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Vol. 45, No. 4, 2012
Issue release date: June 2012
Section title: Original Paper
Psychopathology 2012;45:235–243
(DOI:10.1159/000329998)

Insight and Awareness as Related to Psychopathology and Cognition

Trevisi M. · Talamo A. · Bandinelli P.L. · Ducci G. · Kotzalidis G.D. · Santucci C. · Manfredi G. · Girardi N. · Tatarelli R.
aDepartment of Neurosciences, Mental Health, and Sensory Functions (NESMOS), 2nd Medical School, Sapienza University, Sant’Andrea Hospital, and bAcute Psychiatric Care Unit, Department of Mental Health, Roma E Health Trust, San Filippo Neri Hospital, Rome, Italy; cDepartment of Psychiatry, Harvard Medical School, International Consortium for Bipolar and Psychotic Disorders Research, McLean Division of Massachusetts General Hospital, Boston, Mass., USA

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 5/20/2010 2:30:46 PM
Accepted: 6/10/2011
Published online: 5/22/2012

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 4

ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)

For additional information: http://www.karger.com/PSP

Abstract

Background: Insight affects adherence and treatment outcome and relates to cognitive impairment and psychopathology. We investigated the relationship of insight with cognition in patients with major depression, schizophrenia and bipolar disorder in acute psychiatric care, long-term inpatient, and outpatient settings. Methods: Eighty-one patients (women, 59.5%; age, 45.9 ± 13.5 years; 27 in each setting group; 33.3% with DSM-IV bipolar disorder, 39.5% with unipolar major depression, and 27.2% with schizophrenia) underwent the Wisconsin Card Sorting Test (WCST) to test flexibility, clinician-rated Scale to Assess Unawareness of Mental Disorder (SUMD), and self-rated Insight Scale (IS) to assess insight/awareness. Results: Poor performance on the WCST correlated with higher SUMD scores such as current psychiatric illness unawareness, impaired symptom attribution, unawareness of medication effect, or of social consequences, but not with IS scores. The latter correlated with days on continuous treatment. Patients receiving psycho-education showed greater symptom awareness compared to patients treated with drugs alone. Cognitive flexibility and diagnostic category did not correlate. Poor insight corresponded with severe mental illness, particularly acute psychosis. Conclusions: Treatment setting specificity reflects psychopathology and severity. Insight is inversely proportional to illness severity and cognitive flexibility, which is also affected by psychopathology. Limitations comprise group heterogeneity, cross-sectional design, and limited sample size.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 5/20/2010 2:30:46 PM
Accepted: 6/10/2011
Published online: 5/22/2012

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 4

ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)

For additional information: http://www.karger.com/PSP


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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References

  1. Edelman GM: Neural Darwinism – The Theory of Neuronal Group Selection. New York, Basic Books, 1987.
  2. Lewis A: The psychopathology of insight. J Med Psychol 1934;14:332–348.

    External Resources

  3. Amador XF, Strauss DH, Yale SC, Gorman JM: Awareness of illness in schizophrenia. Schizophr Bull 1991;17:113–132.
  4. Raffard S, Bayard S, Gely-Nargeot MC, Capdevielle D, Maggi M, Barbotte E, Morris D, Boulenger JP: Insight and executive functioning in schizophrenia: a multidimensional approach. Psychiatry Res 2009;167:239–250.

    External Resources

  5. Cuesta MJ, Peralta V, Zarzuela A: Reappraising insight in psychosis. Multi-scale longitudinal study. Br J Psychiatry 2000;177:233–240.
  6. Donohoe G, Hayden J, McGlade N, O’Gráda C, Burke T, Barry S, Behan C, Dinan TG, O’Callaghan E, Gill M, Corvin AP: Is ‘clinical’ insight the same as ‘cognitive’ insight in schizophrenia? J Int Neuropsychol Soc 2009;15:471–475.

    External Resources

  7. Marková IS, Berrios GE: The meaning of insight in clinical psychiatry. Br J Psychiatry 1992;160:850–860.
  8. Marková IS, Berrios GE: The assessment of insight in clinical psychiatry: a new scale. Acta Psychiatr Scand 1992;86:159–164.
  9. Pompili M, Ruberto A, Kotzalidis GD, Girardi P, Tatarelli R: Suicide and awareness of illness in schizophrenia: an overview. Bull Menninger Clin 2004;68:297–318.

    External Resources

  10. Yen CF, Cheng CP, Ko CH, Yen JY, Huang CF, Chen CS: Suicidality and its association with insight and neurocognition in Taiwanese patients with bipolar I disorder in remission. J Nerv Ment Dis 2008;196:462–467.

