Cognitive insight and verbal memory in first episode of psychosis

Abstract

Beck and collaborators have proposed a distinction between clinical insight and cognitive insight and have developed a tool for the assessment of the latter, namely the Beck Cognitive Insight Scale (BCIS). The present study explored in 51 patients with a first episode of psychosis the neurocognitive correlates of cognitive insight as assessed with the BCIS. Global measures for seven domains of cognition including verbal learning and memory, visual learning and memory, working memory, speed of processing, reasoning and problem solving, attention, and social cognition were examined. Secondly, we examined whether two clinical insight measures, the Scale to assess Unawareness of Mental Disorder (SUMD) and the insight item from the Positive and Negative Symptoms Scale (PANSS), could produce similar or different patterns of association with neurocognitive functions as those identified with the BCIS. Correlational analyses revealed significant associations between the BCIS Composite Index and the verbal learning and memory. No significant associations were observed between any of the neurocognitive domains and the PANSS or SUMD clinical insight measures, despite high inter-correlations among the three insight measures. These results suggest that cognitive insight, but not clinical insight, may rely on memory processes whereby current experiences are appraised based on previous ones.

Assessment of Cognitive Insight: A Qualitative Review

“…36 Similarly, another group of researchers has shown that the neurocognitive domains of verbal learning and memory, as well as attention, were significantly correlated with Composite Index and Self-Certainty; the Composite Index, additionally, was associated with social cognition; and neither the SUMD nor the PANSS correlated with neurocognitive or social cognitive measures. 21 A second study by this group largely corroborated these findings, with the exception that Self-Reflectiveness (rather than Self-Certainty) correlated with verbal memory. 29 This last study was also the first to report brain imaging results.…”

“…Convergent validity has been determined by correlating the BCIS with 5 different measures of clinical insight. Two groups have replicated the finding of Beck et al that the Composite Index correlated with the SUMD, finding moderate-to-large correlations with the Awareness of a Mental Illness item 21 and the total score.…”

“…30 Further evidence of a complementary relationship between clinical insight and cognitive insight comes from the studies showing the BCIS, and not the SUMD, to be associated with neurocognitive and neurobiological factors. 21,29,36 These findings suggest that cognitive insight is a basic ability that is more proximal to neurobiological vulnerabilities than clinical insight. The development of adequate clinical insight may therefore depend upon a certain degree of cognitive insight-eg, neurocognitive deficits may limit a patient's ability to consider alternative viewpoints and refrain from thinking that is impermeable to outside information, which may in turn limit the patient's ability to understand that he or she has an illness.…”

“…However, this link is based on 3 studies. 21,29,36 The neuroanatomical finding is also promising, especially the link between hippocampal volume and Self-Certainty. We anticipate considerable growth in this area of study in the coming years and, accordingly, make the following proposals for future research:…”

“…Five studies 11,12,15,17,21 have reported significant mild-tomoderate correlations between the BCIS and Positive and Negative Syndrome Scale (PANSS) Lack of Insight item. 22 Similarly, the BCIS has shown significant mildto-moderate correlations with the Birchwood Insight Scale, 16,23 the Schedule for Assessment of Insight (Japanese version), and the Revised Insight Scale for Psychosis.…”