Impasse-Driven problem solving: The multidimensional nature of feeling stuck

This study reports findings across four preregistered experiments (total N = 856) that establish the multidimensional nature of impasse and resolve two paradoxes implicit in the problem-solving literature: how a state of impasse can be at once necessary to solve a problem with insight yet also have appear to have a catastrophic effect on solution rates, and why individuals such as problem-solving and gaming enthusiasts seem to seek out this apparently aversive state. We introduce a new way of measuring impasse based on qualitative reports and subsequently confirmed through quantitative analysis that exploits two aspects of impasse: its dynamic and unstable nature (it can be resolved or unresolved) and its multidimensionality in terms of feelings of cognitive speediness, motivation, and affect. The feeling of being stuck varies between resolved and unresolved impasse in terms of feelings of speediness and positive affect, but not motivation, which remains constant. We demonstrate that the feeling of insight can be reliably elicited by experiencing and resolving impasse but also in the absence of impasse, which suggests that there is more than one path to an insight experience. This adds depths to current proposals of the cognitive mechanisms underlying both insight problem-solving and impasse. Our findings are robust across a range of problem types. The novel conception of impasse in this paper as dynamic and multidimensional has implications for theories of insight problem solving, and also wider implications for understanding how impasse can be resolved across different domains such as education and design.

Characterizing the dynamic learning process: Implications of a quantitative analysis

Understanding the neural mechanisms involved in learning processes is crucial for unraveling the complexities of behavior and cognition. Sudden change from the untrained level to the fully-learned level is a pivotal feature of instrumental learning. However, the concept of change point and suitable methods to conveniently analyze the characteristics of sudden change in groups remain elusive, which might hinder a fuller understanding of the neural mechanism underlying dynamic leaning process. In the current study, we investigated the learning processes of mice that were trained in an aversive instrumental learning task, and introduced a novel strategy to analyze behavioral variations in instrumental learning, leading to improved clarity on the concept of sudden change and enabling comprehensive group analysis. By applying this novel strategy, we examined the effects of cocaine and a cannabinoid receptor agonist on instrumental learning. Intriguingly, our analysis revealed significant differences in timing and occurrence of sudden changes that were previously overlooked using traditional analysis. Overall, our research advances understanding of behavioral variation during instrumental learning and the interplay between learning behaviors and neurotransmitter systems, contributing to a deeper comprehension of learning processes and informing future investigations and therapeutic interventions.

Influence of anosognosia on patient-reported outcomes for psychiatric symptoms and quality of life in Huntington's disease

INTRODUCTION

Anosognosia, defined as reduced awareness of one's deficit or symptom, is common in Huntington's disease (HD) and detectable at each disease stage. The impact of anosognosia on self-reporting in HD populations is critical to understand given growing use of patient-reported outcomes in HD clinical care and research. We aimed to determine the influence of anosognosia on patient-reported outcome measures assessing psychiatric symptoms and quality of life in HD.

METHODS

We enrolled HD patients to complete a battery of patient-reported and rater-administered measures, including the Anosognosia Scale, at baseline and 6 months later. Patient-reported outcome measures included NeuroQoL short forms for depression, anxiety, satisfaction with social roles and activities, and positive affect and well-being and Patient-Reported Outcomes Measurement Information System short forms for emotional distress-anger and sleep-related impairment. Anosognosia Scale-Difference Score indexed patient-clinician agreement on patient motor, cognitive, and behavioral abilities. We conducted multivariable linear regression analyses to quantify the association of baseline anosognosia with 6-month patient-reported outcomes.

RESULTS

Of 79 patients with complete Anosognosia Scale data at baseline, 25 (31.6 %) met the scale's criterion for anosognosia. In the regression analyses, baseline Difference Score improved prediction of 6-month patient-reported outcomes for depression, anxiety, anger, and positive affect and well-being (χ2(1) value range for likelihood ratio tests contrasting models with and without Difference Score: 13.1-20.9, p-values <0.001). Patients with more anosognosia self-reported less severe psychiatric symptoms and more positive affect and well-being.

CONCLUSION

Study results suggest that anosognosia influences patient-reported outcomes for psychiatric symptoms and quality of life in HD populations.

A meta-cognitive Wisconsin Card Sorting Test in people with schizophrenia and bipolar disorder: Self-assessment of sorting performance

People with serious mental illness have challenged self-awareness, including momentary monitoring of performance. A core feature of this challenge is in the domain of using external information to guide behavior, an ability that is measured very well by certain problem-solving tasks such as the Wisconsin Card Sorting Test (WCST) . We used a modified WCST to examine correct sorts and accuracy decisions regarding the correctness of sort. Participants with schizophrenia (n = 99) or bipolar disorder (n = 76) sorted 64 cards and then made judgments regarding correctness of each sort prior to feedback. Time series analyses examined the course of correct sorts and correct accuracy decisions by examining the momentary correlation and lagged correlation on the next sort. People with schizophrenia had fewer correct sorts, fewer categories, and fewer correct accuracy decisions (all p<.001). Positive response biases were seen in both groups. After an incorrect sort or accuracy decision, the groups were equally likely to be incorrect on the next sort or accuracy decision. Following correct accuracy decisions, participants with bipolar disorder were significantly (p=.003) more likely to produce a correct sort or accuracy decision. These data are consistent with previous studies implicating failures to consider external feedback for decision making. Interventions aimed at increasing consideration of external information during decision making have been developed and interventions targeting use of feedback during cognitive test performance are in development.

Self-awareness and quality of relationships after acquired brain injury: Systematic review without meta-analysis (SWiM)

BACKGROUND

Relational aspects of self-awareness following Acquired Brain Injury (ABI) are increasingly being recognized. However, research underpinning the nature of the association between self-awareness and quality of relationships has yet to be synthesized.

METHOD

Searches, which were completed between February 2022 and February 2023, consisted of combining terms related to ABI, self-awareness, and quality of relationships. Data were analyzed using the Synthesis Without Meta-Analysis (SWiM) approach.

RESULTS

Associations between self-awareness and relationship quality across eight studies identified for this review differed in direction and significance. A more consistent pattern emerged, however, when studies assessing the quality of specific types of relationships i.e., spousal (N = 1) and therapeutic (N = 3), were compared to studies assessing the quality of a person's broader network of relationships (N = 4). In particular, good awareness was positively associated with the quality of specific relationships (r = 0.66) whereas it was negatively associated with the quality of a person's broader network of relationships (r = -0.35).

CONCLUSION

Results are discussed with consideration given to measures assessing the quality of specific relationships. In particular, such measures may tap into important patterns of interaction between two individuals, such as those related to attunement or communication, which may be valuable preconditions for improving awareness.

Impact of Delusions and Hallucinations on Clinical Insight Dimensions in Schizophrenia Spectrum Disorders

INTRODUCTION

Insight in psychosis has been conceptualized as a continuous, dynamic, and multidimensional phenomenon. This study aims to determine the impact of delusions and hallucinations in different dimensions of clinical insight in schizophrenia spectrum disorders.

METHODS

Cross-sectional multicenter study including 516 patients (336 men) diagnosed with schizophrenia spectrum disorders. Based on dichotomized scores of Positive and Negative Syndrome Scale (PANSS) items P1 (delusions) and P3 (hallucinations), patients were assigned to four groups according to current clear presence of delusions (scores 4 or above 4 in PANSS item P1) and/or hallucinations (scores 4 or above 4 in PANNS item P3). Insight was assessed using the three main dimensions of the Scale of Unawareness of Mental Disorder (SUMD).

