, N. C., Lauriello, J. & Schulz, S. C. (2010). Cognitive deficits in recent-onset and chronic schizophrenia. Journal of Psychiatric Research, 44(7), 421-428. https://doi.org/10.1016/j.jpsychires.2009.09.010
Srivastava, K., & Kumar, R. (2016). Cognitive insight and executive function in schizophrenia. SIS Journal of Projective Psychology & Mental Health, 23(2), 106-114.
Van Camp, L., Sabbe, B., & Oldenburg, J. (2017). Cognitive insight: A systematic review. Clinical Psychology Review, 55, 12-24. https://doi.org/10.1016/j.cpr.2017.04.011
Warman, D. M., Lysaker, P. H., & Martin, J. M. (2007). Cognitive insight and psychotic disorder: The impact of active delusions. Schizophrenia Research, 90(1–3), 325-333. https://doi.org/10.1016/j.schres.2006.09.011
Warman, D. M., & Martin, J. M. (2006). Cognitive insight and delusion proneness: An investigation using the beck cognitive insight scale. Schizophrenia Research, 84(2–3), 297-304. https://doi.org/10.1016/j.schres.2006.02.004
Weintraub, M. J., & Weisman de Mamani, A. (2015). Effects of sub-clinical psychosis and cognitive insight on psychological well-being: A structural equation model. Psychiatry Research, 226(1), 149-155. https://doi.org/10.1016/j.psychres.2014.12.039
Wells, A., & Matthews, G. (1994). Self-consciousness and cognitive failures as predictors of coping in stressful episodes. Cognition & Emotion, 8(3), 279-295. https://doi.org/10.1080/02699939408408942
Woodward, T. S., Moritz, S., Cuttler, C., & Whitman, J. C. (2006). The contribution of a cognitive bias against disconfirmatory evidence (BADE) to delusions in schizophrenia. Journal of Clinical and Experimental Neuropsychology, 28(4), 605-617. https://doi.org/10.1080/13803390590949511
Copyright (c) 2022 Servicio de Publicaciones, University of Murcia (Spain)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The works published in this journal are subject to the following terms:
1. The Publications Service of the University of Murcia (the publisher) retains the property rights (copyright) of published works, and encourages and enables the reuse of the same under the license specified in paragraph 2.
© Servicio de Publicaciones, Universidad de Murcia, 2022
2. The works are published in the online edition of the journal under a Creative Commons Reconocimiento-CompartirIgual 4.0 (legal text). You can copy, use, distribute, transmit and publicly display, provided that: i) you cite the author and the original source of publication (journal, editorial and URL of the work), ii) are not used for commercial purposes, iii ) mentions the existence and specifications of this license.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
3. Conditions of self-archiving. Is allowed and encouraged the authors to disseminate electronically pre-print versions (version before being evaluated and sent to the journal) and / or post-print (version reviewed and accepted for publication) of their works before publication, as it encourages its earliest circulation and diffusion and thus a possible increase in its citation and scope between the academic community. RoMEO Color: Green.
