Self-Awareness Deficits of Cognitive Impairment in Individuals With Schizophrenia. Really?

Raffard, Stéphane; Lebrun, Cindy; Bayard, Sophie; Macgregor, Alexandra; Capdevielle, Delphine

doi:10.3389/fpsyt.2020.00731

Cited by 11 publications

(12 citation statements)

References 46 publications

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“…One explanation for the interaction at 6 months but not 12 months is that people who will respond to treatment have responded by that point, creating variability in scores and a subsequently larger, detectable effect. Another possibility is there that are genuinely negative effects of better IA, as noted in recent work on IA and functioning ( Olsson et al, 2019 ) and subjective neurocognitive complaints ( Raffard et al, 2020 ). As to why better symptom control could accompany poorer IA, evidence suggests that the depressive clinical insight paradox in schizophrenia ( Davis et al, 2020 ; Lysaker et al, 2018 , Lysaker et al, 2007 ; Vohs et al, 2016 ) applies across domains of IA ( Harvey et al, 2017 ; Jones et al, 2020 ; Siu et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Introspective accuracy for substance use across a year of treatment for first episode psychosis

Mervis

Fischer

Cooper

et al. 2021

Schizophrenia Research: Cognition

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Substance use exacerbates psychosis, mania, depression, and poor functioning in people with first episodes of psychosis (FEP) and is associated with poor treatment outcomes, even when it does not reach the level of a formal disorder. Impaired insight and substance use are common issues that may interfere with treatment outcomes among people experiencing FEP, yet both are treatable. Improvements in these domains are associated with better outcomes. Low insight could increase risk for substance use by impairing the ability to self-appraise and assess consequences. Introspective accuracy (IA) is understudied in this area and is one way of considering self-appraisal. This study is an archival review using data collected from NAVIGATE, a coordinated specialty care program treating people with FEP. IA was operationalized as the difference between clinician and client ratings of substance use. We tested whether IA changed over one year of treatment and whether those changes occurred alongside changes in symptoms and illness self-management. No changes in IA were detected in relation to illness self-management. Changes in IA for substance use occurred midway through treatment—individuals with greater symptom remission had more overconfident IA. Prior research on insight has shown a paradox where greater insight accompanies more symptoms. However, past research has also shown a relationship between IA and functional outcomes, like illness self-management, and that overconfidence in one domain can positively bias clinician ratings in another. Our findings suggest either a positive bias for ratings associated with overconfident IA or an insight paradox type effect.

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Section: Discussionmentioning

confidence: 99%

Introspective accuracy for substance use across a year of treatment for first episode psychosis

Mervis

Fischer

Cooper

et al. 2021

Schizophrenia Research: Cognition

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“…Research on the discrepancy between subjective and objective executive function in schizophrenia is limited, but studies on cognition in general have found the associations between subjective and objective measures to be weaker among individuals with schizophrenia than among healthy individuals ( Medalia et al, 2008 ; Potvin et al, 2014 ). It has been suggested that co-morbid symptoms and lack of insight into cognitive impairment biases subjective cognitive assessment for a substantial portion of individuals with schizophrenia ( Burton et al, 2016 ; Harvey and Pinkham, 2015 ; Raffard et al, 2020 ). Overestimation of cognition is problematic because it is associated with poorer functional outcomes ( Gould et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

“…Disorganized symptoms are particularly interesting in this regard as they share a stronger relationship with cognition than positive symptoms ( Rodriguez-Jimenez et al, 2013 ; Ventura et al, 2010 ). Furthermore, depressive symptoms have been associated with more subjective cognitive complaints among persons with schizophrenia ( Burton et al, 2016 ; Raffard et al, 2020 ; Sellwood et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

Executive dysfunction in schizophrenia: Predictors of the discrepancy between subjective and objective measures

Haugen

Stubberud

Ueland

et al. 2021

Schizophrenia Research: Cognition

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This study aimed to investigate what characterizes individuals with schizophrenia who experience more or less subjective executive dysfunction in everyday life compared to objective executive performance on neuropsychological tests. Sixty-six participants with broad schizophrenia spectrum disorders completed a comprehensive assessment of executive function. Discrepancies between performance on neuropsychological tests (objective) and an extensive self-report questionnaire (subjective) of central executive functions (inhibition, shifting and working memory) were calculated. Higher level of self-efficacy was the best predictor of experiencing fewer subjective cognitive complaints compared to objective performance, followed by higher levels of disorganized symptoms. Depressive symptoms did not predict discrepancy between subjective and objective executive function. Higher estimated IQ predicted greater subjective working memory difficulties in everyday life despite better objective performance. Results may aid clinicians in the assessment and remediation of cognitive impairment. Low self-efficacy may identify individuals who are not able to utilize their potential executive functions in daily life. Interventions aimed at fostering self-efficacy ought to be included in cognitive remediation for these individuals. Disorganized symptoms could prove useful in identifying individuals who are in need of cognitive remediation for executive dysfunction, despite that they overestimate their skills. These individuals may benefit from efforts to increase insight into cognitive dysfunction.