RESULTS

Around 40% of patients showed unawareness of illness; 30% unawareness of the need for treatment; and 45% unawareness of the social consequences of the disorder. Patients with current clear presence of delusions had higher overall lack of awareness, regardless of current clear presence of hallucinations. Similarly, the clear presence of delusions showed a greater predictive value on insight than the presence of hallucinations, although the implication of both in the prediction was modest.

CONCLUSIONS

Our results confirm that lack of insight is highly prevalent in schizophrenia spectrum disorders, particularly when patients experience delusions. This study adds insight-related data to the growing symptom-based research, where specific types of psychotic experiences such as hallucinations and delusions could form different psychopathological patterns, linking the phenomenology of delusions to a lack of clinical insight.

The irreconcilability of insight

We are said to experience insight when we suddenly and unexpectedly become aware of the solution to a problem that we previously took ourselves to be unable to solve. In the field of comparative cognition, there is rising interest in the question of whether non-human animals are capable of insightful problem-solving. Putative cases of animals demonstrating insight have generally attracted two types of criticism: first, that insight is being conflated with other cognitive capacities (e.g., causal cognition, or mental trial and error); and, second, that the relevant performances merely reflect associative learning-and on the received understanding of insight within comparative cognition, insight necessarily involves non-associative processes. I argue that even if we grant that some cases of animal insight do withstand these two criticisms, these cases of purported animal insight cannot shed light on the nature of insightful problem-solving in humans. For the phenomenon studied by cognitive psychologists under the heading of insight is fundamentally different from that studied in comparative cognition. In light of this impasse, I argue that the reinterpretation of the extant research on animal insight in terms of other high-level cognitive capacities (means-end reasoning in particular) can improve the prospect of a successful comparative research program.

Functioning, clinical severity, education and sex moderate the inverse relationship between insight and quality of life in patients with schizophrenia

BACKGROUND

In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life, a phenomenon that has been described as the "insight paradox". Here, we aimed to determine whether certain socio-demographic and clinical characteristics strengthen or weaken this negative relationship.

METHODS

We used data from the French network of rehabilitation centers REHABase (N = 769). We explored mean differences in quality-of-life scores between patients with good insight vs. poor insight. We also explored modifying effects of socio-demographic and clinical characteristics (sex, education, age, functioning, clinical severity, duration of illness).

RESULTS

Patients with good insight had a decreased quality-of-life total score. Similar effects were found for the following sub-dimensions of quality of life: autonomy, physical and psychological well-being, and self-esteem. The negative effect of insight on quality of life was attenuated for people who had >12 years of education and for people with a higher level of functioning. By contrast, the negative effect of insight on quality of life was accentuated in people with greater clinical severity. Functioning and clinical severity showed similar modifying effects for other quality-of-life dimensions: autonomy, physical and psychological well-being, and self-esteem. Finally, males demonstrated an increased negative association between insight and self-esteem.

CONCLUSIONS

The relationship between insight and quality of life is moderated by socio-demographic and clinical circumstances. Future inquiries may utilize our findings by integrating socio-demographic and clinical factors in treatment programs designs to conjointly improve insight and quality of life.

The Nepean Belief Scale (NBS) as a tool to investigate the intensity of beliefs in anorexia nervosa: psychometric properties of the Italian version

BACKGROUND

People with anorexia nervosa (AN) show a peculiar impairment of insight regarding their condition, often manifesting a denial of extreme emaciation and sometimes hiding or underreporting socially undesirable abnormal eating patterns. Sometimes the intensity of the beliefs held by patients with AN reach a delusional intensity.

OBJECTIVES

In this study, the Italian version of the Nepean Belief Scale was applied to a sample of patients diagnosed with AN to investigate the intensity of their beliefs and convictions and its clinical correlates.

METHODS

The Nepean Belief Scale (NBS) was translated and adapted to Italian and applied to a sample of patients diagnosed with AN based on the Structured Clinical Interview for DSM-5 (SCID-5).

RESULTS

The Italian version of the 5-item NBS showed excellent reliability. Convergent validity was proved by negative association with levels of insight measured with the Schedule for the Assessment of Insight in Eating Disorders. Beliefs of delusional intensity were reported by 10% of participants. Those with a greater intensity of beliefs, either overvalued or delusional ideas, were more likely to report poorer general cognitive performances on the Montreal Cognitive Assessment. No association was observed between NBS score and age, body mass index, symptoms of eating disorders, body dissatisfaction, or levels of depression. Fear of weight gain and control seeking were the most often reported themes at the NBS.

CONCLUSIONS

The Italian version of the NBS is a reasonably reliable, valid, and usable tool for the multidimensional assessment of insight in AN. Level of evidence Level III, Evidence obtained from well-designed cohort or case-control analytic studies.

Discrepancies in Patient and Caregiver Ratings of Personality Change in Alzheimer's Disease and Related Dementias

OBJECTIVE

Personality change in Alzheimer's disease and related dementias (ADRD) is complicated by the patient and informant factors that confound accurate reporting of personality traits. We assessed the impact of caregiver burden on informant report of Big Five personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness) and investigated the regional cortical volumes associated with larger discrepancies in the patient and informant report of the Big Five personality traits.

METHOD

Sixty-four ADRD participants with heterogeneous neurodegenerative clinical phenotypes and their informants completed the Big Five Inventory (BFI). Caregiver burden was measured using the Zarit Burden Interview. Discrepancy scores were computed as the difference between patient and informant ratings for the BFI. Regional gray matter volumes from T1-weighted 3T MRI were normalized to intracranial volume and related to global Big Five discrepancy scores using linear regression.

RESULTS

Higher levels of caregiver burden were associated with higher informant ratings of patient neuroticism (ß = 0.08, p = .012) and with lower informant ratings of patient agreeableness (ß = 0.11, p = .021) and conscientiousness (ß = 0.04, p = .034) independent of disease severity. Patients with greater Big Five discrepancy scores showed smaller cortical volumes in the right medial prefrontal cortex (β = -5.24, p = .045) and right superior temporal gyrus (β = -7.91, p = .028).

CONCLUSIONS

Informant ratings of personality traits in ADRD can be confounded by the caregiver burden, highlighting the need for more objective measures of personality and behavior in dementia samples. Discrepancies between informant and patient ratings of personality may additionally reflect loss of insight secondary to cortical atrophy in the frontal and temporal structures.

Patterns and correlates of insight among patients with schizophrenia in China：A network perspective

OBJECTIVE

To explore the patterns and correlates of insight among patients with schizophrenia in a large Chinese population.

METHOD

A multi-center cross-sectional study was conducted in Guangdong province, China. Patients with schizophrenia were included. Basic socio-demographic and clinical characteristics were collected in this study. Univariate analyses, multivariate logistic regression, and network analysis were conducted.

