Insight in psychosis and neuropsychological function

Alemán, André; Agrawal, Niruj; Morgan, Kevin; David, Anthony S.

doi:10.1192/bjp.189.3.204

Cited by 281 publications

(193 citation statements)

References 60 publications

(34 reference statements)

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“…Consistent with an earlier meta-analysis 131 and systematic review 13 , a more recent meta-analysis has found a very weak link between neurocognition and insight 132 . Other published studies continue to fail to find a link between insight and multiple facets of neurocognition in patients in varying phases of illness 47,51,133,134 .…”

Section: World Psychiatry 17:1 -February 2018supporting

confidence: 62%

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

et al. 2018

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Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.

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Section: World Psychiatry 17:1 -February 2018supporting

confidence: 62%

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

et al. 2018

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“…All findings were in the anticipated direction, with lower awareness being associated with poorer WCST performance. The most comprehensive and quantitative systematic review and meta-analysis of work in this area [49] suggests that WCST performance has more in common with awareness than other measures, such as IQ or memory, with 13 studies creating a pooled effect size of r ¼ 0.23. The pattern of neuropsychological impairment associated with poor insight in first-episode psychosis (FEP) is also unclear.…”

Section: Clinical Insightmentioning

confidence: 99%

Failures of metacognition and lack of insight in neuropsychiatric disorders

David

Bedford

Wiffen

et al. 2012

Phil. Trans. R. Soc. B

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197

129

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Lack of insight or unawareness of illness are the hallmarks of many psychiatric disorders, especially schizophrenia (SCZ) and other psychoses and could be conceived of as a failure in metacognition. Research in this area in the mental health field h as burgeoned with the development and widespread use of standard assessment instruments and the mapping out of the clinical and neuropsychological correlates of insight and its loss. There has been a growing appreciation of the multi-faceted nature of the concept and of the different 'objects' of insight, such as the general awareness that one is ill, to more specific metacognitive awareness of individual symptoms, impairments and performance. This in turn has led to the notion that insight may show modularity and may fractionate across different domains and disorders, supported by work that directly compares metacognition of memory deficits and illness awareness in patients with SCZ, Alzheimer's disease and brain injury. The focus of this paper will be on the varieties of metacognitive failure in psychiatry, particularly the psychoses. We explore cognitive models based on self-reflectiveness and their possible social and neurological bases, including data from structural and functional MRI. The medial frontal cortex appears to play an important role in self-appraisal in health and disease.

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“…Nous avons donc opté pour une troisième approche, intermédiaire, qui consiste à remplacer la valeur manquante par la limite inférieure de l'intervalle de confiance de la taille de l'effet composé. Il s'agit d'une approche dont la validité est reconnue (Aleman et al, 2006).…”

Section: Analyses Statistiquesunclassified

La conscience des déficits neurocognitifs dans la schizophrénie : une méta-analyse

Potvin

Pelletier

Stip

2014

smq

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Contexte La schizophrénie est un trouble allant de pair avec un manque d’autocritique par rapport aux délires et aux hallucinations. En contrepartie, on en sait beaucoup moins en ce qui concerne la conscience des patients par rapport à leurs déficits cognitifs, qui sont des symptômes clés de ce trouble psychiatrique. Afin de faire la synthèse de l’état de la connaissance à ce sujet, nous avons effectué une méta-analyse de 22 études comprenant 1609 patients. Les analyses ont révélé que les patients rapportent davantage de plaintes subjectives que les sujets sains. La corrélation entre la cognition subjective et objective s’est avérée faible toutefois. Les études utilisant la Scale to Investigate Cognition in Schizophrenia ont produit des corrélations plus fortes que celles utilisant d’autres échelles de plaintes subjectives. La relation entre la cognition subjective et les symptômes dépressifs s’est avérée comparable à la relation entre la cognition subjective et la cognition objective. Enfin, une relation faible a été observée entre la cognition subjective et l’autocritique par rapport aux symptômes positifs. Les résultats de la présente méta-analyse montrent que les patients atteints de la schizophrénie se plaignent de déficits cognitifs, mais qu’ils n’ont pas une représentation claire de la nature de ceux-ci, ce qui confirme l’existence de déficits méta-cognitifs dans la schizophrénie.

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Insight in psychosis and neuropsychological function

Abstract: Neuropsychological dysfunction, specifically impairment of set-shifting and error monitoring, contributes to poor insight in psychosis. Specific relations with different dimensions of insight and the putative role of metacognitive functions require further study.

Cited by 281 publications

References 60 publications

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

Failures of metacognition and lack of insight in neuropsychiatric disorders

La conscience des déficits neurocognitifs dans la schizophrénie : une méta-analyse

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