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Dong M, Wu D, Mao G, Yan Z. Association between cognitive insight and anxiety among community-dwelling schizophrenia patients: the chain mediating effects of family cohesion and chronotype. Front Psychiatry 2024; 15:1371431. [PMID: 39267698 PMCID: PMC11391349 DOI: 10.3389/fpsyt.2024.1371431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/17/2024] [Indexed: 09/15/2024] Open
Abstract
Objective To investigate the effect of cognitive insight on anxiety in community-dwelling schizophrenia patients and to construct a chain mediating model to determine the underlying mechanisms of the relationship between cognitive insight and anxiety through family cohesion and chronotype. Methods The Beck Cognitive Insight Scale, the Chinese version of the Family Adaptability and Cohesion Scale, the Morningness-Eveningness Scale, and the Generalized Anxiety Disorder Scale were used to assess cognitive insight, family cohesion, chronotype, and anxiety in a sample of 785 individuals with schizophrenia living in the community. Spearman correlation analysis, multiple linear regression and Bootstrap methods were employed to analyze the four variables. Results Residential region, current employment status, and family economic status impacted anxiety among community-dwelling schizophrenia patients. All variables were associated with each other, but self-certainty was not significantly associated with anxiety. Cognitive insight and self-reflection had direct effects on anxiety, as well as indirect effects on anxiety through the partial mediating effect of chronotype, the suppressing effect of family cohesion, and the chain mediating effect of family cohesion and chronotype. Conclusions Family cohesion and chronotype can mediate the relationship between cognitive insight and anxiety. Improving family functioning, promoting emotional relationships within families, and correcting non-circadian sleep patterns can reduce anxiety in community-dwelling schizophrenia patients, with important implications for improving adverse mental health outcomes.
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Affiliation(s)
- Meijun Dong
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongmei Wu
- Nursing Department, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Guoju Mao
- Nursing Department, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhangrong Yan
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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2
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Kikutani M, Takiguchi Y, Ebina K, Matsui M. The relationship between script memory for everyday events and schizotypy: an investigation through a development of Japanese Situational Feature Recognition Test. Front Psychiatry 2024; 15:1345789. [PMID: 38983369 PMCID: PMC11231421 DOI: 10.3389/fpsyt.2024.1345789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/23/2024] [Indexed: 07/11/2024] Open
Abstract
Background Script memory is stored information about a sequential structure of an activity (e.g., going shopping), including what actors do, the purpose of the activity, and the likely consequences of the actor's actions. It has been reported that script memory is impaired among schizophrenia patients. The present research investigated the relationship between schizotypal personality tendencies (schizotypy) and script memory by testing Japanese individuals. Method First, a new test to measure the intactness of the script memory was created by asking the public to report activities they often perform and what behaviors each activity contains. The test contains 15 everyday activities, each accompanied by 15 behavior choices, either strongly associated, completely unrelated, or weakly associated with the activity. Next, undergraduate participants were presented with the test and chose appropriate behaviors for each activity (Study 1 and 2). Their extent of schizotypy was measured using Schizotypal Personality Questionnaire Brief (SPQ-B). Study 3 targeted the public of various ages. In addition to Study 2 procedure, participants reported the extent of psychological burden for performing each activity, their life satisfaction, and subjective evaluation of their memory ability. Results All studies consistently found that the script memory performance was worse for individuals with higher schizotypy. Signal detection indices for accurate discrimination between correct and incorrect choices, which were A' in Study 1 and C in Study 2 and 3, negatively correlated with the SPQ-B scores (r = -0.16, -0.11, -0.17, respectively). Study 3 found that the relationship between schizotypy and memory task performance was mediated by the extent of psychological burden. When a signal detection index (d') for the memory task was regressed on the SPQ-B, while the psychological burden scores being a mediator, the mediation effect was significant (B = 0.003, SE = 0.001, 95% CI [0.001, 0.005]). Conclusion Individuals with higher schizotypy seem to associate unrelated behaviors to an event, forming script memory with irrelevant information, maybe due to the schizotypy symptom of having peculiar thoughts. The newly created test must be validated using a clinical population to expand its potential to be used in clinical research.
