Insight and neurocognitive function in schizophrenia.

Abstract

Back to table of contents Previous article Next article LetterFull AccessInsight and Neurocognitive Function in SchizophreniaAndrÉ Aleman, Ph.D., Edward H.F. de Haan, Ph.D., and RenÉ S. Kahn, M.D., Ph.D., AndrÉ AlemanSearch for more papers by this author, Ph.D., Edward H.F. de HaanSearch for more papers by this author, Ph.D., and RenÉ S. KahnSearch for more papers by this author, M.D., Ph.D., Department of Psychiatry, University Medical Center (a.a., r.s.k.), and Psychological Laboratory, Helmholtz Research Institute (a.a., e.h.f.deh.), Utrecht University, The NetherlandsPublished Online:1 May 2002AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail SIR: Although impaired awareness of illness (poor insight) was already recognized as the single most common symptom in acute schizophrenia three decades ago, only recently have vigorous research efforts been made to uncover mechanisms associated with impaired insight. Neuropsychological accounts have focused on poor insight as a result of neurocognitive deficits secondary to the cerebral disease process in schizophrenia, specifically those associated with frontal lobe dysfunction. Consistent with these accounts, several studies have provided evidence of a relationship between poor insight and poor performance on neuropsychological tests sensitive to frontal lobe functioning,1 although relationships with generalized cognitive deficits have also been described.2 However, results of other studies regarding the relation between insight and neurocognitive function are equivocal.3,4We investigated the relationship between insight and measures of short-term/working memory and source memory in 38 patients with schizophrenia who were also participants in a larger study on the neurocognitive basis of hallucinations. Insight was measured with item 12 of the general psychopathology subscale of the Positive and Negative Syndrome Scale (PANSS). We included measures of passive and active working memory: the Digit Span forward and backward (from the Wechsler Adult Intelligence Scale) and the Visual Elevator task (from the Test of Everday Attention), respectively. In addition, we included a measure of source memory;5 this type of memory has been related to frontal cortex activation and to schizophrenia symptoms.Multiple regression analysis showed that the four neurocognitive tests did not explain any significant portion of observed variance in insight ratings (Fmodel=1.88, df=37, P=0.14). Individual partial correlations between the tests and insight ratings were neither significant (all r<0.27, all P>0.10). However, insight ratings did correlate significantly with the negative symptoms subscale of the PANSS (r=0.37, n=38, P=0.02), in accordance with a very recent report by Buckley et al.6 Negative symptoms might thus be a confounding factor for which previous studies have failed to control.In sum, our findings provide additional evidence for the recent conclusion by Carroll et al.4 that poor insight in schizophrenia may result directly from the disease process itself rather than being secondary to neurocognitive deficits.References1 Laroi F, Fannemel M, Ronneberg U, et al: Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests. Psychiatry Res 2000; 100:49-58Crossref, Medline, Google Scholar2 Startup M: Insight and cognitive deficits in schizophrenia: evidence for a curvilinear relationship. Psychol Med 1996; 26:1277-1281Crossref, Medline, Google Scholar3 Cuesta MJ, Peralta V, Caro F, et al: Is poor insight in psychotic disorders associated with poor performance on the Wisconsin Card Sorting Test? Am J Psychiatry 1995; 152:1380-1382Crossref, Medline, Google Scholar4 Carroll A, Fattah S, Clyde Z, et al: Correlates of insight and insight change in schizophrenia. Schizophr Res 1999; 35:247-253Crossref, Medline, Google Scholar5 Böcker KBE, Hijman R, Kahn RS, et al: Perception, mental imagery and reality discrimination in hallucinating and nonhallucinating schizophrenic patients. Br J Clin Psychol 2000; 39:397-406Crossref, Medline, Google Scholar6 Buckley PF, Hasan S, Friedman L, et al: Insight and schizophrenia. Compr Psychiatry 2001; 42:39-41Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByPsychiatry Research, Vol. 251RéférencesSchizophrenia Research, Vol. 152, No. 1Insight in stable schizophrenia: Relations with psychopathology and cognitionComprehensive Psychiatry, Vol. 54, No. 5Schizophrenia Research, Vol. 135, No. 1-3The relation between neurocognitive dysfunction and impaired insight in patients with schizophrenia16 April 2020 | European Psychiatry, Vol. 24, No. 4Irish Journal of Psychological Medicine, Vol. 26, No. 1Insight dimensions and cognitive function in psychosis: a longitudinal study31 May 2006 | BMC Psychiatry, Vol. 6, No. 1British Journal of Psychiatry, Vol. 189, No. 3Schizophrenia Research, Vol. 75, No. 2-3 Volume 14Issue 2 May 2002Pages 241-242 Metrics History Published online 1 May 2002 Published in print 1 May 2002