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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    • "Individuals with psychotic disorders tend to show a lack of insight that impacts psychosocial functioning, symptom expression , and treatment outcomes (Mohamed et al., 2009; Riggs et al., 2012; Lysaker et al., 2013). In recent years, researchers have contrasted two kinds of insight: clinical insight and cognitive insight (Donohoe et al., 2009; Lysaker et al., 2013). "
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    ABSTRACT: Cognitive insight is implicated in the formation and maintenance of hallucinations and delusions. However, it is not yet known whether cognitive insight relates to broader outcome measures like quality of life. In the current study, we investigated whether the component elements of cognitive insight—self-certainty and self-reflectiveness—were related to quality of life for 43 outpatients with schizophrenia or schizoaffective disorder. Cognitive insight was assessed using the Beck Cognitive Insight Scale (BCIS) while quality of life was assessed with Quality of Life Scale (QLS). We tested whether this relationship was moderated by clinical insight and symptom severity using the Scale to Assess Unawareness of Mental Disorder (SUMD) and the Positive and Negative Syndrome Scale (PANSS). We found that self- reflectiveness had an unmoderated positive relationship with quality of life. Self-certainty was associated with better quality of life for people with more severe symptoms. Theoretical and clinical implications of these findings are discussed and areas of future research are proposed.
    Full-text · Article · Nov 2015 · Psychiatry Research
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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.
    Full-text · Article · Jun 2015 · Schizophrenia Research
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    • "Nevertheless, the results suggest that the VLPFC is one brain region that appears to support Self-Reflectiveness in FES. Cognitive insight has been linked to several other variables including psychopathology, clinical insight and functional outcome, among others (Riggs et al., 2012). Future work may apply multivariate statistical models to explore latent factors and mediating relations between these variables and cognitive insight in schizophrenia. "
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    ABSTRACT: In people with psychoses, Self-Reflectiveness may rely on the right ventrolateral prefrontal cortex (VLPFC). We used functional magnetic resonance imaging (fMRI) and a novel virtual reality paradigm to evaluate the role of the VLPFC for Self-Reflectiveness in 25 first-episode of schizophrenia (FES) participants and 24 controls. Participants first viewed 20 characters each paired with a unique object/location, and later completed source memory judgements during fMRI scanning. Self-Reflectiveness, measured with the Beck Cognitive Insight Scale, was significantly and positively correlated to activation in bilateral VLPFC in FES, but not in controls, providing further evidence that the VLPFC supports Self-Reflectiveness in FES.
    Full-text · Article · May 2015 · Schizophrenia Research
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