Assessment of cognitive insight: a qualitative review.

The concept of cognitive insight was introduced in 2004 to describe the capacity of patients with psychosis to distance themselves from their psychotic experiences, reflect on them, and respond to corrective feedback. The Beck Cognitive Insight Scale (BCIS) was developed to evaluate these aspects of cognitive flexibility and to complement scales that describe the lack of awareness of mental illness and its characteristics. The BCIS has generated a moderate research literature, which is the subject of the current review. Several independent groups have demonstrated that the BCIS is reliable, demonstrates convergent and construct validity, and distinguishes patients with psychosis from healthy controls and patients without psychosis. While the majority of the studies have focused on the relationship of the BCIS to delusions, several have examined its relationship to negative symptoms, depression, anxiety, and functional outcome. Cognitive insight has predicted positive gains in psychotherapy of psychosis, and improvement in cognitive insight has been correlated with improvement in delusional beliefs. Finally, preliminary findings relate neurocognition, metacognition, and social cognition, as well as reduced hippocampal volume to cognitive insight. A heuristic framework is presented to guide future research.

[1]  Hok Pan Yuen,et al.  Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features , 2004, Schizophrenia Research.

[2]  V. Morozov GENERAL PSYCHOPATHOLOGY , 1951, Zhurnal nevropatologii i psikhiatrii imeni S.S. Korsakova.

[3]  N. Short Schizophrenia: Cognitive Theory, Research and Therapy , 2010 .

[4]  T. Tenhave,et al.  Mediation Analysis: A Retrospective Snapshot of Practice and More Recent Directions , 2009, The Journal of general psychology.

[5]  O. Andreassen,et al.  Delusions are associated with poor cognitive insight in schizophrenia. , 2010, Schizophrenia bulletin.

[6]  O. Andreassen,et al.  Measuring cognitive insight in schizophrenia and bipolar disorder: a comparative study , 2007, BMC psychiatry.

[7]  M. Lepage,et al.  Insight in first episode psychosis: who is measuring what? , 2008, Early intervention in psychiatry.

[8]  A. Beck,et al.  A new instrument for measuring insight: the Beck Cognitive Insight Scale , 2004, Schizophrenia Research.

[9]  Paul M. Grant,et al.  Cognitive insight predicts favorable outcome in cognitive behavioral therapy for psychosis , 2010 .

[10]  Joel M. Martin,et al.  Cognitive insight and delusion proneness: An investigation using the Beck Cognitive Insight Scale , 2006, Schizophrenia Research.

[11]  D. Umbricht,et al.  Cognitive functioning in the schizophrenia prodrome. , 2007, Schizophrenia bulletin.

[12]  J. Haro,et al.  Adaptation and validation of the quality-of-life scale: Satisfaction with Life Domains Scale by Baker and Intagliata. , 2009, Comprehensive psychiatry.

[13]  W. Fenton,et al.  Measurement and Treatment Research to Improve Cognition in Schizophrenia: NIMH MATRICS initiative to support the development of agents for improving cognition in schizophrenia , 2004, Schizophrenia Research.

[14]  Y. Kao,et al.  The Beck Cognitive Insight Scale (BCIS): translation and validation of the Taiwanese version , 2010, BMC psychiatry.

[15]  E. Granholm,et al.  Therapeutic Factors Contributing to Change in Cognitive-Behavioral Group Therapy for Older Persons with Schizophrenia , 2006, Journal of Contemporary Psychotherapy.

[16]  E. Chung,et al.  Cross-Cultural Validation of the Beck Cognitive Insight Scale in Korean , 2007 .

[17]  A. Beck,et al.  Cognitive insight: theory and assessment , 2004 .

[18]  M. Lepage,et al.  Cognitive insight and verbal memory in first episode of psychosis , 2008, European Psychiatry.

[19]  R. Buchanan,et al.  A separate disease within the syndrome of schizophrenia. , 2001, Archives of general psychiatry.

[20]  Philip D. Harvey,et al.  Determinants of everyday outcomes in schizophrenia: The influences of cognitive impairment, functional capacity, and symptoms , 2009, Schizophrenia Research.

[21]  A. David,et al.  Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders , 2004 .

[22]  K. Dobson,et al.  Insight in schizophrenia: a meta-analysis , 2003, Schizophrenia Research.