RESULTS

A total of 6090 participants (58.8% were male, and 41.2% were female) met the study criteria and completed all the assessments. 63.5% (n = 3869) patients with schizophrenia had impaired insight. Fewer drug sides effect, higher psychological and environment domains scores in quality of life have a positive significant impact on insight in patients with schizophrenia. Younger age, higher BPRS scores have a negative significant impact on insight in patients with schizophrenia. The node ITAQ 8 (strength=1.17) was the most central node within the ITAQ network, while node ITAQ 3 was the least central node (strength=0.69). The edge ITAQ 1-ITAQ 2 was the thickest and most saturated edge in network model.

CONCLUSIONS

Considering patterns and correlation of insight, it is necessary to ensure adherence to medications and engagement with mental health services for patients with schizophrenia, which could also improve their quality of life. Taking medication actively is more central to identify ITAQ and might be the potential targets for future interventions.

Characteristics of persistent depression in the long-term: Randomized controlled trial and two-year observational study

Major depressive disorder is a chronic condition that can recur and relapse. It would be clinically useful to know the patient background to predict the chronicity of depressive symptoms, and the change in diagnosis of bipolar disorder. This study included 197 patients enrolled in a six-week randomized controlled trial with a two-year follow-up. We conducted multiple logistic regression analyses to identify the clinical and sociodemographic characteristics associated with persistent depressive disorder (PDD), relapse, and changes in bipolar disorder diagnosis. The significantly correlated factors were residual symptoms, including insight, work and activity, and general somatic symptoms at week six. We could not identify any factors that contributed to relapse or change in the diagnosis of bipolar disorder. We found that the specific residual symptoms of acute treatment affected long-term treatment outcomes for depression. Attention should be paid to the residual symptoms of depression in the early stages of treatment, and measures should be considered to improve them. There are several limitations to this study, including the fact that PDD may exist among patients who discontinued treatment, treatment was not standardized during the study period, and adherence was confirmed verbally.

Crowdsourced EEG experiments: A proof of concept for remote EEG acquisition using EmotivPRO Builder and EmotivLABS

The development of online research platforms has made data collection more efficient and representative of populations. However, these benefits have not been available for use with cognitive neuroscience tools such as electroencephalography (EEG). In this study, we introduce an approach for remote EEG data collection. We demonstrate how an experiment can be built via the EmotivPRO Builder and deployed to the EmotivLABS website where it can be completed by participants who own EMOTIV EEG headsets. To demonstrate the data collection technique, we collected EEG while participants engaged in a resting state task where participants sat with their eyes open and then eyes closed for 2 min each. We observed a significant difference in alpha power between the two conditions thereby demonstrating the well-known alpha suppression effect. Thus, we demonstrate that EEG data collection, particularly for frequency domain analysis, can be successfully conducted online.

The effect of interpersonal relations theory-based motivational interviews on functional remission and insight levels of patients with schizophrenia: A randomized controlled trial

BACKGROUND

Using therapeutic techniques and conducting motivational interviews in communication with patients with schizophrenia increases individuals' functional remission, insight, and motivation levels.

AIM

This single-blind, randomized controlled study examines the effect of Interpersonal Relations Theory-Based motivational interviews on functional remission and insight levels in patients with schizophrenia.

METHODS

The participants of this study were 40 patients with schizophrenia randomly assigned to either the experimental or control groups (20 in each group). The researchers carried out a 6-session Interpersonal Relations Theory-based motivational interview with the participants in the experimental group. Study data were collected using a demographic questionnaire, the Functional Remission of General Schizophrenia Scale (FROGS), and the Scale for Assessing the Three Components of Insight (SAI).

RESULTS

Social Functioning, Health and Treatment, Daily Living Skills, and SAI scores of the individuals in the intervention group were statistically higher than those in the control group (p < 0.05) in the post-intervention and follow-up measures. There was a positive and significant correlation between the post-intervention Social Functioning, Health and Treatment, Daily Life Skills, and total FROGS scores and the SAI score of the individuals in the intervention group (p < 0.05).

CONCLUSIONS

It was concluded that motivational interviews based on Interpersonal Relations Theory were effective in increasing the insights and functionality of patients with schizophrenia. Psychiatric nurses' practice of motivational interviews based on the therapeutic relationship is considered to increase the quality of care and satisfaction of patients with schizophrenia. It is recommended that this practice be used extensively in clinical practice.

Exploring different stakeholders' perspectives on ward rounds in paediatric oncology: a qualitative study

RATIONAL/AIMS AND OBJECTIVES

Ward rounds are a core routine for interprofessional communication and clinical care planning: Health care professionals and patients meet regularly and it encourages patients to actively participate. In paediatric oncology, the long treatment process, the serious diagnosis, and involvement of both patients and their parents in shared-decision-making require specific ward round skills. Despite its high value for patient-centred care, a universal definition of ward round is lacking. Little is known about attitudes and expectations of different participants towards a 'good' ward round. This study aims to capture experiences and expectations of different stakeholders to better understand ward round needs in paediatric oncology and serve as a basis to improve future ward rounds.

METHOD

Semi-structured interviews were conducted with patients, parents, nurses and medical doctors of a paediatric oncology ward until theoretical saturation (13 interviews). A standardised qualitative analysis using the phenomenological framework defined by Colaizzi was used to identify important aspects in the interviews.

RESULTS

Three major themes were identified in the interviews: [1] Structure and Organisation; [2] Communication; [3] Education. Further analysis revealed 23 categories and elucidated several opportunities and unmet needs recognized by stakeholders: Ward round functions in comforting families in stressful situations, and relationship building. Interviewees expressed their concerns about missing structures. Families pleaded for smaller ward round teams and layperson language. Health care professionals underscored the lack of ward round training. Paediatric patients stated that ward round scared them without proper explanation. All interviewees emphasized the need for professionalization of the ward round in the setting of paediatric oncology.

CONCLUSION

This study gives important insights into ward round functions and organisational requirements. It addresses special challenges for ward round participants in paediatric oncology, such as consideration of the emotional aspect of cancer treatment or the limits of shared decision making. Furthermore, this study underscores the great significance of ward rounds in paediatric oncology, with an emphasis on communication and relationship-building. Although performed universally, ward rounds are poorly explored or evaluated. This structured analysis synthesizes important expectations of different WR stakeholders, revealing opportunities of improvement and stressing the need for guidelines, training, and preparation.

Clinical insight among persons with schizophrenia spectrum disorders treated with amisulpride, aripiprazole or olanzapine: a semi-randomised trial

BACKGROUND

Antipsychotic treatment may improve clinical insight. However, previous studies have reported inconclusive findings on whether antipsychotics improve insight over and above the reduction in symptoms of psychosis. These studies assessed homogeneous samples in terms of stage of illness. Randomised studies investigating a mixed population of first- and multiepisode schizophrenia spectrum disorders might clarify this disagreement.

METHODS

Our data were derived from a pragmatic, rater-blinded, semi-randomised trial that compared the effectiveness of amisulpride, aripiprazole and olanzapine. A sample of 144 patients with first- or multiepisode schizophrenia spectrum disorders underwent eight assessments during a 1-year follow-up. Clinical insight was assessed by item General 12 from the Positive and Negative Syndrome Scale (PANSS). We analysed latent growth curve models to test if the medications had a direct effect on insight that was over and above the reduction in total psychosis symptoms. Furthermore, we investigated whether there were differences between the study drugs in terms of insight.