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Affiliation(s)
- Mariko Kikutani
- Institute of Liberal Arts and Science, Kanazawa University, Ishikawa, Japan
| | - Yuta Takiguchi
- Institute of Liberal Arts and Science, Kanazawa University, Ishikawa, Japan
| | - Kota Ebina
- Institute of Liberal Arts and Science, Kanazawa University, Ishikawa, Japan
| | - Mie Matsui
- Institute of Liberal Arts and Science, Kanazawa University, Ishikawa, Japan
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Webster L, Norman C, Jones G, Marriott M. Mediating role for metacognitive processes in the relationship between schizotypy and anxiety and depression symptoms. Cogn Neuropsychiatry 2022; 27:393-410. [PMID: 35975632 DOI: 10.1080/13546805.2022.2108388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Depression and anxiety symptoms are highly prevalent in schizophrenia-spectrum disorders and are commonly associated with schizotypy in non-clinical samples. However, it remains unclear what factors could be contributing to the relationships between schizotypy and anxiety and depression symptoms. Using path analysis, we explored the complex interplay between schizotypy, metacognitive beliefs, cognitive insight, and symptoms of emotional distress.Methods: Self-report data of schizotypy, metacognitive beliefs, cognitive insight, depression, and anxiety symptoms were collected from 344 participants from a predominantly student sample.Results: Path analysis confirmed unique associations between schizotypy dimensions, metacognitive beliefs, and cognitive insight. Furthermore, negative beliefs about worry mediated the link between the schizotypy dimensions, unusual experiences, cognitive disorganisation, and introvertive anhedonia and both depression and anxiety symptoms. Lack of cognitive confidence also mediated the relationship between cognitive disorganisation and depression symptoms. Finally, the cognitive insight subcomponent self-reflectiveness mediated the relationship between unusual experiences and cognitive disorganisation and anxiety.Conclusions: This study significantly furthers our understanding of the complex relationship between schizotypy, metacognitive processes, and emotional distress. Our findings also provide support for interventions which modify metacognitive beliefs and self-reflectiveness, which may prove beneficial for treatment in clinical settings.
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Affiliation(s)
- Lucy Webster
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Christine Norman
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Gary Jones
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Mike Marriott
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
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Prasannakumar A, Korann V, Jacob A, Bharath RD, Kumar V, Varambally S, Venkatasubramanian G, Rao NP. Relation between frontal pole volumes and cognitive insight in Schizophrenia. Asian J Psychiatr 2022; 76:103204. [PMID: 35907267 DOI: 10.1016/j.ajp.2022.103204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/03/2022] [Accepted: 07/11/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cognitive insight comprising self-reflection and self-certainty is an important determinant of functional outcomes in Schizophrenia. The neural correlates of cognitive insight in Schizophrenia are underexamined. The frontal pole (FP) is implicated in metacognitive function in healthy individuals, but its role is not well examined in Schizophrenia. We had earlier reported the relationship between Frontal pole volumes and cognitive insight in a small sample of only male patients. Hence, we studied this relationship in an independent sample of schizophrenia patients and healthy controls. METHODS We examined 41 healthy volunteers (HV) and 57 patients with Schizophrenia (SCZ). We used a previously validated manual morphometric method to perform FP parcellation on images obtained from a 3 T scanner and calculated the volumes. Cognitive insight was measured using Beck's Cognitive insight scale (BCIS). To assess the relationship between FP volumes and BCIS scores, multiple linear regression analyses were performed. RESULTS In the overall sample, age, years of education, and intracranial volume were significant predictors of BCIS scores. Within the SCZ group, age and left FP volume were significant predictors of BCIS composite scores and age, ICV for BCIS-self certainty. There was no significant relationship between age and FP volumes in either SCZ or HV group. DISCUSSION The current study in an independent sample further supports the critical role of the frontal pole in cognitive insight, earlier reported by us. As cognitive insight has a vital role in functional outcome, our findings have potential clinical implications.
