Lack of insight in schizophrenia.

Psychiatric Unit of Virgen del Camino Hospital, Pamplona, Spain.
Schizophrenia Bulletin (Impact Factor: 8.61). 02/1994; 20(2):359-66. DOI: 10.1093/schbul/20.2.359
Source: PubMed

ABSTRACT A neuropsychological etiology has been suggested for lack of insight in schizophrenia patients, mainly based on frontal, right parietal, right hemisphere, or diffuse cerebral dysfunctions. The aim of this study ws to investigate the neuropsychological pathogeny of lack of insight in schizophrenia patients. We examined a sample of 40 DSM-III-R schizophrenia inpatients admitted because of a recrudescence of symptoms. Schizophrenic symptoms were evaluated through the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms. Neurologic explorations included an assessment of frontal neurologic signs, abnormal involuntary movements, and soft neurologic signs. Lack of insight was assessed through three items from the Manual for the Assessment and Documentation of Psychopathology (AMDP). A global index from these three items (lack of feeling ill, lack of insight, and uncooperativeness) was obtained. A neuropsychological battery composed of tests involving many functional areas of the brain was used. No correlation between bad performance and lack of insight was found on any test. On the contrary, lack of insight was associated with better performance on immediate verbal, immediate visual, and delayed visual memory tasks. Moreover, the three components of lack of insight were extracted as an independent factor when they were included together with the positive and negative symptoms, neurologic abnormalities (frontal and soft neurologic signs, and abnormal movements), and a global measure of cognitive performance. The results of the study do not support the neuropsychological hypothesis of lack of insight.(ABSTRACT TRUNCATED AT 250 WORDS)

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    ABSTRACT: The neurocognitive theory of insight posits that poor insight in psychotic illnesses is related to cognitive deficits in cognitive self-appraisal mechanisms. In this paper we perform a comprehensive meta-analysis examining relationships between clinical insight and neurocognition in psychotic disorders. We have also completed a meta-analysis of studies examining 'cognitive insight', as measured by the Beck Cognitive Insight Scale (BCIS), and its relationship with neurocognitive function in patients with psychosis. The clinical insight analysis included data from 72 studies and a total population of 5429 patients. We found that insight in psychosis was significantly associated with total cognition (r=0.16, p<0.001), IQ (r=0.16, p<0.001), memory (r=0.13, p<0.001) and executive function (r=0.14, p<0.001). All of these correlations were stronger when examined in patients with schizophrenia only. In the BCIS analysis we included 7 studies and 466 patients in total. We found that no significant associations were found between the self-reflectiveness sub-component and neurocognition. By contrast there were significant correlations between the self-certainty subcomponent and memory (r=-0.23, p<0.001), IQ (r=-0.19, p<0.001) and total cognition (r=-0.14, p=0.01). We did not find evidence of significant publication bias in any analyses. Overall, our results indicate that there is a small but significant relationship between clinical insight, some aspects of cognitive insight and neurocognition. These findings reflect the complexity of the insight construct and indicate that while the neurocognitive model is important it is likely to be one of many which contribute to the understanding of this phenomenon.
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    ABSTRACT: SUMMARY Objective: Deficit syndrome is a symptom complex that progresses with primary and persistent negative symptoms; therefore, it is difficult to diagnose. Low-level social functioning may be anticipated in patients with deficit schizophrenia. Moreover, lack of insight, which is another significant symptom of schizophrenia, is thought to occur more frequently in patients with deficit syndrome. The present study aimed to compare insight and social functioning in schizophrenia patients with and without deficit syndrome. Materials and Methods: The study included 71 outpatients that were followed-up at Eskişehir Osmangazi University, School of Medicine, Psychotic Disorders Polyclinic. All the patients were diagnosed as schizophrenia according to DSM-IV Axis I criteria via administration of the Structured Clinical Interview I (SCID-I). Participants were also evaluated using the Schedule for Deficit Syndrome (SDS), and were accordingly divided into 2 groups: deficit schizophrenia (n = 30) and non-deficit schizophrenia (n = 41). Additionally, the patients were assessed to determine if they had the paranoid subtype of schizophrenia. Both groups were administered the Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Schedule for Assessing the Three Components of Insight (SAI) and Personal and Social Performance Scale (PSP). Results: There were significantly more patients with the non-paranoid subtype in the deficit schizophrenia group than in the non-deficit schizophrenia group. Mean SAI and PSP scores were significantly lower, and mean SAPS and SANS scores were significantly higher in the deficit group than in the non-deficit group. Conclusion: The present findings indicate the importance of lack of insight and low-level social functioning in patients with deficit schizophrenia. Keywords: Schizophrenia, deficit syndrome, insight, social functioning
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