RESULTS

Based on allocation analysis, all three drugs were associated with a reduction in total psychosis symptoms in the initial phase (weeks 0-6). Amisulpride and olanzapine were associated with improved insight over and above what was related to the reduction in total psychosis symptoms in the long-term phase (weeks 6-52). However, these differential effects were lost when only including the participants that chose the first drug in the randomisation sequence. We found no differential effect on insight among those who were antipsychotic-naïve and those who were previously medicated with antipsychotics.

CONCLUSIONS

Our results suggest that antipsychotic treatment improves insight, but whether the effect on insight surpasses the effect of reduced total psychosis symptoms is more uncertain.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01446328, 05.10.2011.

Insight in cognitive impairment assessed with the Cognitive Assessment Interview in a large sample of patients with schizophrenia

The Cognitive Assessment Interview (CAI) is an interview-based scale measuring cognitive impairment and its impact on functioning in subjects with schizophrenia (SCZ). The present study aimed at assessing, in a large sample of SCZ (n = 601), the agreement between patients and their informants on CAI ratings, to explore patients' insight in their cognitive deficits and its relationships with clinical and functional indices. Agreement between patient- and informant-based ratings was assessed by the Gwet's agreement coefficient. Predictors of insight in cognitive deficits were explored by stepwise multiple regression analyses. Patients reported lower severity of cognitive impairment vs. informants. A substantial to almost perfect agreement was observed between patients' and informants' ratings. Lower insight in cognitive deficits was associated to greater severity of neurocognitive impairment and positive symptoms, lower severity of depressive symptoms, and older age. Worse real-life functioning was associated to lower insight in cognitive deficit, worse neurocognitive performance, and worse functional capacity. Our findings indicate that the CAI is a valid co-primary measure with the interview to patients providing a reliable assessment of their cognitive deficits. In the absence of informants with good knowledge of the subject, the interview to the patient may represent a valid alternative.

Explanations in the wild

Why do some explanations strike people as highly satisfying while others, seemingly equally accurate, satisfy them less? We asked laypeople to generate and rate thousands of open-ended explanations in response to 'Why?' questions spanning multiple domains, and analyzed the properties of these explanations to discover (1) what kinds of features are associated with greater explanation quality; (2) whether people can tell how good their explanations are; and (3) which cognitive traits predict the ability to generate good explanations. Our results support a pluralistic view of explanation, where satisfaction is best predicted by either functional or mechanistic content. Respondents were better able to judge how accurate their explanations were than how satisfying they were to others. Insight problem solving ability was the cognitive ability most strongly associated with the generation of satisfying explanations.

Double bookkeeping in schizophrenia spectrum disorder: an empirical-phenomenological study

Double bookkeeping is a term introduced by Eugen Bleuler to describe a fundamental feature of schizophrenia where psychotic reality can exist side by side with shared reality even when these realities seem mutually exclusive. Despite increasing theoretical interest in this phenomenon over the recent years, there are no empirical studies addressing this issue. We have, therefore, conducted a phenomenologically descriptive qualitative study of 25 patients with schizophrenia in which we addressed the following issues: (1) Experience of double reality; (2) Emergence and development of two realities; (3) Truth quality of psychotic or private reality; (4) Insight into illness; (5) Communication of psychotic experiences. The most important result was that most patients felt to be in contact with another dimension of reality. Hallucinatory and delusional experience pertained to this different reality, which patients most frequently kept separated from the shared reality. This other dimension was considered by the patients as being more profound and real. The pre-psychotic and psychotic experiences were difficult to verbalize and typically described as totally different than ordinary experience. Double reality was persistent across remissions. None of the patients considered their condition as an illness analogous to a somatic disorder. Most patients described a vague sense of duality preceding the crystallization of double bookkeeping. This emergence of doubleness was associated with a fundamental alienation from oneself, the world, and others stretching back to childhood or early adolescence. We discuss the results with a special emphasis on the concept of psychosis, clinical interview, treatment, and pathogenetic research.

Decreased insight, but not self-stigma or belief about medicine, is associated with greater severity of delusions in a sample of long-stay patients with schizophrenia: a cross-sectional study

BACKGROUND

There are, to date, limited and inconsistent findings concerning the relationship between insight and psychotic symptoms, despite some evidence in favor of the clinical and therapeutic relevance of the insight construct. We aimed to add to the pool of the available data in this area, by examining the correlations between the severity of insight and positive psychotic symptoms (delusions and auditory hallucinations), while accounting for self-stigma and attitudes towards medication, in a sample of long-stay inpatients with schizophrenia.

METHODS

A cross-sectional study was conducted at the Psychiatric Hospital of the Cross, between July and October 2021. A total of 82 patients diagnosed with schizophrenia (aged 55.55 ± 10.21 years, 54.9% males) were enrolled. The semi-structured psychotic symptom rating scales, the Birchwood Insight Scale, the Belief About Medicine Questionnaire, and the Internalized Stigma of Mental Illness were used.

RESULTS

The mean duration of illness in years was 30.15 ± 11.73, and the mean duration of hospitalization in years was 17.56 ± 9.24. Sixteen out of the 82 patients (19.5%) were considered as having poor insight. Bivariate analyses showed that higher chlorpromazine equivalent dose was significantly associated with more delusions, whereas higher insight was significantly associated with lower delusions. Multivariable analyses revealed that Higher chlorpromazine equivalent dose (Beta = 0.004) was significantly associated with more delusions, whereas higher insight (Beta = - 0.89) was significantly associated with less delusions. No significant associations were found between insight, self-stigma and hallucinations.

CONCLUSION

Our results imply that more impaired insight is associated with greater severity of delusions, above and beyond the effects of self-stigma and medication doses. These findings are valuable to aid clinicians and researchers improve their understanding of the relationship insight-psychotic symptoms, and could help personalize prevention and early intervention strategies in schizophrenia.

Psychoanalytic proof: Revisiting Freud's Tally Argument

This paper explores the notion of proof in clinical psychoanalysis by reconsidering an argument Freud made concerning the relation between successful psychoanalytic treatment and truth, dubbed the "Tally Argument" by the philosopher Adolf Grünbaum. I first reiterate criticisms of Grünbaum's reconstruction of this argument, which bring out the degree to which he has misunderstood Freud. I then offer my own interpretation of the argument and the reasoning that underlies its key premise. Drawing from this discussion, I explore three forms of proof, each inspired also by analogies with other disciplines. Laurence Perrine's "The Nature of Proof in the Interpretation of Poetry" stimulates my discussion of inferential proof, the relevant form of which involves proving an interpretation through a strong enough Inference to the Best Explanation. Mathematical proof stimulates my discussion of apodictic proof, of which psychoanalytic insight is a fitting example. Finally, holism in legal reasoning stimulates my discussion of holistic proof, which provides a reliable means by which therapeutic success can verify epistemic conclusions. These three forms of proof can play a crucial role in ascertaining psychoanalytic truth.

Residual or re-emergent impaired insight into delusions following remission is unrelated to later relapse during a randomized clinical trial of continuation pharmacotherapy for psychotic depression - The STOP-PD II Study

BACKGROUND

Impaired insight into delusions is associated with a lower probability of remission of psychotic depression, independent of illness severity. The relationship between participant characteristics and impaired insight into delusions in remitted psychotic depression, and whether impaired insight is associated with risk of relapse of psychotic depression during continuation pharmacotherapy were examined.