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Affiliation(s)
- Akash Prasannakumar
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Vittal Korann
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Arpitha Jacob
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rose Dawn Bharath
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Vijay Kumar
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Shivarama Varambally
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Naren P Rao
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
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Xu L, Cui H, Wei Y, Qian Z, Tang X, Hu Y, Wang Y, Hu H, Guo Q, Tang Y, Zhang T, Wang J. Relationships between self-reflectiveness and clinical symptoms in individuals during pre-morbid and early clinical stages of psychosis. Gen Psychiatr 2022; 35:e100696. [PMID: 35721834 PMCID: PMC9161056 DOI: 10.1136/gpsych-2021-100696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Self-reflectiveness, one dimension of cognitive insight, plays a protective role in an individual's mental state. Both high and low levels of self-reflectiveness have been reported in patients with schizophrenia and individuals at clinical high risk for the illness. Aims This study aimed to explore the relationship patterns between self-reflectiveness and clinical symptoms in individuals during the pre-morbid and early clinical stages of psychosis. Methods A total of 181 subjects, including individuals with attenuated positive symptoms (APS, n=122) and patients with first-episode psychosis (FEP, n=59), completed the Beck Cognitive Insight Scale and were evaluated using the Schedule of Assessment of Insight and Positive and Negative Syndrome Scale. All subjects were classified into three groups according to their level of self-reflectiveness: low level (LSR, n=59), medium level (MSR, n=67) and high level (HSR, n=55). Both linear and non-linear relationships between self-reflectiveness and clinical symptoms were explored. Results More individuals with APS were classified into the MSR group, while more patients with FEP were classified into the LSR group. The LSR group demonstrated less awareness of illness than the MSR and HSR groups, more stereotyped thinking and poorer impulse control but less anxiety than the MSR group, and lower levels of blunted affect and guilt feelings than the HSR group. The MSR group demonstrated lower stereotyped thinking than the HSR group. Compared to the LSR group, the MSR group had increased self-reflectiveness, improved awareness of illness, decreased stereotyped thinking, and better impulse control, but increased feelings of guilt. The HSR group showed increased stereotyped thinking when compared to the MSR group, but the other variables did not change significantly between these two groups. Overall, self-reflectiveness demonstrated an approximately inverse S-shaped relationship with the awareness of illness, a U-shaped relationship with stereotyped thinking and poor impulse control, and an almost linear relationship with anxiety and guilt feelings. Conclusions Self-reflectiveness demonstrates complex relationships with clinical symptoms and fails to exert significant positive effects when reaching a certain high level.
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Affiliation(s)
- Lihua Xu
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiru Cui
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanyan Wei
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenying Qian
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochen Tang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yegang Hu
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingchan Wang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Hu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Guo
- Department of Early Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Tang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianhong Zhang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jijun Wang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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6
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Co-occurrence of schizo-obsessive traits and its correlation with altered executive control network functional connectivity. Eur Arch Psychiatry Clin Neurosci 2022; 272:301-312. [PMID: 33389057 DOI: 10.1007/s00406-020-01222-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
The prevalence of obsessive-compulsive symptoms (OCS) in schizophrenia patients is as around 30%. Evidence suggested that mild OCS could reduce symptoms of schizophrenia, supporting the presence of compensatory functions. However, severe OCS could aggravate various impairments in schizophrenia patients, supporting the "double jeopardy hypothesis". Patients with schizo-obsessive comorbidity, schizophrenia patients and obsessive-compulsive disorder patients have been found to have similarities in executive dysfunctions and altered resting-state functional connectivity within the executive control network (ECN). Executive functions could be associated with the ECN. However, little is known as to whether such overlap exists in the subclinical populations of individuals with schizo-obsessive traits (SOT), schizotypal individuals and individuals with high levels of obsessive-compulsive symptoms (OCS). In this study, we recruited 30 schizotypal individuals, 25 individuals with OCS, 29 individuals with SOT and 29 controls for a resting-state ECN-related functional connectivity (rsFC) and a go/shift/no-go task. We found that individuals with SOT exhibited increased rsFC within the ECN compared with controls, while schizotypal individuals exhibited the opposite. Individuals with OCS exhibited decreased rsFC within the ECN and between the ECN and the default mode network (DMN), relative to controls. No significant correlational results between altered rsFC related to the ECN with executive function performance were found after corrections for multiple comparisons in three subclinical groups. Our findings showed that individuals with SOT had increased rsFC within the ECN, while schizotypal individuals and individuals with OCS showed the opposite. Our findings provide evidence for possible neural substrates of subclinical comorbidity of OCS and schizotypy.