[23]  S. Kay,et al.  The positive and negative syndrome scale (PANSS) for schizophrenia. , 1987, Schizophrenia bulletin.

[24]  A. Lewis The psychopathology of insight , 1934 .

[25]  A. Beck,et al.  Cognitive Insight in Inpatients with Psychotic, Bipolar, and Major Depressive Disorders , 2006 .

[26]  E. Granholm,et al.  Effortful cognitive resource allocation and negative symptom severity in chronic schizophrenia. , 2007, Schizophrenia bulletin.

[27]  M. Slade,et al.  A self‐report Insight Scale for psychosis: reliability, validity and sensitivity to change , 1994, Acta psychiatrica Scandinavica.

[28]  Thomas E. Smith,et al.  Anxiety and Schizophrenia: The Interaction of Subtypes of Anxiety and Psychotic Symptoms , 2005, CNS Spectrums.

[29]  E. Granholm,et al.  A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. , 2005, The American journal of psychiatry.

[30]  Kazunori Matsumoto,et al.  Psychometric properties of the Japanese version of the Beck Cognitive Insight Scale: Relation of cognitive insight to clinical insight , 2009, Psychiatry and clinical neurosciences.

[31]  A. Beck,et al.  Depression: Causes and Treatment , 1967 .

[32]  W. Mak,et al.  Cognitive insight and causal attribution in the development of self-stigma among individuals with schizophrenia. , 2006, Psychiatric services.

[33]  J. Pruessner,et al.  Toward a model of cognitive insight in first-episode psychosis: verbal memory and hippocampal structure. , 2010, Schizophrenia bulletin.

[34]  P. Lysaker,et al.  Cognitive insight and psychotic disorder: The impact of active delusions , 2007, Schizophrenia Research.

[35]  E. Bora,et al.  Cognitive insight and acute psychosis in schizophrenia , 2007, Psychiatry and clinical neurosciences.

[36]  P. Chadwick,et al.  Pathways to Defense of the Self: A Theory of Two Types of Paranoia , 1995 .

[37]  R. Porter,et al.  Illustrations of Madness , 1989 .

[38]  W. Mak,et al.  Cognitive Insight and Causal Attribution in the Development of Self-Stigma Among Individuals With Schizophrenia , 2006 .

[39]  G. Dimaggio,et al.  Metacognition in Schizophrenia: Associations With Multiple Assessments of Executive Function , 2008, The Journal of nervous and mental disease.

[40]  R. Gur,et al.  Facial emotion recognition in schizophrenia: intensity effects and error pattern. , 2003, The American journal of psychiatry.

[41]  Y. Khazaal,et al.  The Beck Cognitive Insight Scale in Outpatients with Psychotic Disorders: Further Evidence from a French-Speaking Sample , 2008, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[42]  P. Chadwick,et al.  The revised Beliefs About Voices Questionnaire (BAVQ-R). , 2000, The British journal of psychiatry : the journal of mental science.

[43]  D. Penn,et al.  A randomized controlled trial of group cognitive-behavioral therapy vs. enhanced supportive therapy for auditory hallucinations , 2009, Schizophrenia Research.

[44]  E. Granholm,et al.  Measuring cognitive insight in middle-aged and older patients with psychotic disorders , 2004, Schizophrenia Research.

[45]  M. Lepage,et al.  Delusions are associated with low self-reflectiveness in first-episode psychosis , 2009, Schizophrenia Research.

[46]  A. Beck,et al.  Depression: Causes and treatment, 2nd ed. , 2009 .

[47]  W. Carpenter,et al.  Deficit and nondeficit forms of schizophrenia: the concept. , 1988, The American journal of psychiatry.

[48]  J. Gorman,et al.  Assessment of insight in psychosis. , 1993, The American journal of psychiatry.

[49]  E. Knudsen Fundamental components of attention. , 2007, Annual review of neuroscience.

[50]  P. Lysaker,et al.  Cognitive insight in non-psychiatric individuals and individuals with psychosis: An examination using the Beck Cognitive Insight Scale , 2010, Schizophrenia Research.

[51]  Henry,et al.  Understanding and assessing insight , 2004 .

[52]  H. Kraemer,et al.  Mediators and moderators of treatment effects in randomized clinical trials. , 2002, Archives of general psychiatry.