METHODS

Data were analyzed from 126 participants in the STOP-PD II study who experienced sustained remission of psychotic depression during 8-week stabilization treatment with sertraline plus olanzapine and were then randomized to 36 weeks of continuation treatment with sertraline plus either olanzapine or placebo. Insight into delusions was assessed with the Resolution of Delusions Scale (RODS). Linear regression analyses examined the associations between participant characteristics and insight into delusions. Cox proportional-hazards models examined whether i) change in RODS during stabilization treatment; or ii) RODS at the end of stabilization treatment predicted risk of relapse during 36 weeks of continuation treatment.

RESULTS

Severity of psychosis before initiation of treatment was the only participant characteristic associated with the change in insight during stabilization treatment. Neither change in insight during stabilization treatment nor insight at the end of stabilization treatment was associated with risk of relapse.

LIMITATIONS

Insufficient statistical power and the lack of variability in RODS scores at the time of randomization may have contributed to the absence of a relationship between RODS and risk of relapse.

CONCLUSION

Residual or reemergent insight impairment following acute treatment does not preclude patients from sustaining remission of psychotic depression in a randomized placebo-controlled trial.

Restructuring insight: An integrative review of insight in problem-solving, meditation, psychotherapy, delusions and psychedelics

Occasionally, a solution or idea arrives as a sudden understanding - an insight. Insight has been considered an "extra" ingredient of creative thinking and problem-solving. Here we propose that insight is central in seemingly distinct areas of research. Drawing on literature from a variety of fields, we show that besides being commonly studied in problem-solving literature, insight is also a core component in psychotherapy and meditation, a key process underlying the emergence of delusions in schizophrenia, and a factor in the therapeutic effects of psychedelics. In each case, we discuss the event of insight and its prerequisites and consequences. We review evidence for the commonalities and differences between the fields and discuss their relevance for capturing the essence of the insight phenomenon. The goal of this integrative review is to bridge the gap between the different views and inspire interdisciplinary research efforts for understanding this central process of human cognition.

The illusion of insight: detailed warnings reduce but do not prevent false "Aha!" moments

False "Aha!" moments can be elicited experimentally using the False Insight Anagram Task (FIAT), which combines semantic priming and visual similarity manipulations to lead participants into having "Aha!" moments for incorrect anagram solutions. In a preregistered experiment (N = 255), we tested whether warning participants and explaining to them exactly how they were being deceived, would reduce their susceptibility to false insights. We found that simple warnings did not reduce the incidence of false insights. On the other hand, participants who were given a detailed explanation of the methods used to deceive them experienced a small reduction in false insights compared to participants given no warning at all. Our findings suggest that the FIAT elicits a robust false insight effect that is hard to overcome, demonstrating the persuasive nature of false insights when the conditions are ripe for them.

The Popcorn Illusion

A popcorn popping is almost magical. And yet, the science of popcorn is safe and clear about the steps until the pop: the components, processes, and results of making popcorn. Nature has its own way to produce surprise in the form of "pops" (i.e., emergence, qualitative shifts). Emergent features spread throughout the life of taxa and individuals. A pop can be sudden and chaotic. And so is creativity. There is no incompatibility between creativity and naturalistic endeavors in science. Creativity is no god given gift blown inside humans. When creativity is defined by originality and spontaneity, it describes a feature with no past or present. I briefly summarize how one can see non-random innovation, no free occurring spontaneity, and non-heuristic effectiveness as features of behaviors that are not necessarily considered creative. Those three features reveal how traditional views of creativity undermine its real determiners and how it can be objectively defined and observed.

Relationships between neuropsychological performance, insight, medication adherence, and social metacognition in schizophrenia

BACKGROUND

Social metacognition is still poorly understood in schizophrenia, particularly its neuropsychological basis and its impact on insight and medication adherence. We therefore quantified social metacognition as the agreement between objective and subjective mentalization and assessed its correlates in a sample of individuals with schizophrenia spectrum disorders.

METHODS

Participants consisted of 143 patients with schizophrenia or schizoaffective disorders who underwent a metacognitive version of a mentalization task, an extensive neuropsychological battery, and a clinical evaluation to assess their insight into illness and medication adherence. We studied potential interactions between confidence judgments and several neuropsychological and clinical variables on mentalization accuracy with mixed-effects multiple logistic regressions.

RESULTS

Confidence judgments were closely associated with mentalization accuracy, indicative of good social metacognition in this task. Working memory, visual memory, and reasoning and problem-solving were the three neuropsychological dimensions positively associated with metacognition. By contrast, the two measures of medication adherence were associated with poorer metacognition, whereas no association was found between metacognition and clinical insight. The multiple regression model showed a significant positive impact of better working memory, older age at onset, longer duration of hospitalization, and worse medication adherence on social metacognition.

CONCLUSIONS

We discuss possible mechanisms underlying the apparent association between social metacognition and working memory. Adherence should be monitored when remediating social metacognition, and psychoeducation should be given to patients with a high level of awareness of their capacity to mentalize.

The safe pilot study: A prospective naturalistic study with repeated measures design to test protective factors against violence in and after discharge from forensic facilities

Assessing violence risk amongst forensic patients is a vital legal and clinical task. The field of violence risk assessment has developed considerably over the past two decades but remains primarily risk focused. Despite this, growing attention to and work on protective factors or strengths has occurred. In this prospective naturalistic study with repeated observer-rated measures of 27 forensic patients, we tested the role of three potentially important but understudied dynamic protective factors: hope, insight, and resilience, along with a history of criminality, in terms of their impact on violence. Main effects models indicated that higher hopelessness and past criminal convictions were predictive of violence acts; higher resilience was associated with lower violence. In interaction models, hopelessness remained predictive. Importantly, there were significant interactions between resilience and past criminal convictions, with higher levels of resilience leading to lower violence, most amongst those with criminal convictions, and between resilience and hopelessness related emotional distress, in that higher resilience at high levels of patient acknowledged emotional distress due to hopelessness led to lower violence. Findings indicate the importance of focusing on strengths or protective factors in the assessment of risk and treatment planning for forensic patients. Despite the small sample, the repeated measures design was feasible and informative.

Face matching and metacognition: investigating individual differences and a training intervention

Background

Although researchers have begun to consider metacognitive insight during face matching, little is known about the underlying mechanism. Here, I investigated whether objective ability, as well as self-assessed ability, were able to predict metacognitive performance, that is, the ability to differentiate correct and incorrect responses in terms of confidence. In addition, I considered whether a training intervention resulted in improvements to both face matching performance and metacognitive insight.

Methods

In this experiment (N = 220), participants completed a face matching task, with either a diagnostic feature training course or a control course presented at the halfway point. In addition, a second face matching task, as well as a self-report questionnaire regarding ability, were completed to provide measures of objective and self-assessed ability respectively.

Results

Higher self-assessed ability with faces, as well as higher objective ability with face matching, predicted better metacognitive performance, i.e., greater confidence in correct, in comparison with incorrect, responses. This pattern of results was evident both when objective ability was measured through performance on the same task used to measure metacognitive insight and when a different task was used. Finally, the training intervention failed to produce improvements in face matching performance and showed no evidence of altering metacognitive ability.

Discussion

The current work begins to address the mechanism underlying individual differences in metacognitive insight during face matching. Although support was provided for a competence-based account, where better face matchers showed greater performance on the task and were more successful in monitoring their performance, further work might focus on decoupling task performance and competence in order to more conclusively explain why some people are more insightful than others.