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Wang YM, Cai XL, Zhou HY, Zhang RT, Zhang YJ, Wang YY, Cheung EFC, Chan RCK. Altered default mode network functional connectivity in individuals with co-occurrence of schizotypy and obsessive-compulsive traits. Psychiatry Res Neuroimaging 2020; 305:111170. [PMID: 32836136 DOI: 10.1016/j.pscychresns.2020.111170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/03/2020] [Accepted: 07/28/2020] [Indexed: 11/21/2022]
Abstract
In this study, we examined differences in resting-state functional connectivity between sub-regions of the Default Mode Network (DMN) and whole brain voxels in 22 individuals with high schizo-obsessive traits (SOT), 30 with high schizotypal traits (SCT) alone, 20 with high obsessive-compulsive traits (OCT) alone and 30 with low trait scores (LT). We found that the SOT group showed the most reduced functional connectivity within the DMN compared with the other groups. The SOT group also showed increased connectivity between the DMN and the Salience Network, and between the DMN and the Auditory Network compared with the LT group. The SCT group exhibited increased connectivity between the DMN and the Salience Network, and between the DMN and the Executive Control Network (ECN) compared with the LT group. The OCT group exhibited decreased connectivity within the DMN, between the DMN and the Salience Network, and between the DMN and the ECN compared with the LT group. These findings highlight different changes in DMN-related functional connectivity associated with high SOT, SCT and OCT traits and may provide insight into the dysfunctional brain networks in the early stage of schizophrenia spectrum disorders.
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Affiliation(s)
- Yong-Ming Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing, 100190, PR China; Sino-Danish Center for Education and Research, Beijing, 100190, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Xin-Lu Cai
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing, 100190, PR China; Sino-Danish Center for Education and Research, Beijing, 100190, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Han-Yu Zhou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Rui-Ting Zhang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Yi-Jing Zhang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Yan-Yu Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, PR China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing, 100190, PR China; Sino-Danish Center for Education and Research, Beijing, 100190, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China.
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8
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García-Mieres H, De Jesús-Romero R, Ochoa S, Feixas G. Beyond the cognitive insight paradox: Self-reflectivity moderates the relationship between depressive symptoms and general psychological distress in psychosis. Schizophr Res 2020; 222:297-303. [PMID: 32518005 DOI: 10.1016/j.schres.2020.05.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND People with psychosis experience significant emotional burden and distress associated with the symptomatic consequences of their mental disorder, thus difficulting their recovery. Several studies have found self-reflectivity, a dimension of cognitive insight, to be associated with effects which taken together may seem paradoxical, by predicting less psychotic symptom severity but more depression. To elucidate this issue, we examined the influence of psychotic symptoms, depressive symptoms, and self-reflectivity, on psychological distress. Further, we tested whether self-reflectivity moderated the relationship between depressive symptoms and psychological distress. METHODS Seventy-six outpatients with psychotic-spectrum disorders were assessed using measures of psychotic symptoms, depressive symptoms, cognitive insight (i.e., self-reflectivity, self-certainty) and psychological distress. RESULTS A regression model revealed that depressive, positive symptoms and the interaction between depressive symptoms and self-reflectivity had a significant effect on psychological distress. The moderation analysis showed that higher levels of self-reflectivity were related to less psychological distress associated with depressive mood. CONCLUSIONS The role of self-reflectivity on depression and distress may be more complex than a direct effect. Interventions targeted to improve metacognition by enhancing self-reflectivity might be important for lowering the psychological distress associated with depressive symptoms in people with psychosis.
