Do Psychosis Patients with Poor Insight Show Implicit Awareness on the Emotional Stroop Task?

Abstract

Background: The insight into psychosis can be assessed reliably by clinicians from interviews with patients. However, patients may retain implicit awareness of illness while lacking explicit awareness. Sampling and Methods: In a sample of first-episode psychosis patients, we used a test of processing of mental illness-related and other negative words as a measure of implicit awareness to see how this varied in relation to insight. An emotional-counting Stroop task tested reaction times to words of three types: psychosis-related (e.g. ‘crazy'), general negative (e.g. ‘cancer') and neutral (e.g. ‘oyster'). Data were available from 43 patients and 23 healthy controls. Patients' insight was assessed using the Schedule for the Assessment of Insight (SAI-E). Results: Patients reacted slower than controls to words across all conditions, and both patients and controls reacted slower to salient and negative words than neutral words. There was a near significant interaction between word type and group (Wilks' lambda = 0.53, p = 0.055); patients experienced greater interference from negative rather than psychosis-related words (p = 0.003), and controls experienced greater interference from salient rather than negative words (p = 0.01). Within the patient group, there was a correlation between insight and interference on salient words (r = 0.33, p = 0.05), such that those with less insight experienced less interference on psychosis-related words. Conclusions: Psychosis-related words were less threatening and less self-relevant to psychosis patients with less insight. This suggests that the lack of awareness such patients have of their illness is genuine and more likely to be mediated by lower-level information processing mechanisms than strategies such as conscious, motivated denial.

Trauma and the psychosis spectrum: A review of symptom specificity and explanatory mechanisms

“…Trauma fits within this model, as those exposed to TLEs often disproportionately allocate attention to threatening stimuli, which consequently could lead to incorrect inferences in line with paranoid ideation (Sherrer, 2011). These biases in information processing, measured behaviorally (e.g., Emotional Stroop task) or neurophysiologically (e.g., EEG), have been found in traumatized (Caparos & Blanchette, 2014; Wingenfeld et al, 2011), psychotic disordered (Bendall et al, 2013b; Besnier et al, 2010; Kinderman, Prince, Waller, & Peters, 2003; Wiffen et al, 2013), CHR (Rosier et al, 2013; Nieman et al, 2014), and subclinical psychosis samples (Fisher et al, 2014b; Marks, Steel, & Peters, 2012). These populations have been found to have longer reaction times for threatening words, suggesting a general attention bias towards threatening stimuli (Bendall et al, 2013b; Cisler et al, 2011; Wiffen et al, 2013).…”

Attentional avoidance in peer victimized individuals with and without psychiatric disorders

“…However, von Ceumern-Lindenstjerna and colleagues (2010) could determine that an attentional bias towards negative faces was not due to Borderline personality disorder per-se but to an interaction between mood and the personality disorder, i.e., only patients with negative mood showed facilitated attention towards threatening stimuli [46]. Furthermore, attentional biases were demonstrated in patients with schizophrenia and psychotic disorders [47][48][49]. Again, attention was allocated towards disorder-related stimuli.…”

More work on lack of awareness and insight in healthy people and psychiatric patients will assist model building

“…Using the Stroop paradigm-along the lines of the authors' (Martyr et al, 2011)-we examined implicit awareness in people with psychosis. Unlike Alzheimer's disease, we demonstrated that psychosis patients did not show increased interference with psychosisrelated words (e.g., crazy, schizophrenic) as compared with physical-disease related words (e.g., cancer; Wiffen, O'Connor, Russo, et al, 2013). Furthermore, a measure of interference was positively associated with explicit awareness-unlike the lack of association or paradoxical dissociation between implicit and explicit awareness, which has driven much of the authors' model.…”