Correlates of poor insight: A comparative fMRI and sMRI study in obsessive-compulsive disorder and schizo-obsessive disorder

BACKGROUND

Despite the several researches on the correlates of insight in psychosis, less is known regarding the specificity of disease diagnosis on the relationship between insight and the correlates. The current study sought to explore the effects of insight and disease diagnosis on those in patients with obsessive-compulsive disorder (OCD) and patients with schizo-obsessive disorder (SOD).

METHODS

We evaluated clinical symptoms and neurocognitions among 111 patients (including 41 OCD with good insight, 40 OCD with poor insight, 14 SOD with good insight and 16 SOD with poor insight. Gray matter volume and spontaneous neural activity were also examined by analyzing the voxel-based morphometry and amplitude of low frequency fluctuation (ALFF), respectively.

RESULTS

Interactive effects of insight and diagnosis was found on working memory and the gray matter volume in right superior and middle temporal gyrus. Main effect of insight was found on working and visual memory, compulsion and obsession, and ALFF in right middle and superior occipital cortex. Main effect of diagnosis was found on severity of compulsion, relative verbal IQ, executive function, verbal and visual memory, working memory and ALFF in precuneus, medial superior frontal gyrus, anterior cingulate and paracingulate gyri, and inferior parietal, postcentral gyrus, paracentral lobule.

CONCLUSIONS

As a common feature in mental disorders, insight has its own special influence on neurocognition and possible structural/functional alterations in brain, and the influence is partly dependent of disease diagnosis.

Stress disrupts insight-driven mnemonic reconfiguration in the medial temporal lobe

Memories are not stored in isolation. Insight into the relationship of initially unrelated events may trigger a flexible reconfiguration of the mnemonic representation of these events. Such representational changes allow the integration of events into coherent episodes and help to build up-to-date-models of the world around us. This process is, however, frequently impaired in stress-related mental disorders resulting in symptoms such as fragmented memories in PTSD. Here, we combined a real life-like narrative-insight task, in which participants learned how initially separate events are linked, with fMRI-based representational similarity analysis to test if and how acute stress interferes with the insight-driven reconfiguration of memories. Our results showed that stress reduced the activity of medial temporal and prefrontal areas when participants gained insight into the link between events. Moreover, stress abolished the insight-related increase in representational dissimilarity for linked events in the anterior part of the hippocampus as well as its association with measures of subsequent memory that we observed in non-stressed controls. However, memory performance, as assessed in a forced-choice recognition test, was even enhanced in the stress group. Our findings suggest that acute stress impedes the neural integration of events into coherent episodes but promotes long-term memory for these integrated narratives and may thus have implications for understanding memory distortions in stress-related mental disorders.

Quality of life among patients with obsessive compulsive disorder: Impact of stigma, severity of illness, insight, and beliefs

Background

No Indian studies have evaluated the impact of stigma, severity, and insight on the quality of life in obsessive compulsive disorder.

Methods

A hospital-based, cross-sectional, descriptive study on 100 patients of obsessive-compulsive disorder (OCD) as per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was conducted. Data were collected using socio-demographic performa, Yale-Brown obsessive-compulsive scale (Y-BOCS), WHOQoL-Bref hindi, hindi stigma scale, and Brown Assessment of Beliefs Scale (BABS) from March to June 2021. Appropriate statistical analyses were used.

Results

A majority of patients were males (58%), married (65%), above matric pass (89%), and belonged to rural areas (62%). The total stigma score showed a significant negative correlation with overall QoL (P < 0.01**), overall health (P < 0.002**), satisfaction with physical health (P 0.006**), psychological health (P < 0.01**), and social relations (P < 0.01**) on WHOQoL-Bref. Discrimination, disclosure, and positive aspect domains of the stigma scale also showed a significant negative correlation with many domains of QoL. Severity of illness showed a significant negative correlation with overall QoL (P 0.045*), satisfaction with physical health (P < 0.01**), psychological health (P 0.01**), social relations (P 0.004**), and environment (P 0.007**). Poorer insight on BABS was associated with poorer overall health (P 0.04*), satisfaction with physical health (P 0.001**), social relations (P 0.03**), and environment (P 0.009**). Stigma was significantly increased by higher severity of obsessions (P 0.04*), compulsions (P 0.007**), and total Y-BOCS score (P 0.007**).

Conclusion

Stigma and severity of OCD have a significant negative impact on quality of life. Stigma reduction and appropriate management of severity should be an integral part of management for patients with OCD.

Assessing creativity independently of language: A language-independent remote associate task (LI-RAT)

Most creativity measures are either complex or language-dependent, hindering cross-cultural creativity assessment. We have therefore developed and tested a simple, language-independent insight task based on pictures in the style of the widely used verbal remote associate task (RAT). We demonstrate that the language-independent RAT (LI-RAT) allows assessment of different aspects of insight across large samples with different languages. It also correlates with other creativity and general problem-solving tasks. The entire stimulus set, including its preliminary normative data, is made freely available. This information can be used to select items based on accuracy, mean solution time, likelihood to produce an insight, or conceptual and perceptual similarity between the pictures per item.

Insight Problem Solving Ability Predicts Reduced Susceptibility to Fake News, Bullshit, and Overclaiming

The information humans are exposed to has grown exponentially. This has placed increased demands upon our information selection strategies resulting in reduced fact-checking and critical-thinking time. Prior research shows that problem solving (traditionally measured using the Cognitive Reflection Test-CRT) negatively correlates with believing in false information. We argue that this result is specifically related to insight problem solving. Solutions via insight are the result of parallel processing, characterized by filtering external noise, and, unlike cognitively controlled thinking, it does not suffer from the cognitive overload associated with processing multiple sources of information. We administered the Compound Remote Associate Test (problems used to investigate insight problem solving) as well as the CRT, 20 fake and real news headlines, the bullshit, and overclaiming scales to a sample of 61 participants. Results show that insight problem solving predicts better identification of fake news and bullshit (over and above traditional measures i.e., the CRT), and is associated with reduced overclaiming. These results have implications for understanding individual differences in susceptibility to believing false information.

Psychiatric patients' attitudes towards being hospitalized: a national multicentre study in Norway

BACKGROUND

The aim of the study was to explore patients' attitudes towards voluntary and involuntary hospitalization in Norway, and predictors for involuntary patients who wanted admission.

METHODS

A multi-centre study of consecutively admitted patients to emergency psychiatric wards over a 3 months period in 2005-06. Data included demographics, admission status (voluntary / involuntary), symptom levels, and whether the patients expressed a wish to be admitted regardless of judicial status. To analyse predictors of wanting admission (binary variable), a generalized linear mixed modelling was conducted, using random intercepts for the site, and fixed effects for all variables, with logit link-function.

RESULTS

The sample comprised of 3.051 patients of witch 1.232 (40.4%) were being involuntary hospitalised. As expected 96.5% of the voluntary admitted patients wanted admission, while as many as 29.7% of the involuntary patients stated that they wanted the same. The involuntary patients wanting admission were less likely to be transported by police, had less aggression, hallucinations and delusions, more depressed mood, less use of drugs, less suicidality before admission, better social functioning and were less often referred by general practitioners compared with involuntary patients who did not want admission. In a multivariate analysis, predictors for involuntary hospitalization and wanting admission were, not being transported by police, less aggression and less use of drugs.