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Affiliation(s)
- Helena García-Mieres
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035, Barcelona, Spain; The Institute of Neurosciences, University of Barcelona, 08035, Barcelona, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
| | - Robinson De Jesús-Romero
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 47405, IN, United States
| | | | - Susana Ochoa
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Mental Health Networking Biomedical Research Centre, CIBERSAM, Madrid, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035, Barcelona, Spain; The Institute of Neurosciences, University of Barcelona, 08035, Barcelona, Spain
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9
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Wang YM, Zhang YJ, Cai XL, Yang HX, Shan HD, Cheung EFC, Chan RCK. Altered grey matter volume and white matter integrity in individuals with high schizo-obsessive traits, high schizotypal traits and obsessive-compulsive symptoms. Asian J Psychiatr 2020; 52:102096. [PMID: 32315977 DOI: 10.1016/j.ajp.2020.102096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022]
Abstract
Altered brain structures have been found in patients with schizo-obsessive disorder, schizophrenia and obsessive-compulsive disorder in previous studies. However, it is unclear whether similar brain changes are also found in individuals with high schizo-obsessive traits (SOT), high schizotypal traits (SCT) and obsessive-compulsive symptoms (OCS). We examined grey matter volume (GMV) and white matter integrity (WMI, including fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity) in 26 individuals with high SOT, 30 individuals with high SCT, 25 individuals with OCS and 30 individuals with low trait scores (LT) in this study. Correlation analysis between GMV, WMI, Schizotypal Personality Questionnaire (SPQ) scores and Obsessive-Compulsive Inventory-Revised (OCI-R) scores in the subclinical groups was also carried out. We found that the SOT group exhibited increased GMV at the right superior occipital gyrus and the left postcentral gyrus compared with the LT group. The SCT group exhibited increased GMV at the right precentral gyrus and the bilateral cuneus compared with the LT group, and decreased fractional anisotropy at the anterior corona radiata compared with the other three groups. The OCS group exhibited increased GMV at the left superior temporal gyrus and decreased GMV at the left pre-supplementary motor area compared with the LT group. These findings highlight specific brain changes in individuals with high SOT, high SCT and OCS, and may thus provide new insights into the neurobiological changes that occur in sub-clinical populations of these disorders.
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Affiliation(s)
- Yong-Ming Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing, 100190, PR China; Sino-Danish Center for Education and Research, Beijing, 100190, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Yi-Jing Zhang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Xin-Lu Cai
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing, 100190, PR China; Sino-Danish Center for Education and Research, Beijing, 100190, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Han-Xue Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Hai-di Shan
- Translational Neuropsychology and Applied Cognitive Neuroscience Laboratory, Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, PR China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, PR China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing, 100190, PR China; Sino-Danish Center for Education and Research, Beijing, 100190, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China.
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Sagayadevan V, Jeyagurunathan A, Lau YW, Shafie S, Chang S, Ong HL, Samari E, Verma SK, Chong SA, Subramaniam M. Cognitive insight and quality of life among psychiatric outpatients. BMC Psychiatry 2019; 19:201. [PMID: 31253121 PMCID: PMC6599343 DOI: 10.1186/s12888-019-2163-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past studies have focused primarily on clinical insight and less on cognitive insight among individuals with mental illness. METHODS This study examined the level of cognitive insight (CI) and its association with quality of life (QoL) among psychiatric outpatients (N = 400) in Singapore. The Beck Cognitive Insight Scale (BCIS) consisting of two subscales (self-reflectiveness (SR) and self-certainty (SC)) was used to measure CI while the brief version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was used to assess the subjective well-being of the individual. RESULTS Socio-demographic correlates of CI, differences in SR, SC, and CI scores across diagnostic groups, and the association between insight and QoL were examined. Significant differences across diagnostic groups were found only for SR scores. Higher SR and overall CI scores were significantly associated with higher QoL in the environmental domain whereas higher SC scores were associated with lower QoL in the social relationships domain. CONCLUSIONS An understanding of cognitive insight is necessary to produce a significant change in the underlying belief system of an individual. Together with clinical insight, these two forms of insight can be used to inform therapeutic approaches to increase awareness and improve the QoL of those with mental illnesses.