    External Resources

  11. Appelbaum PS, Grisso T: MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR). Sarasota, Professional Resource Press, 2001.
  12. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(suppl 20):22–33.
  13. Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM: Assessment of insight in psychosis. Am J Psychiatry 1993;150:873–879.
  14. Amador XF, Strauss DH: The Scale to Assess Unawareness of Mental Disorder (SUMD). New York, Columbia University and New York State Psychiatric Institute, 1990.
  15. Overall JE: The brief psychiatric rating scale in psychopharmacology research; in Pichot P (ed): Psychological Measurements in Psychopharmacology. Mod Probl Pharmacopsychiatry. Basel, Karger, 1974, vol 7, pp 67–78.
  16. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
  17. Young RC, Biggs JT, Ziegler VE, Meyer DA: A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;133:429–435.
  18. Berg EA: A simple objective technique for measuring flexibility in thinking. J Gen Psychol 1948;39:15–22.
  19. Bayard S, Capdevielle D, Boulenger JP, Raffard S: Dissociating self-reported cognitive complaint from clinical insight in schizophrenia. Eur Psychiatry 2009;24:251–258.

    External Resources

  20. Buchy L, Czechowska Y, Chochol C, Malla A, Joober R, Pruessner J, Lepage M: Toward a model of cognitive insight in first-episode psychosis: verbal memory and hippocampal structure. Schizophr Bull 2010;36:1040–1049.
  21. Simon V, De Hert M, Wampers M, Peuskens J, van Winkel R: The relation between neurocognitive dysfunction and impaired insight in patients with schizophrenia. Eur Psychiatry 2009;24:239–243.

    External Resources

  22. Lepage M, Buchy L, Bodnar M, Bertrand MC, Joober R, Malla A: Cognitive insight and verbal memory in first episode of psychosis. Eur Psychiatry 2008;23:368–374.

    External Resources

  23. Copeland LA, Zeber JE, Salloum IM, Pincus HA, Fine MJ, Kilbourne AM: Treatment adherence and illness insight in veterans with bipolar disorder. J Nerv Ment Dis 2008;196:16–21.

    External Resources

  24. Mohamed S, Rosenheck R, McEvoy J, Swartz M, Stroup S, Lieberman JA: Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia. Schizophr Bull 2009;35:336–346.

    External Resources

  25. Drake R: Insight into illness: impact on diagnosis and outcome of nonaffective psychosis. Curr Psychiatry Rep 2008;10:210–216.

    External Resources

  26. Schwartz RC, Cohen BN, Grubaugh A: Does insight affect long-term impatient treatment outcome in chronic schizophrenia? Compr Psychiatry 1997;38:283–288.
  27. Colom F, Vieta E, Reinares M, Martínez-Arán A, Torrent C, Goikolea JM, Gastó C: Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement. J Clin Psychiatry 2003;64:1101–1105.
  28. Vieta E: Improving treatment adherence in bipolar disorder through psychoeducation. J Clin Psychiatry 2005;66(suppl 1):24–29.
  29. Pitschel-Walz G, Bäuml J, Bender W, Engel RR, Wagner M, Kissling W: Psychoeducation and compliance in the treatment of schizophrenia: results of the Munich Psychosis Information Project Study. J Clin Psychiatry 2006;67:443–452.
  30. Pekkala E, Merinder L: Psychoeducation for schizophrenia. Cochrane Database Syst Rev 2002;CD002831.
  31. Amador XF, Flaum M, Andreasen NC, Strauss DH, Yale SA, Clark SC, Gorman JM: Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry 1994;51:826–836.
  32. Pini S, de Queiroz V, Dell’Osso L, Abelli M, Mastrocinque C, Saettoni M, Catena M, Cassano GB: Cross-sectional similarities and differences between schizophrenia, schizoaffective disorder and mania or mixed mania with mood-incongruent psychotic features. Eur Psychiatry 2004;19:8–14.

    External Resources

  33. Yen CF, Chen CS, Yeh ML, Yen JY, Ker JH, Yang SJ: Comparison of insight in patients with schizophrenia and bipolar disorder in remission. J Nerv Ment Dis 2002;190:847–849.

    External Resources

  34. Yen CF, Chen CC, Cheng CP, Yen CN, Lin HC, Ko CH, Yen JY, Chen CS: Comparisons of insight in schizophrenia, bipolar I disorder, and depressive disorders with and without comorbid alcohol use disorder. Psychiatry Clin Neurosci 2008;62:685–690.

    External Resources

  35. Varga M, Babovic A, Flekkoy K, Ronneberg U, Landro NI, David AS, Opjordsmoen S: Reduced insight in bipolar I disorder: neurofunctional and neurostructural correlates. A preliminary study. J Affect Disord 2009;116:56–63.
  36. Engh JA, Friis S, Birkenaes AB, Jónsdóttir H, Ringen PA, Ruud T, Sundet KS, Opjordsmoen S, Andreassen OA: Measuring cognitive insight in schizophrenia and bipolar disorder: a comparative study. BMC Psychiatry 2007;7:71.
  37. Ghaemi SN, Boiman E, Goodwin FK: Insight and outcome in bipolar, unipolar, and anxiety disorders. Compr Psychiatry 2000;41:167–171.
  38. Yen CF, Chena CC, Leeb Y, Tanga TC, Koa CH, Yena JY: Insight and correlates among outpatients with depressive disorders. Compr Psychiatry 2005;46:384–389.

