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RESEARCH WEEKLY: Cognition and Insight in Schizophrenia
By Shanti Silver
(October 5, 2022) People with schizophrenia often lack insight into having a mental illness. ‘Insight’ refers to a person’s ability to know that they have an illness, acknowledge that their symptoms are not normal, and recognize their need for treatment. People with schizophrenia who have lower levels of insight can have worse treatment outcomes, more severe symptoms and lower community functioning.
Research suggests that having poor insight (i.e., being unable to recognize that one has a mental illness) is a common symptom of psychotic disorders and is not a form of denial or a coping mechanism. However, causes of poor insight in schizophrenia are unclear and there are few treatment strategies that have been effective at improving insight in patients with schizophrenia.
A recent publication from Psychopathology explores cognitive processes that may contribute to poor insight in schizophrenia in hopes of finding results that can help in the development of interventions for people with schizophrenia.
Study Details
To identify specific elements of poor insight, researchers looked at three measures of cognition:
• Jumping to conclusions: the extent to which people draw conclusions with incomplete evidence
• Cognitive insight: the ability to recognize when one is wrong and correct wrong beliefs
• Theory of mind: the ability to understand other people’s thoughts, beliefs and emotions
These measures, along with clinical insight, were evaluated by a research psychiatrist or through performance on cognitive tasks like the Emotions Recognition Test.
Findings and Future Directions
Researchers found that participants who jumped to conclusions had lower recognition of having an illness. Additionally, those who had higher cognitive insight had better insight overall, as well as a better ability to label psychotic symptoms as abnormal. Theory of mind had no relation to insight. Additionally, none of the cognitive measures were associated with awareness of the need for treatment.
The results of this study suggest that cognitive insight and jumping to conclusions are two cognitive factors that contribute to insight in schizophrenia spectrum disorders. However, the researchers note that improving these cognitive abilities may not impact a person’s willingness to accept treatment given the lack of a relationship between these cognitive abilities and awareness of needing treatment. Thus, while these results may be useful in developing interventions to increase insight, further research will be needed to determine if these interventions are successful in improving insight and outcomes in people with schizophrenia.
References
Lopez-Morinigo, J. D., Escobedo-Aedo, P. J., Martínez, A. S. E., et al. (March 2022). Investigating the Contribution of Decision-Making, Cognitive Insight, and Theory of Mind in Insight in Schizophrenia: A Cross-Sectional Study. Psychopathology, 55(2), 104-115.
Lysaker, P.H., Pattison, M.L., Leonhardt, B.L., et al. (February 2018). Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry, 17(1):12-23.
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