Neurocognitive insight, treatment utilization, and cognitive training outcomes in schizophrenia

Abstract

Background The degree to which people with schizophrenia show awareness of cognitive dysfunction and whether this neurocognitive insight affects treatment use or outcome is understudied. We aimed to examine neurocognitive insight among a treatment-seeking sample of patients with psychotic disorders, and whether neurocognitive insight affected treatment utilization or outcome. Method 69 individuals with schizophrenia-spectrum disorders enrolled in a trial comparing Compensatory Cognitive Training (CCT) to standard pharmacotherapy. Participants with objective cognitive impairment were identified and grouped into “intact” vs. “impaired” neurocognitive insight groups. These groups were then compared via ANCOVA on three treatment utilization variables and six post-treatment cognitive/functional variables. Results 43 participants demonstrated objective cognitive impairment. Among those individuals, 31 were considered to have intact neurocognitive insight and 12 showed impaired neurocognitive insight. These two groups did not differ on CCT attendance, satisfaction with the intervention, or self-reported cognitive strategy use at post-treatment. There were significant treatment group by neurocognitive insight group interactions for verbal memory and functional capacity outcomes, such that individuals with impaired neurocognitive insight who received treatment performed better than those who did not receive treatment. Conclusions Even among individuals who self-select into a cognitive treatment study, many show minimal awareness of cognitive dysfunction. Impaired neurocognitive insight, however, was not associated with decreased treatment utilization, and was associated with positive treatment outcomes in some cognitive domains as well as functional capacity. As cognitive training treatments become increasingly available, impaired neurocognitive insight need not be a barrier to participation.

Self-Awareness Deficits of Cognitive Impairment in Individuals With Schizophrenia. Really?

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A new perspective on the role of the CREB family of transcription factors in memory consolidation via adult hippocampal neurogenesis

“…In addition, some neuropsychiatric or neurodegenerative diseases such as depression (Zaninotto et al, 2015 ), schizophrenia (Burton and Twamley, 2015 ), and AD (Takeda et al, 2014 ) are associated with memory loss. In this regard, CREB has been postulated to change the sensitivity of the nucleus accumbens to rewarding and aversive drugs (Bilbao et al, 2014a , b ).…”

Cognitive Impairment in Schizophrenia: Description and Cognitive Familiar Endophenotypes. A Review of the Literature

“…Those who are better aware of their deficits are not associated with a lower use of treatment, nor with a lesser deterioration of executive function. But they do have better results in the rehabilitation of some cognitive domains, in adherence to treatment and in their functional capacity [41,42].…”