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Affiliation(s)
- Vathsala Sagayadevan
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747, Singapore.
| | - Ying Wen Lau
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Saleha Shafie
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Sherilyn Chang
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Hui Lin Ong
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Ellaisha Samari
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Swapna Kamal Verma
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore ,0000 0004 0469 9592grid.414752.1Early Psychosis Intervention Programme (EPIP) & General Psychiatry (GP1), Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Siow Ann Chong
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Mythily Subramaniam
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
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11
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Lien YJ, Chang HA, Kao YC, Tzeng NS, Lu CW, Loh CH. The impact of cognitive insight, self-stigma, and medication compliance on the quality of life in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2018; 268:27-38. [PMID: 28756468 DOI: 10.1007/s00406-017-0829-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 07/24/2017] [Indexed: 12/20/2022]
Abstract
Impaired quality of life (QoL) is a common and clinically relevant feature of schizophrenia. In the present study, we attempted to formulate a model of QoL in the chronic stage of schizophrenia by including key variables-namely cognitive insight, self-stigma, insight into treatment, and medication compliance-that were proposed as its significant predictors in previous studies. We employed structural equation modeling (SEM) to simultaneously test the associations between these variables. A total of 170 community-dwelling patients with schizophrenia participated in this study. Cognitive insight, self-stigma, insight into treatment, medication compliance, and QoL were assessed through self-reporting. Symptoms were rated by interviewers. The influences of cognitive insight, stigma, insight into treatment, and medication compliance on QoL were supported using SEM. Our findings indicated that cognitive insight had a significant, positive, and direct effect on both self-stigma and insight into treatment; in contrast, it had a negative and direct effect on medication compliance. Notably, no evidence indicated a direct effect of cognitive insight on QoL. Thus, individuals with high cognitive insight reported low QoL because of stigma, low medication compliance, and their increased insight into treatment. In contrast, cognitive insight might indirectly ameliorate QoL mediated by the effect of insight into treatment on medication compliance. The findings provide additional support of the links between cognitive and clinical insight, self-stigma, medication compliance, and QoL in those with schizophrenia and suggest the need for screening and intervention services appropriate for this high-risk population.
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Affiliation(s)
- Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan. .,Department of Psychiatry, Tri-Service General Hospital Songshan Branch, 131 Jiankang Road, Songshan District, Taipei, 10581, Taiwan.
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Wen Lu
- Department of Psychiatry, Tri-Service General Hospital Songshan Branch, 131 Jiankang Road, Songshan District, Taipei, 10581, Taiwan
| | - Ching-Hui Loh
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
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12
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Lysaker PH, Pattison ML, Leonhardt BL, Phelps S, Vohs JL. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry 2018; 17:12-23. [PMID: 29352540 PMCID: PMC5775127 DOI: 10.1002/wps.20508] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
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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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle L Pattison
- College of Applied Behavioral Sciences, University of Indianapolis, Indianapolis, IN, USA
| | - Bethany L Leonhardt
- Indiana University School of Medicine, Eskenazi Health-Midtown Community Mental Health, Indianapolis, IN, USA
| | | | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, IN, USA
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13
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Pu S, Nakagome K, Itakura M, Ohtachi H, Iwata M, Nagata I, Kaneko K. Right Frontotemporal Cortex Mediates the Relationship between Cognitive Insight and Subjective Quality of Life in Patients with Schizophrenia. Front Psychiatry 2018; 9:16. [PMID: 29456514 PMCID: PMC5801421 DOI: 10.3389/fpsyt.2018.00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/17/2018] [Indexed: 11/19/2022] Open
Abstract
Although prior studies identified a relationship between cognitive insight and subjective quality of life (QOL) in patients with schizophrenia, the brain regions mediating this relationship remain unknown. Recent studies have shown that the ventrolateral prefrontal cortex may be particularly important for cognitive insight in individuals with schizophrenia. Here, we examined whether frontotemporal function mediates the relationship between cognitive insight and QOL in 64 participants, including 32 patients with schizophrenia and 32 healthy controls. Cognitive insight was measured using the Beck Cognitive Insight Scale (BCIS), while participants' subjective QOL was assessed using the Medical Outcomes Study 36-item Short-form Health Survey. Frontotemporal function was evaluated during a verbal fluency task using multichannel near-infrared spectroscopy. Consistent with previous findings, we found that frontotemporal function was impaired in patients with schizophrenia. Interestingly, our data also revealed that the right ventrolateral PFC and the right anterior part of the temporal cortex significantly mediated the relationship between the self-reflectiveness (SR) subscale of the BCIS and subjective QOL. These findings suggest that cognitive insight, particularly SR, is associated with subjective QOL in patients with schizophrenia via right frontotemporal function. The findings of this study provide important insight into a QOL model of schizophrenia, which may guide the development of cost-effective interventions that target frontotemporal function in patients with schizophrenia.
