Insight, neurocognition and psychopathology in schizophrenia

Abstract

Introduction. In recent years, research has been aimed at finding variables mediating between neurocognition and psychosocial functioning in schizophrenia, proposing insight as one of these variables. Some authors have found associations between insight and functional outcome, and between insight and symptomatology, although these associations remain unclear. These different findings could be explained by the insight definition used. The current study evaluates insight unidimensionally and multidimensionally and studies its relationship with cognitive and psychopathological variables.

Methods. The sample consisted of 94 subjects admitted to an outpatient Psychosocial Rehabilitation Program, all diagnosed of schizophrenia according to ICD-10 diagnostic criteria. A brief version of the Neuropsychology Battery Test Barcelona and the Wisconsin Card Sorting Test were used to evaluate cognitive variables. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate psychopathology. Insight was assessed with the PANSS item «lack of judgment and insight», and with a semi-structured interview.

Results. Two insight factors were found, one including more specific knowledge about the disease and its consequences (cognitive factor), that is related to executive functions, and another referring to unspecific knowledge about suffering from an illness and the need for treatment (psychotic factor). Each factor was statistically related to positive symptoms and superior cognitive functions.

Conclusions. These findings support a relationship between insight and low cognitive performance.