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“…zołek, Kłosowska, Staszkiewicz & Moritz, 2018;Homayoun, Nadeau-Marcotte, Luck & Stip, 2011) as well as between subjective cognition and schizophrenia severity indices (Burton, Harvey, Patterson & Twamley, 2016;Raffard, Lebrun, Bayard, MacGregor & Capdevielle, 2020); (2) of associations between subjective cognition and daily-life functioning in schizophrenia (Higuchi, Sumiyoshi, Seo et al, 2017;Shin, Joo & Kim, 2016); and (3) that scores in self-assessment instruments have high heritability estimates (Boomsma, 1998); the latter highlights their value in endophenotypic research. Shedding light on similarities and/or differences between objective and subjective measures in schizotypy also adds further value in the related research area as it can help explain findings that might seem to be paradoxical at first glance (discussed in Davis, 2009 andCohen, Auster, MacAulay &McGovern, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, self‐assessment instruments, such as the Cognitive Failures Questionnaire (CFQ; Broadbent, Cooper, Fitzgerald & Parkes, 1982), are also of use in the study of cognitive failures as most of them require participants to rate their cognitive capacities in everyday life situations, they are more cost‐effective and less time consuming than standard tests and reflect the individual’s own appraisal of his/her capacities. Although the latter might be biased by the examinee’s self‐perception (either lack of insight or trend towards malingering), it is worth noting that there is evidence: (1) of associations between self‐reported and objectively measured cognitive functioning in schizophrenia (Gawęda, Prochwicz, Krężołek, Kłosowska, Staszkiewicz & Moritz, 2018; Homayoun, Nadeau‐Marcotte, Luck & Stip, 2011) as well as between subjective cognition and schizophrenia severity indices (Burton, Harvey, Patterson & Twamley, 2016; Raffard, Lebrun, Bayard, MacGregor & Capdevielle, 2020); (2) of associations between subjective cognition and daily‐life functioning in schizophrenia (Higuchi, Sumiyoshi, Seo et al ., 2017; Shin, Joo & Kim, 2016); and (3) that scores in self‐assessment instruments have high heritability estimates (Boomsma, 1998); the latter highlights their value in endophenotypic research. Shedding light on similarities and/or differences between objective and subjective measures in schizotypy also adds further value in the related research area as it can help explain findings that might seem to be paradoxical at first glance (discussed in Cohen & Davis, 2009 and Cohen, Auster, MacAulay & McGovern, 2014).…”

Section: Introductionmentioning

confidence: 99%

Self‐perceived cognitive lapses and psychological well‐being in schizotypy: Generalized and domain‐specific associations

Giakoumaki

Karamaouna

Karagiannopoulou

et al. 2020

Scandinavian J Psychology

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A critical link between schizotypy and schizophrenia is impoverished cognitive functioning. In the majority of studies, though: (1) cognition is examined with standard neuropsychological tasks; and (2) high-schizotypal individuals are defined according to criteria applied in the respective study sample. Taking these considerations into account, the aims of the present study were to examine: (1) differences between four pre-defined, according to normative criteria, schizotypal (paranoid, negative, disorganized and cognitive-perceptual) and one control groups in self-perceived cognitive lapses; and (2) associations between schizotypal dimensions, self-perceived cognitive lapses and psychological well-being. Two hundred and sixty-one participants were administered the Schizotypal Personality Questionnaire, the Cognitive Failures Questionnaire (CFQ) and the Flourishing Scale, which assesses psychological well-being. Negative schizotypals reported higher scores in almost all CFQ measures compared with the control group (all p values < 0.01) along with poorer psychological well-being compared with the control and the cognitive-perceptual groups (both p values < 0.001). The disorganized group had higher scores in distractibility, blunders and total CFQ scores compared with the control group (all p values < 0.001). High psychological wellbeing was significantly associated with low negative schizotypy and CFQ blunders along with high cognitive-perceptual schizotypy (all p values < 0.05). To summarize, negative schizotypy is associated with a profile of "generalized" self-perceived cognitive lapses while disorganized schizotypy is characterized by self-perceived cognitive slips that have previously been shown to be mediated by a fronto-parietal network. Although psychological wellbeing is negatively associated with social-context specific cognitive failures and negative schizotypy, it is positively associated with cognitive-perceptual schizotypy.

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Self-Awareness Deficits of Cognitive Impairment in Individuals With Schizophrenia. Really?

Cited by 11 publications

References 46 publications

Introspective accuracy for substance use across a year of treatment for first episode psychosis

Introspective accuracy for substance use across a year of treatment for first episode psychosis

Executive dysfunction in schizophrenia: Predictors of the discrepancy between subjective and objective measures

Self‐perceived cognitive lapses and psychological well‐being in schizotypy: Generalized and domain‐specific associations

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