Assessment of Cognitive Insight: A Qualitative Review

Department of Psychiatry, School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 03/2012; 38(2):338-50. DOI: 10.1093/schbul/sbq085
Source: PubMed


The concept of cognitive insight was introduced in 2004 to describe the capacity of patients with psychosis to distance themselves from their psychotic experiences, reflect on them, and respond to corrective feedback. The Beck Cognitive Insight Scale (BCIS) was developed to evaluate these aspects of cognitive flexibility and to complement scales that describe the lack of awareness of mental illness and its characteristics. The BCIS has generated a moderate research literature, which is the subject of the current review. Several independent groups have demonstrated that the BCIS is reliable, demonstrates convergent and construct validity, and distinguishes patients with psychosis from healthy controls and patients without psychosis. While the majority of the studies have focused on the relationship of the BCIS to delusions, several have examined its relationship to negative symptoms, depression, anxiety, and functional outcome. Cognitive insight has predicted positive gains in psychotherapy of psychosis, and improvement in cognitive insight has been correlated with improvement in delusional beliefs. Finally, preliminary findings relate neurocognition, metacognition, and social cognition, as well as reduced hippocampal volume to cognitive insight. A heuristic framework is presented to guide future research.

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Available from: Dimitri Perivoliotis, May 20, 2014
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    • "The initial paper presenting the BCIS by Beck et al., (2004) demonstrated that there was no correlation between psychosis patients' depression scores and any BCIS sub scale. This finding was replicated by (Pedrelli et al., 2004), but since these initial studies, a review of subsequent work has shown different results (Riggs et al., 2012), with selfreflection at least showing a reliable relationship with mood. "
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    ABSTRACT: Lack of insight is a commonly observed problem in patients with psychosis and schizophrenia. Clinical insight in patients has been associated with low mood. Cognitive insight is a recently defined concept, relating to the ability to self-reflect and the degree to which patients are over-confident regarding their interpretations of illness-related experiences, and is related to clinical insight. We therefore sought to investigate whether there is a positive relationship between cognitive insight and mood. A literature search identified 17 relevant papers published between 2004 and 2014. Our analysis indicated that there was a small but significant positive correlation between the composite index (CI) of the Beck Cognitive Insight Scale (BCIS) and depression scores, but this was driven by a significant positive relationship between depression and the BCIS self-reflection (SR) sub-scale, where low mood was related to higher SR scores. There was no significant relationship between the self-certainty sub-scale and depression. Post-hoc analysis indicated that different depression scales did not significantly affect the relationship with SR. Our results support the idea that cognitive insight is significantly related to mood in schizophrenia, and the effect size is similar to that between clinical insight and mood. Potential applications of this knowledge into treatment and rehabilitation are discussed and a model of cognitive insight is proposed. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 06/2015; 166(1-3). DOI:10.1016/j.schres.2015.05.032 · 3.92 Impact Factor
    • "Using these diagnostic tools, later development in the psychology of insight has been predominantly focused on research of cognitive deficits representing various neuropsychological changes related to pathological perception of internal and external reality (David, 1990; Smith et al., 2000; Beck et al., 2004; Keshavan et al., 2004; Aleman et al., 2006; Riggs et al., 2012). In this context, insight has been defined as a patient's current capacity to evaluate his or her anomalous experiences and atypical interpretations of events. "
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    ABSTRACT: Abstract According to recent research, disturbances of self-awareness and conscious experience have a critical role in the pathophysiology of schizophrenia, and in this context, schizophrenia is currently understood as a disorder characterized by distortions of acts of awareness, self-consciousness, and self-monitoring. Together, these studies suggest that the processes of disrupted awareness and conscious disintegration in schizophrenia might be related and represented by similar disruptions on the brain level, which, in principle, could be explained by various levels of disturbed connectivity and information disintegration that may negatively affect usual patterns of synchronous activity constituting adaptive integrative functions of consciousness. On the other hand, mental integration based on self-awareness and insight may significantly increase information integration and directly influence neural mechanisms underlying basic pathophysiological processes in schizophrenia.
    Reviews in the neurosciences 03/2015; 26(3). DOI:10.1515/revneuro-2014-0063 · 3.33 Impact Factor
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    • "As to the second question, we chose the BCIS since it has already been used in two Cognitive Behavioral Therapy (CBT) trials for improving cognitive insight, which demonstrated a potential signal in favor of the CBT [14] [33]. As suggested by Riggs et al. [38], insight might be a mediating variable in the psychosocial treatment of symptoms, and GSD-SZ might improve some sort of insight, whereby participants develop a better understanding of their illness. However, this process may take time and still develop after the intervention ends, which might explain, why our positive findings first emerge at 12 months. "
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    ABSTRACT: Poor insight has a negative impact on the outcome in schizophrenia; consequently, poor insight is a logical target for treatment. However, neither medication nor psychosocial interventions have been demonstrated to improve poor insight. A method originally designed for diabetes patients to improve their illness management, Guided Self-Determination (GSD), has been adapted for use in patients with schizophrenia (GSD-SZ). The purpose of this study was to investigate the effect on insight of GSD-SZ as a supplement to treatment as usual (TAU) as compared to TAU alone in outpatients diagnosed with schizophrenia. The design was an open randomized trial. The primary hypothesis was cognitive insight would improve in those patients who received GSD-SZ + TAU as assessed by the BCIS. We additionally explored whether the intervention led to changes in clinical insight, self-perceived recovery, self-esteem, social functioning and symptom severity. Assessments were conducted at baseline, and at 3-, 6- and 12-month follow-up. Analysis was based on the principles of intention to treat and potential confounders were taken into account through applying a multivariate approach. A total of 101 participants were randomized to GSD-SZ + TAU (n = 50) or to TAU alone (n = 51). No statistically significant differences were found on the cognitive insight. However, at 12-month follow-up, clinical insight (measured by G12 from the Positive and Negative Syndrome Scale), symptom severity, and social functioning had statistically significantly improved in the intervention group as compared to the control group. “Improving insight in patients diagnosed with schizophrenia”, NCT01282307,
    European Psychiatry 01/2015; 30(5). DOI:10.1016/j.eurpsy.2014.12.007 · 3.44 Impact Factor
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