CONCLUSIONS

Almost a third of the involuntary admitted patients stated that they actually wanted to be hospitalized. It thus seems to be important to thoroughly address patients' preferences, both before and after admission, regarding whether they wish to be hospitalized or not.

Effects of bilateral, bipolar-nonbalanced, frontal transcranial Direct Current Stimulation (tDCS) on negative symptoms and neurocognition in a sample of patients living with schizophrenia: Results of a randomized double-blind sham-controlled trial

Negative symptoms (NS), conceived as Avolition-Apathy (AA) and Expressive Deficit (EXP) domains, and neurocognitive impairments represent unmet therapeutic needs for patients with schizophrenia. The present study investigated if bilateral bipolar-nonbalanced frontal transcranial Direct Current Stimulation (tDCS) could improve these psychopathological dimensions. This randomized, double-blind, sham-controlled study (active-tDCS versus sham-tDCS, both, n = 25) included 50 outpatients diagnosed with schizophrenia clinically stabilized. Patients received 20-min 2 mA active-tDCS or sham-tDCS (anode: left Dorsolateral Prefrontal Cortex; cathode: right orbitofrontal region). Primary outcomes included: PANSS-Negative subscale, Negative Factor (Neg-PANSS), AA and EXP domains; neurocognitive performance at Brief Assessment of Cognition in Schizophrenia. Secondary outcomes included: PANSS subscales and total score, Disorganized/Concrete (DiscC-PANSS) and Positive Factors, Clinical Global Impression (CGI) scores, clinical insight at Scale to Assess Unawareness of Mental Disorder (SUMD). Analysis of covariance (ANCOVA) was performed evaluating between-group changes over time. Significant improvements following active-tDCS were observed for all NS measures (all, p < 0.001; d > 0.8) and for working memory (p = 0.025, d = 0.31). Greater variations following to active treatment emerged also for PANSS-General Psychopathology subscale (p < 0.001; d = 0.54), PANSS total score (p < 0.001; d = 0.69), CGI indexes (all, p < 0.001; d > 0.6), DiscC-PANSS (p < 0.001; d = 0.80) and SUMD-general Unawareness index (p = 0.005; d = 0.15) but not for positive symptoms and others insight measures. Good safety/tolerability profiles were found. Bilateral bipolar-nonbalanced frontal-tDCS is a non-pharmacological approach in schizophrenia effectively improving NS, particularly the AA and EXP domains, probably acting by modulating dysfunctional cortical-subcortical networks. Preliminary results also suggest working memory improvements following tDCS. Further studies are needed to confirm the neurobiological basis of these results.

Is clinical insight a determinant factor of subjective recovery in persons living with schizophrenia or schizoaffective disorders?

Good clinical insight is predictive of clinical recovery in schizophrenia (i.e. symptomatic remission and functional improvement). However, the recent subjective recovery paradigm (i.e. the self-identity reconstruction process with and beyond psychosis) questioned the relevance of seeking patients' awareness of their medically-defined illness. This study aimed to assess the relationship between clinical insight and subjective recovery in individuals with psychotic disorders. Sixty-seven outpatients diagnosed with schizophrenia or schizoaffective disorder were assessed for clinical insight using the Scale to assess Unawareness of Mental Disorder (SUMD) and for self-rated subjective recovery using the Recovery Assessment Scale (RAS). Among all dimensions of insight, only the unawareness of current symptoms was significantly associated with RAS total score, with illness duration as the only moderating factor. On the final regression model, unawareness of current symptoms was confirmed as the strongest of six factors explaining all together 44% of the subjective recovery variance, whereas clinical insight taken as an independent multidimensional construct did not significantly participate in explaining subjective recovery. Our study highlights the weak and only partial implication of clinical insight in subjective recovery, and invites clinicians to consider the patients' meaning making process of morbid experiences in order to build a self-directed and medically-supported recovery.

Association between obsession, compulsion, depression and insight in obsessive-compulsive disorder: a meta-analysis

BACKGROUND

Previous studies examining potential relationships of impaired insight with severity obsessive-compulsive (O-C) symptoms and depressive symptoms in patients diagnosed with obsessive-compulsive disorder (OCD) have produced mixed results. Here, we examined differences in these clinical characteristics and their changes after treatment in adult patients with OCD who have poor insight (OCD-PI) versus in those who have good insight (OCD-GI).

METHODS

Fifty-nine full-text articles were screened for eligibility with 20 studies ultimately being included in the present meta-analysis.

RESULTS

The OCD-PI and OCD-GI groups differed from each other with respect to O-C symptom (p < 0.001, g > 0.7) and depressive symptom (p < 0.001, g = 0.614) severity. Significant and moderate correlations were observed between insight and treatment outcomes (O-C symptoms, r = 0.33; depressive symptoms, r = 0.47). Exploratory meta-regression showed that methodological factors influenced the magnitudes of inter-group O-C symptom differences.

CONCLUSIONS

The current meta-analysis indicates that poorer insight is associated with more severe O-C and depression, and less improvement of symptoms in patients with OCD. Insight impairment may be a critical and core OCD-related deficit.

Clinical insight in first-episode psychosis: Clinical, neurocognitive and metacognitive predictors

OBJECTIVE

Poor insight is a major problem in psychosis, being detrimental for treatment compliance and recovery. Previous studies have identified various correlates of insight impairment, mostly in chronic samples. The current study aimed to determine clinical, neurocognitive, metacognitive, and socio-cognitive predictors of insight in first-episode psychosis.

METHODS

Regression analyses of different insight dimensions were conducted in 190 patients with first-episode psychosis. Measures of clinical symptoms, neurocognition, metacognition, social cognition, and 'jumping to conclusions' bias were entered as predictors.

RESULTS

Delusions, disorganisation, and certain negative symptoms were associated with unawareness in various domains, while depression was associated with greater awareness of illness. Deficit in theory of mind and self-reflective processes, as well as a 'jumping to conclusions' bias, contributed to poor insight. Several neuropsychological scores also contributed to this but their contribution was no longer observed in regression analyses that included all the previously identified clinical and cognitive predictors. A measure of perseverative errors was still associated with unawareness and misattribution of symptoms.

CONCLUSION

In models that account for 28 % to 50 % of the variance, poor insight in first-episode psychosis is mainly associated with delusions and certain negative symptoms. At the cognitive level it does not appear to result from neuropsychological impairment but rather from altered reasoning bias and dysfunction in metacognitive processes. Therapeutic strategies specifically directed at these mechanisms could help improve the evolution of insight in first episode psychosis.

Youth Insight About Social Media Effects on Well/Ill-Being and Self-Modulating Efforts

PURPOSE

We aim to investigate youth insight about how their social media use affects them. We hope to understand if and how they self-modulate their use.

METHODS

Using a text message-based platform, codable survey responses were returned by a minimum of 871 of 1,144 youth aged 14-24 in November, 2020. Youth were asked the following three questions: (1) What advice would you give to young people who are new to social media? (2) Have you ever felt like you need to change your social media use (what you view, time spent, etc.)? Why? (3) Have you ever deleted or thought about deleting your social media account(s)? Why? A codebook was created from the data and two coders independently coded the entirety of the data set using the 18-code codebook. Coders resolved discrepancies in coding patterns together and the frequency of each code was recorded.