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Affiliation(s)
- Shenghong Pu
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | | | - Masashi Itakura
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroaki Ohtachi
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masaaki Iwata
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Izumi Nagata
- National Hospital Organization, Tottori Medical Center, Tottori-shi, Japan
| | - Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
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14
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Rathee R, Luhrmann TM, Bhatia T, Deshpande SN. Cognitive insight and objective quality of life in people with schizophrenia and auditory hallucinations. Psychiatry Res 2018; 259:223-228. [PMID: 29091820 PMCID: PMC5758479 DOI: 10.1016/j.psychres.2017.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/27/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
Poor cognitive insight in schizophrenia has been linked to delusions, hallucinations, and negative symptoms as well as to depressive/anxiety symptoms. Its impact on quality of life has been less studied, especially in schizophrenia subjects with ongoing auditory hallucinations. The Beck Cognitive Insight Scale (BCIS) and the Quality of Life Scale (QLS) were administered to subjects who met DSM IV criteria for schizophrenia after due translation and validation. All subjects reported ongoing auditory hallucinations at recruitment. Mean composite cognitive insight scores from participants (N = 60) (2.97 ± 2.649) were in the lower range as compared to published literature. Cognitive insight scores as well as self-reflectiveness subscale scores, but not self-certainty scores, correlated significantly with the QLS scores p < 0.001. Results suggest that better cognitive insight, especially self-reflectiveness, may be linked to better quality of life. Self-reflectiveness could be a useful construct to address in psychotherapy to improve rehabilitation.
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Affiliation(s)
- Ruchika Rathee
- Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital (PGIMER-RMLH), Park Street, New Delhi, India.
| | | | - Triptish Bhatia
- Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital (PGIMER-RMLH), Park Street, New Delhi, India.
| | - Smita N. Deshpande
- Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital (PGIMER-RMLH), Park Street, New Delhi, India,Correspondence to: Department of Psychiatry, PGIMER, Dr. R.M.L. Hospital, New Delhi 110001, India
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15
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Cognitive insight: A systematic review. Clin Psychol Rev 2017; 55:12-24. [DOI: 10.1016/j.cpr.2017.04.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 03/12/2017] [Accepted: 04/30/2017] [Indexed: 11/23/2022]
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16
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Phalen PL, Viswanadhan K, Lysaker PH, Warman DM. The relationship between cognitive insight and quality of life in schizophrenia spectrum disorders: Symptom severity as potential moderator. Psychiatry Res 2015; 230:839-45. [PMID: 26599388 DOI: 10.1016/j.psychres.2015.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/03/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
Abstract
Cognitive insight is implicated in the formation and maintenance of hallucinations and delusions. However, it is not yet known whether cognitive insight relates to broader outcome measures like quality of life. In the current study, we investigated whether the component elements of cognitive insight-self-certainty and self-reflectiveness-were related to quality of life for 43 outpatients with schizophrenia or schizoaffective disorder. Cognitive insight was assessed using the Beck Cognitive Insight Scale (BCIS) while quality of life was assessed with Quality of Life Scale (QLS). We tested whether this relationship was moderated by clinical insight and symptom severity using the Scale to Assess Unawareness of Mental Disorder (SUMD) and the Positive and Negative Syndrome Scale (PANSS). We found that self- reflectiveness had an unmoderated positive relationship with quality of life. Self-certainty was associated with better quality of life for people with more severe symptoms. Theoretical and clinical implications of these findings are discussed and areas of future research are proposed.
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Affiliation(s)
- Peter L Phalen
- School of Psychological Sciences, University of Indianapolis, 1400 E Hanna Ave, Indianapolis, IN 46227, USA.
| | - Katya Viswanadhan
- School of Psychological Sciences, University of Indianapolis, 1400 E Hanna Ave, Indianapolis, IN 46227, USA
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center, 1481W 10th St, Indianapolis, IN 46202, USA
| | - Debbie M Warman
- School of Psychological Sciences, University of Indianapolis, 1400 E Hanna Ave, Indianapolis, IN 46227, USA
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