Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-23T23:30:59.407Z Has data issue: false hasContentIssue false
  • English
  • Français

The relation between neurocognitive dysfunction and impaired insight in patients with schizophrenia

Published online by Cambridge University Press:  16 April 2020

Viktoria Simon ,
Marc De Hert ,
Martien Wampers ,
Joseph Peuskens  and
Ruud van Winkel
Viktoria Simon
Affiliation:
Semmelweis University Budapest, Department of Psychiatry and Psychotherapy, Balassa u. 6., 1083Budapest, Hungary
Marc De Hert*
Affiliation:
University Psychiatric Center, Catholic University Leuven, Leuvensesteenweg 517, 3070Kortenberg, Belgium
Martien Wampers
Affiliation:
University Psychiatric Center, Catholic University Leuven, Leuvensesteenweg 517, 3070Kortenberg, Belgium
Joseph Peuskens
Affiliation:
University Psychiatric Center, Catholic University Leuven, Leuvensesteenweg 517, 3070Kortenberg, Belgium
Ruud van Winkel
Affiliation:
University Psychiatric Center, Catholic University Leuven, Leuvensesteenweg 517, 3070Kortenberg, Belgium Department of Psychiatry and Neuropsychology, EURON, South Limburg Mental Health Research and Teaching Network, Maastricht University, PO Box 616, 6200MDMaastricht, The Netherlands
*
*Corresponding author. University Psychiatric Center, Catholic University Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium. Tel.: +32 2 758 05 11; fax: +32 2 759 98 78. E-mail address: marc.de.hert@uc-kortenberg.be.
Get access

Abstract

Objectives

The present study aimed to (i) evaluate the association between insight and measures of executive functions and working memory in a sample of 132 patients with schizophrenia and (ii) to explore to what proportion neurocognitive dysfunction contributed to the variance in insight after controlling for symptomatology.

Methods

Subjects were evaluated with a standardized neurocognitive test battery and a semi-structured interview, the Psychosis Evaluation tool for Common use by Caregivers (PECC). PECC, apart from evaluating symptoms and side-effects, measures insight on a 4-point scale by two of its dimensions: awareness of having a mental illness (AMI) and awareness of having symptoms attributed to a mental illness (ASAMI). Executive functioning was measured by the Wisconsin Card Sort Test (WCST) and the Trail Making B (TMB). Working memory was measured by the Letter Number Sequencing (LNS) test from the Wechsler Adult Intelligence Scale (WAIS).

Results

Only one significant association was found after correction for multiple testing, between WCST categories completed and AMI (r = −0.29, p = 0.0006). WCST categories completed explained only 7.9% of the variance in AMI, while symptomatology explained 20% of variance in AMI and 16.5% of variance in ASAMI.

Conclusions

The current results show a significant but subtle association with the WCST, which is in agreement with earlier literature. No other associations between cognitive functioning and insight were found. In general, these findings seem to suggest that factors other than cognition have a greater impact on insight in patients with schizophrenia.

