Neuropsychological and psychopathological variables modulating cognitive insight in people with schizophrenia

Cognitive insight is the capacity of patients with schizophrenia to evaluate their psychotic experiences and respond to the corrective feedback. The relationship with their neuropsychological functions and the modulation exercised by mood and anxiety are still not clear. To make advances and deepen our knowledge would have an important impact on our understanding of the cognitive mechanisms and intervention programmes. Two samples were chosen, one clinical with persons suffering from schizophrenia (n = 43) and another with healthy individuals (n = 50). The Cognitive Insight Scale (BCIS), a neuropsychological battery and questionnaire concerning depression and anxiety, was applied to them. The results suggest an influence of anxiety and the deficits in cognitive flexibility on the development of the mechanisms of Self-Reflection in persons with schizophrenia, with a different pattern to that found in healthy individuals. The results are discussed with respect to the intervention programmes. El insight cognitivo es la capacidad de los pacientes con esquizofrenia de evaluar sus experiencias psicóticas y responder a la retroalimentación correctiva. Su relación con el funcionamiento neuropsicológico y la modulación que ejercen el estado de ánimo y la ansiedad están aún poco claras. Avanzar y profundizar en su conocimiento tendría un impacto importante sobre la comprensión de los mecanismos cognitivos y los programas de intervención. Se seleccionaron dos muestras, muestra clínica, con personas con esquizofrenia (n = 43), muestra personas sanas (n = 50), a las que se aplicó la Escala de insight cognitivo (EICB), una batería neuropsicológica y cuestionarios de depresión y ansiedad. Los resultados sugieren una influencia de la ansiedad y de los déficits de flexibilidad cognitiva en el desarrollo de los mecanismos de la Auto-Reflexión en personas con esquizofrenia, con un patrón diferente al encontrado en personas sanas. Se discuten los resultados con respecto a los programas de intervención.

Improvement of Insight with Non-Invasive Brain Stimulation in Patients with Schizophrenia: A Systematic Review

Patients with schizophrenia are often unaware of their condition and the consequences of their illness. This lack of insight results in impaired functioning, treatment non-adherence and poor prognosis. Here, we aimed to investigate the effects of non-invasive brain stimulation (NIBS) on two forms of insight, clinical and cognitive, in patients with schizophrenia. We conducted a systematic review of the literature registered in the PROSPERO database (CRD42020220323) according to PRISMA guidelines. The literature search was conducted in Medline and Web of Science databases based on studies published up until October 2020 that included pre-NIBS and post-NIBS measurements of clinical and/or cognitive insight in adults with schizophrenia. A total of 14 studies were finally included, and their methodological quality was assessed by using the QualSyst tool. Despite the lack of well-conducted large randomized-controlled studies using insight as the primary outcome, the available findings provide preliminary evidence that NIBS can improve clinical insight in patients with schizophrenia, with a majority of studies using transcranial direct current stimulation with a left frontotemporal montage. Further studies should investigate the effect of NIBS on insight as a primary outcome and how these effects on insight could translate into clinical and functional benefits in patients with schizophrenia.

Relationship Between Cognitive and Clinical Insight at Different Durations of Untreated Attenuated Psychotic Symptoms in High-Risk Individuals at Risk

Background: This study examines whether cognitive insight is impaired in high-risk individuals with attenuated psychotic symptoms (APS) and explores the relationship between cognitive and clinical insight at different durations of untreated attenuated psychotic symptoms (DUAPS).Methods: The Structured Interview for Psychosis high-risk Syndrome (SIPS) was used to identify APS individuals. APS (n = 121) and healthy control (HC, n = 87) subjects were asked to complete the Beck Cognitive Insight Scale (BCIS). Clinical insight of APS individuals was evaluated using the Schedule for Assessment of Insight (SAI). APS individuals were classified into four subgroups based on DUAPS, including 0–3, 4–6, 7–12, and >12 months. Power analysis for significant correlation was conducted using the WebPower package in R.Results: Compared with HC subjects, APS individuals showed poorer cognitive insight, with lower scores on BCIS self-reflectiveness and composite index (BCIS self-reflectiveness minus BCIS self-certainty). Only when DUAPS was longer than 12 months did the significant positive correlation between cognitive and clinical insight obtain the power about 0.8, including the associations between self-reflectiveness and awareness of illness, self-reflectiveness and the total clinical insight, and composite index and awareness of illness. The positive associations of composite index with awareness of illness within 0–3 months DUAPS and with the total score of SAI when DUAPS > 12 months were significant but failed to obtain satisfactory power.Conclusions: APS individuals may have impaired cognitive insight, demonstrating lower self-reflectiveness. The correlation between cognitive and clinical insight is associated with the duration of untreated attenuated psychotic symptoms.

Unusual experiences and their association with metacognition: investigating ASMR and Tulpamancy

Background: Unusual experiences in Tulpamancer and Autonomous Sensory Meridian Response (ASMR) communities are generally positive and sought after, unlike hallucinations and delusions in clinical populations. Metacognition, the ability to reflect on self-referential experiences, may aid sense-making around unusual experiences, reducing distress. This study investigated group differences in hallucination-proneness, delusion-proneness, and metacognition in these communities compared to controls, and whether metacognition predicted unusual experiences. Methods: 243 participants reporting ASMR, Tulpamancy, or neither, with no history of psychosis, took part in an online observational study. Participants completed the Beck Cognitive Insight Scale, Metacognitions Questionnaire-30, and Brief Core Schema Scales to capture metacognition. A Tulpamancer+ (reporting ASMR) group was identified and included in analyses. ANCOVAs highlighted group differences in hallucination-proneness, with Tulpamancer+ scoring higher, and metacognitive beliefs, with Tulpamancers reporting lower metacognitive belief endorsement. There were no group differences in delusion-proneness, self-reflection, or self-schemas. Stepwise regression demonstrated metacognition does influence unusual experiences in the non-clinical population, and this influence varies across groups. Conclusions: In non-clinical populations, unusual sensory experiences are not associated with increased metacognitive beliefs, but having multiple unusual experiences is associated with higher hallucination-proneness. Results suggest improving metacognition in clinical groups may help reduce distress related to unusual sensory experiences.

APPLICATION OF EXECUTIVE FUNCTION TRAINING AND ITS IMPACT ON COGNITIVE INSIGHT IN PATIENTS WITH SCHIZOPHRENIA

Aim: To assess the effect of executive function re-training on cognitive insight among patients with Schizophrenia. 10 patients with Methodology: schizophrenia (diagnosed as per ICD-10 criteria) having signicant cognitive decits and compliant to intervention were assessed on Executive dysfunctions (Stroop test), and Beck's Cognitive insight Scale (BCIS). These were followed by Executive function training to the participants randomly assigned to the Experimental Group while the remaining 5 formed the control group. Both the groups went through post assessment on the same variables. In the test of executive functioning the experimental group Result: who had received executive function training had performed signicantly better than the control group of patients in the study (p<0.05), and that on BCIS the domains of self-reectiveness, self-certainty and composite index showed signicant improvement post intervention as compared to control group (p<0.01). The present study Conclusions: suggests that in patients with schizophrenia having poor cognitive exibility and executive dysfunction, the executive function retraining improves the executive functioning and signicantly impacts the cognitive insight.