The relationship between cognitive insight and depression in psychosis and schizophrenia: A review and meta-analysis

Palmer, Emma; Gilleen, James; David, Anthony S.

doi:10.1016/j.schres.2015.05.032

Cited by 60 publications

(52 citation statements)

References 61 publications

(73 reference statements)

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“…The finding of a significant relationship between depression and underestimating one's interpersonal function is consistent with prior work in schizophrenia (Palmer et al, 2015) and with prior work showing that people with depressive symptoms often have a negative self-bias (Zahn et al, 2015). Further, we found that although depression levels were related to the patient's own report of interpersonal function, the discrepancy scores continued to relate to depression even when we used residualized change scores, as described in supplemental analyses.…”

Section: Discussionsupporting

confidence: 88%

“…Many individuals with schizophrenia also experience significant levels of depression (Avgustin, 2009, Bosanac and Castle, 2013), which is related to insight (Ampalam et al, 2012, Bowie et al, 2007, Gharabawi et al, 2007, Palmer et al, 2015). An extensive literature suggests that depressed people have a more realistic view, albeit often more negative, of themselves than non-depressed people (Soderstrom et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

“…This idea is termed “depressive realism” (Alloy and Abramson, 1979, Alloy and Abramson, 1988). An additional perspective is that patients who can comprehend more about how their illness negatively affects them (i.e., who have greater insight) become more depressed (Misdrahi et al, 2014, Palmer et al, 2015), a relationship termed the “insight paradox.” Both of these theories would suggest that depressed individuals with psychosis should have better insight. However, depression can also be associated with high levels of self-blaming and feelings of inadequacy and hopelessness (Zahn et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Self versus informant reports on the specific levels of functioning scale: Relationships to depression and cognition in schizophrenia and schizoaffective disorder

Ermel

Carter

Gold

et al. 2017

Schizophrenia Research: Cognition

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The goal of the current study was to examine the relationships between insight and both cognitive function and depression in schizophrenia and schizoaffective disorder, and to determine if there were similar relationships across diagnostic categories. We examined discrepancies between self and informant reports of function on the Specific levels of function scale as a metric of insight for interpersonal, social acceptance, work and activities. We examined two samples of individuals with schizophrenia and/or schizoaffective disorder (Ns of 188 and 67 respectively). In Sample 1, cognition was measured using the Dot Probe Expectancy Task. In Sample 2, cognition was measured by averaging several subtests from the MATRICS consensus cognitive battery, as well as additional measures of working memory. In both samples, depression was measured using the Brief Psychiatric Rating Scale. In both samples, we found significant relationships between worse cognition and overestimations of work function, as well as between higher depression levels and underestimation of interpersonal function. These relationships were specific to interpersonal and work function, with significantly stronger correlations with interpersonal and work function compared to the other areas of function. Similar results were found across diagnostic categories. These results have important implications for treatment planning, as they suggest the need to take into account depression and cognitive function when evaluating the patient's self-report of function, and highlight the utility of informant reports in evaluating function and treatment planning. Further, they add to the literature on the similarity across schizophrenia and schizoaffective disorder in a variety of pathological mechanisms.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Self versus informant reports on the specific levels of functioning scale: Relationships to depression and cognition in schizophrenia and schizoaffective disorder

Ermel

Carter

Gold

et al. 2017

Schizophrenia Research: Cognition

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“…A meta-analysis of 17 studies suggested that the self-reflection dimension of cognitive insight, but not the self-certainty dimension, was responsible for the associations with depression and emotional distress 92 . These findings indicate that how one thinks about oneself may be most proximally linked to the path from insight to depression.…”

Section: Good Cognitive Insight Is Associated With Depression and Poomentioning

confidence: 99%

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

et al. 2018

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Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.

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“…Patients with schizophrenia exhibit a wide range of cognitive dysfunctions,1 including deficits in working memory, verbal and spatial memory, motor and processing speed, attention, and executive function 2,3. Cognitive impairment determines the level of patients’ daily function and social-occupational outcome 4,5.…”

Section: Introductionmentioning

confidence: 99%

Validation of the Chinese version of Brief Assessment of Cognition in Schizophrenia

Wang¹,

Lin²,

Yu³

et al. 2016

NDT

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ObjectiveA test battery that measures cognitive function impairment in patients with schizophrenia, the Brief Assessment of Cognition in Schizophrenia (BACS), has been translated into various languages and validated. This study aimed to test the reliability and validity of the Chinese version of the BACS in a Chinese-speaking population.MethodsAll participants in this study (66 patients with schizophrenia [mean age: 41.2 years, 57.6% male] and 66 age- and sex-matched healthy controls) were from Taiwan and assessed using the BACS and the University of California, San Diego (UCSD) Performance-Based Skills Assessment, Brief Version (UPSA-B). Thirty-eight of the 66 patients with schizophrenia received a reassessment using the BACS.ResultsThe BACS had good test–retest reliability, and all BACS subtests had statistically insignificant practice effects. Principal components analysis demonstrated that a one-factor solution best fits our dataset (60.9% of the variance). In both patients and controls, the BACS composite scores were positively correlated with all BACS subscales (P<0.001) and UPSA-B scales (P<0.001). Furthermore, all BACS subtests (verbal memory, working memory, motor speed, verbal fluency, attention and processing speed, and executive function) significantly differentiated patients with schizophrenia from healthy controls (P<0.001), and the BACS composite score had the best discriminative validity (P<0.001).ConclusionThe Chinese version of the BACS exhibits satisfactory psychometric properties, including high test–retest reliability, high internal consistency, acceptable concurrent validity, and good discriminant validity. We suggest that the BACS is a reliable and practical tool for assessing cognitive function in patients with schizophrenia.

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The relationship between cognitive insight and depression in psychosis and schizophrenia: A review and meta-analysis

Cited by 60 publications

References 61 publications

Self versus informant reports on the specific levels of functioning scale: Relationships to depression and cognition in schizophrenia and schizoaffective disorder

Self versus informant reports on the specific levels of functioning scale: Relationships to depression and cognition in schizophrenia and schizoaffective disorder

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

Validation of the Chinese version of Brief Assessment of Cognition in Schizophrenia

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