Keywords

InsightExecutive functionsWorking memorySchizophrenia
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 4 , May 2009 , pp. 239 - 243
Copyright
Copyright © Elsevier Masson SAS 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aleman, A., Agrawal, N., Morgan, K.D., David, A.S.Insight in psychosis and neuropsychological function: meta-analysis. Br J Psychiatry 2006;189:204–212CrossRefGoogle ScholarPubMed
Aleman, A., de Haan, E.H., Kahn, R.S.Insight and neurocognitive function in schizophrenia. J Neuropsychiatry Clin Neurosci 2002;14(2):241–242CrossRefGoogle Scholar
Amador, X., David, A.Insight and psychosis New YorkOxford University Press 1998Google Scholar
Amador, X.F., Flaum, M., Andreasen, N.C., Strauss, D.H., Yale, S.A., Clark, S.C.et al.Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry 1994;51(10):826–836CrossRefGoogle ScholarPubMed
Amador, X.F., Gorman, J.M.Psychopathologic domains and insight in schizophrenia. Psychiatr Clin North Am 1998;21(1):27–42CrossRefGoogle Scholar
Bora, E., Sehitoglu, G., Aslier, M., Atabay, I., Veznedaroglu, B.Theory of mind and unawareness of illness in schizophrenia: is poor insight a mentalizing deficit?. Eur Arch Psychiatry Clin Neurosci 2007;257(2):104–111CrossRefGoogle ScholarPubMed
Buckley, P.F., Wirshing, D.A., Bhushan, P., Pierre, J.M., Resnick, S.A., Wirshing, W.C.Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs 2007;21(2):129–141CrossRefGoogle ScholarPubMed
Carroll, A., Fattah, S., Clyde, Z., Coffey, I., Owens, D.G., Johnstone, E.C.Correlates of insight and insight change in schizophrenia. Schizophr Res 1999;35(3):247–253CrossRefGoogle Scholar
Collins, A.A., Remington, G.J., Coulter, K., Birkett, K.Insight, neurocognitive function and symptom clusters in chronic schizophrenia. Schizophr Res 1997;27(1):37–44CrossRefGoogle ScholarPubMed
De Hert, M., van Winkel, R., Wampers, M., Kane, J., van Os, J., Peuskens, J.Remission criteria for schizophrenia: evaluation in a large naturalistic cohort. Schizophr Res 2007;92(1–3):68–73CrossRefGoogle Scholar
De Hert, M., Wampers, M., Thys, E., Wieselgren, I.M., Lindstrom, E., Peuskens, J.Validation study of PECC (Psychosis Evaluation tool for Common use by Caregivers): interscale validity and inter-rater reliability. Int J Psych Clin Pract 2002;6:135–140CrossRefGoogle Scholar
Drake, R.J., Lewis, S.W.Insight and neurocognition in schizophrenia. Schizophr Res 2003;62(1–2):165–173CrossRefGoogle Scholar
Freudenreich, O., Deckersbach, T., Goff, D.C.Insight into current symptoms of schizophrenia. Association with frontal cortical function and affect. Acta Psychiatr Scand 2004;110(1):14–20CrossRefGoogle ScholarPubMed
Goldberg, R.W., Green-Paden, L.D., Lehman, A.F., Gold, J.M.Correlates of insight in serious mental illness. J Nerv Ment Dis 2001;189(3):137–145CrossRefGoogle ScholarPubMed
Goodman, C., Knoll, G., Isakov, V., Silver, H.Insight into illness in schizophrenia. Compr Psychiatry 2005;46(4):284–290CrossRefGoogle Scholar
Heaton, R.Wisconsin card sort test manual OdessaPsychological Assessment Resources 1981Google Scholar
Kemp, R., David, A.Psychological predictors of insight and compliance in psychotic patients. Br J Psychiatry 1996;169(4):444–450CrossRefGoogle ScholarPubMed
Keshavan, M.S., Rabinowitz, J., DeSmedt, G., Harvey, P.D., Schooler, N.Correlates of insight in first episode psychosis. Schizophr Res 2004;70(2–3):187–194CrossRefGoogle ScholarPubMed
Koren, D., Seidman, L.J., Poyurovsky, M., Goldsmith, M., Viksman, P., Zichel, S.et al.The neuropsychological basis of insight in first-episode schizophrenia: a pilot metacognitive study. Schizophr Res 2004;70(2–3):195–202CrossRefGoogle ScholarPubMed
Lysaker, P., Bell, M.Insight and cognitive impairment in schizophrenia. Performance on repeated administrations of the Wisconsin Card Sorting Test. J Nerv Ment Dis 1994;182(11):656–660CrossRefGoogle ScholarPubMed
Lysaker, P., Bell, M.Work rehabilitation and improvements in insight in schizophrenia. J Nerv Ment Dis 1995;183(2):103–106CrossRefGoogle Scholar
Lysaker, P.H., Bell, M.D., Bryson, G., Kaplan, E.Neurocognitive function and insight in schizophrenia: support for an association with impairments in executive function but not with impairments in global function. Acta Psychiatr Scand 1998;97(4):297–301CrossRefGoogle Scholar
Lysaker, P.H., Carcione, A., Dimaggio, G., Johannesen, J.K., Nicolo, G., Procacci, M.et al.Metacognition amidst narratives of self and illness in schizophrenia: associations with neurocognition, symptoms, insight and quality of life. Acta Psychiatr Scand 2005;112(1):64–71CrossRefGoogle ScholarPubMed
Lysaker, P.H., Daroyanni, P., Ringer, J.M., Beattie, N.L., Strasburger, A.M., Davis, L.W.Associations of awareness of illness in schizophrenia spectrum disorder with social cognition and cognitive perceptual organization. J Nerv Ment Dis 2007;195(7):618–621CrossRefGoogle ScholarPubMed
McEvoy, J.P., Hartman, M., Gottlieb, D., Godwin, S., Apperson, L.J., Wilson, W.Common sense, insight, and neuropsychological test performance in schizophrenia patients. Schizophr Bull 1996;22(4):635–641CrossRefGoogle ScholarPubMed
Mintz, A.R., Dobson, K.S., Romney, D.M.Insight in schizophrenia: a meta-analysis. Schizophr Res 2003;61(1):75–88CrossRefGoogle ScholarPubMed
Mutsatsa, S.H., Joyce, E.M., Hutton, S.B., Barnes, T.R.Relationship between insight, cognitive function, social function and symptomatology in schizophrenia: the West London first episode study. Eur Arch Psychiatry Clin Neurosci 2006;256(6):356–363CrossRefGoogle ScholarPubMed
Reitan, R.M.Ward Halstead's contributions to neuropsychology and the Halstead–Reitan Neuropsychological Test Battery. J Clin Psychol 1994;50(1):47–703.0.CO;2-X>CrossRefGoogle ScholarPubMed
Rossell, S.L., Coakes, J., Shapleske, J., Woodruff, P.W., David, A.S.Insight: its relationship with cognitive function, brain volume and symptoms in schizophrenia. Psychol Med 2003;33(1):111–119CrossRefGoogle Scholar
Sapara, A., Cooke, M., Fannon, D., Francis, A., Buchanan, R.W., Anilkumar, A.P.et al.Prefrontal cortex and insight in schizophrenia: a volumetric MRI study. Schizophr Res 2007;89(1–3):22–34CrossRefGoogle ScholarPubMed
Shad, M.U., Muddasani, S., Prasad, K., Sweeney, J.A., Keshavan, M.S.Insight and prefrontal cortex in first-episode Schizophrenia. Neuroimage 2004;22(3):1315–1320CrossRefGoogle ScholarPubMed
Simon, V., De Hert, M., Wampers, M., Peuskens, J., van Winkel, R.An 18-month prospective study of associations between insight and symptoms in a large sample of patients with schizophrenia. Schizophr Res 2008;102(S2):228CrossRefGoogle Scholar
Smith, T.E., Hull, J.W., Israel, L.M., Willson, D.F.Insight, symptoms, and neurocognition in schizophrenia and schizoaffective disorder. Schizophr Bull 2000;26(1):193–200CrossRefGoogle ScholarPubMed
Wechsler, D.Wechsler adult intelligence scale – revised New YorkThe Psychological Corporation 1981Google Scholar
Young, D.A., Davila, R., Scher, H.Unawareness of illness and neuropsychological performance in chronic schizophrenia. Schizophr Res 1993;10(2):117–124CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.