    External Resources

  39. David AS: On insight and psychosis: discussion paper. J R Soc Med 1990;83:325–329.
  40. David AS: Insight and psychosis. Br J Psychiatry 1990;156:798–808.
  41. McGlashan TH, Carpenter WT Jr: Postpsychotic depression in schizophrenia. Arch Gen Psychiatry 1976;33:231–239.
  42. Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, Krausz M, Lester D, Meltzer HY, Modestin J, Montross LP, Mortensen PB, Munk-Jørgensen P, Nielsen J, Nordentoft M, Saarinen PI, Zisook S, Wilson ST, Tatarelli R: Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry 2007;6:10.

    External Resources

  43. Meltzer HY, Alphs L, Green AI, Altamura AC, Anand R, Bertoldi A, Bourgeois M, Chouinard G, Islam MZ, Kane J, Krishnan R, Lindenmayer JP, Potkin S, International Suicide Prevention Trial Study Group: Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003;60:82–91 (erratum 60:735).
  44. Stuss DT, Benson DF, Clermont R, Della Malva CL, Kaplan EF, Weir WS: Language functioning after bilateral prefrontal leukotomy. Brain Lang 1986;28:66–70.
  45. Amador XF, Strauss DH: Poor insight in schizophrenia. Psychiatr Q 1993;64:305–318.
  46. Duffy JD, Campbell JJ III: The regional prefrontal syndromes: a theoretical and clinical overview. J Neuropsychiatr Clin Neurosci 1994;6:379–387.
  47. Cuesta MJ, Peralta V, Juan JA: Abnormal subjective experiences in schizophrenia: its relationships with neuropsychological disturbances and frontal signs. Eur Arch Psychiatry Clin Neurosci 1996;246:101–105.
  48. Kemp RA, Lambert TJ: Insight in schizophrenia and its relationship to psychopathology. Schizophr Res 1995;18:21–28.
  49. Bora E, Erkan A, Kayahan B, Veznedaroglu B: Cognitive insight and acute psychosis in schizophrenia. Psychiatry Clin Neurosci 2007;61:634–639.

    External Resources

  50. Cooke MA, Peters ER, Greenwood KE, Fisher PL, Kumari V, Kuipers E: Insight in psychosis: influence of cognitive ability and self-esteem. Br J Psychiatry 2007;191:234–237.

    External Resources

  51. Lysaker PH, Tsai J, Maulucci AM, Stanghellini G: Narrative accounts of illness in schizophrenia: association of different forms of awareness with neurocognition and social function over time. Consc Cogn 2008;17:1143–1151.

    External Resources

  52. De Hert MAF, Simon V, Vidovic D, Franic T, Wampers M, Peuskens J, van Winkel R: Evaluation of the association between insight and symptoms in a large sample of patients with schizophrenia. Eur Psychiatry 2009;24:507–512.
  53. Cuesta MJ, Peralta V: Lack of insight in schizophrenia. Schizophr Bull 1994;20:359–366.
  54. Collins AA, Remington GJ, Coulter K, Birkett K: Insight, neurocognitive function and symptom clusters in chronic schizophrenia. Schizophr Res 1997;27:37–44.
  55. Smith TE, Hull JW, Santos L: The relationship between symptoms and insight in schizophrenia: a longitudinal perspective. Schizophr Res 1998;33:63–67.
  56. Mintz AR, Dobson KS, Romney DM: Insight in schizophrenia: a meta-analysis. Schizophr Res 2003;61:75–88.
  57. Monteiro LC, Silva VA, Louzã MR: Insight, cognitive dysfunction and symptomatology in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2008;258:402–405.

    External Resources

  58. Jónsdóttir H, Engh JA, Friis S, Birkenaes A, Ringen PA, Vaskinn A, Sundet K, Opjordsmoen S, Andreassen OA: Measurement of insight in patients with bipolar disorder: are self-rated scales developed for patients with schizophrenia applicable? J Nerv Men Dis 2008;196:333–335.

    External Resources

  59. Varga M, Magnusson A, Flekkøy K, David AS, Opjordsmoen S: Clinical and neuropsychological correlates of insight in schizophrenia and bipolar I disorder: does diagnosis matter? Compr Psychiatry 2007;48:583–591.

    External Resources

  60. Aleman A, Agrawal N, Morgan KD, David AS: Insight in psychosis and neuropsychological function: meta-analysis. Br J Psychiatry 2006;189:204–212.