RESULTS

Youth showed insight about negative impacts of social media and were especially concerned about safety on social media. A majority of respondents deleted or thought about deleting their social media account or app. Youth were more likely to report wanting to change the amount of time spent on their social media compared to the content they view.

DISCUSSION

Youth are aware of ways in which social media could be negatively impacting them and they have employed methods to modulate their use because of this awareness.

Impaired insight in schizophrenia: impact on patient-reported and physician-reported outcome measures in a randomized controlled trial

BACKGROUND

Impaired insight poses a challenge in the treatment of patients with schizophrenia because of its potential to jeopardize therapeutic engagement and medication adherence. This study explored how insight impairment, graded from none to extreme, is related to patient-reported mental health status, depression, and neurocognition in schizophrenia.

METHODS

In a post hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study (NCT00014001), insight was measured using the Positive and Negative Syndrome Scale (PANSS) Item G12 (lack of insight). Additional assessments for this analysis included the 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS), physician- and patient-reported Clinical Global Impression-Severity (CGI-S), MATRICS Consensus Cognitive Battery, and Calgary Depression Scale for Schizophrenia. Relationships between patient-reported outcomes and PANSS total and Item G12 ratings were evaluated.

RESULTS

Among 1431 CATIE study participants in this analysis, increasingly impaired insight at baseline was significantly associated with better patient-reported quality of life (QoL), lower baseline depression, and greater divergence between physician- and patient-reported illness severity. Patients with more severely impaired insight reported milder illness compared with physician reports, particularly those with moderate-severe to extreme impairment (PANSS Item G12 rating ≥ 5), approximately 10% (138/1431) of CATIE participants. For the 90% of patients with PANSS Item G12 ratings < 5, patient-reported QoL decreased with increasing symptoms. SF-12 MCS scores were linearly related to baseline PANSS total score only in patients with PANSS total score < 90 (moderately ill or better), and better symptom scores were associated with higher QoL. No significant relationship between insight and neurocognition was observed.

CONCLUSIONS

In the small subgroup (10%) of CATIE study patients with schizophrenia and PANSS Item G12 ratings ≥5, moderate-severe-severe/extreme insight impairment was associated with significantly more positive perception of QoL and illness severity by the patient versus the treating physician. This was not observed in the remaining 90% of patients with normal to moderately impaired insight, suggesting that poor insight as a threat to the validity of self-report is uncommon.

Predictors of Awareness of Functional Ability in People with Dementia: The Contribution of Personality, Cognition, and Neuropsychiatric Symptoms - Findings from the IDEAL Program

INTRODUCTION

Discrepancy scores reflecting the difference between parallel ratings made by people living with dementia (PwD) in the mild-to-moderate stages and by their informants provide a way to investigate awareness of functional ability in relation to activities of daily living (ADL).

METHODS

Two measures of ADL (Functional Activities Questionnaire; Dependence Scale) were completed by 1,227 PwD and their informants in the IDEAL cohort study baseline assessment. Self-rated and informant-rated scores were used to calculate discrepancies, which were used as an indicator of awareness of functional ability. Smaller discrepancy scores were considered to reflect greater awareness on the part of PwD. PwD completed questionnaires on depression, personality, comorbidities, neuropsychiatric symptoms, and completed a measure of cognition. Informants provided ratings of stress. Univariable and multiple regressions were used to investigate factors related to ADL discrepancy.

RESULTS

A similar pattern of associations were found for both ADL discrepancy scores. Smaller discrepancy scores were associated with higher levels of depression, higher neuroticism, fewer neuropsychiatric symptoms, higher comorbidity, lower carer stress, and receipt of less than 1 hour of care per day from the informant.

DISCUSSION/CONCLUSION

There was a clear pattern of factors that were associated with greater awareness for both measures of functional ability. These factors associated with smaller discrepancy scores could be used to identify PwD who might benefit from targeted interventions to support their independence.

Thinking style and psychosis proneness do not predict false insights

The FIAT paradigm (Grimmer et al., 2021) is a novel method of eliciting 'Aha' moments for incorrect solutions to anagrams in the laboratory, i.e. false insights. There exist many documented reports of psychotic symptoms accompanying strong feelings of 'Aha!' (Feyaerts, Henriksen, Vanheule, Myin-Germeys, & Sass, 2021; Mishara, 2010; Tulver, Kaup, Laukkonen, & Aru, 2021), suggesting that the newly developed FIAT could reveal whether people who have more false insights are more prone to psychosis and delusional belief. To test this possibility, we recruited 200 participants to take an adapted version of the FIAT and complete measures of thinking style and psychosis proneness. We found no association between experimentally induced false insights and measures of Schizotypy, Need for Cognition, Jumping to Conclusions, Aberrant Salience, Faith in Intuition, or the Cognitive Reflection Task. We conclude that experiencing false insights might not be constrained to any particular type of person, but rather, may arise for anyone under the right circumstances.

The psychometric properties of the Nepean Belief Scale as a tool for assessing delusions in schizophrenia and related psychotic disorders

OBJECTIVES

To examine the psychometric characteristics of the Nepean Belief Scale (NBS) in psychiatric inpatients with delusions. The NBS is a five-item, clinician-administered scale that assesses the characteristics of beliefs, i.e. conviction, fixity, fluctuation, resistance and awareness that the belief is unreasonable.

METHODS

Fifty-five patients were interviewed by two clinicians, within three days of admission to an acute psychiatric unit and were assessed using the NBS, the Brown Assessment of Belief Scale (BABS), the MINI International Neuropsychiatric Interview (MINI) and the Depression Anxiety Stress Scale 21-Item Version (DASS-21). The NBS was administered after two weeks to available participants, to assess test-retest reliability.

RESULTS

Results demonstrated excellent inter-rater reliability of 0.93, Cronbach's alpha coefficient for internal consistency was 0.77. The NBS was found to have good convergent validity with the BABS and good discriminant validity with the DASS. Two-week test-retest reliability suggests that the NBS is sensitive to therapeutic change.

CONCLUSIONS

Advantages of the NBS include its brevity, its ability to assess belief-related insight, its clear instructions and its definitions of belief characteristics. Thus, the NBS has the potential to greatly improve our ability to more objectively assess delusional beliefs.

Cognitive insight in individuals at ultra-high risk for psychosis compared to patients with first-episode psychosis and non-psychotic help-seeking youths

BACKGROUND

Defective insight is a hallmark of schizophrenia. Less is known about insight in emerging psychosis. In this study a widely used measure of cognitive insight, the Beck Cognitive Insight Scale (BCIS), has been applied to a sample including patients with first-episode psychosis (FEP), at ultra-high risk (UHR) for psychosis, and help-seeking youths without psychotic symptoms.

METHODS

The Comprehensive Assessment of At-Risk Mental State (CAARMS) interview was used to classify patients. Enrolled patients were assessed with the General Health Questionnaire-12 (GHQ-12), the Prodromal Questionnaire-16 (PQ-16), the Social and Occupational Functioning Assessment Scale (SOFAS), and the BCIS.

RESULTS

The sample included 212 participants (58%) with non-psychotic mental distress, 131 participants (36%) were UHR, and 22 (6%) were with FEP. Males and females were in equal proportion, mean age was 19.2 ± 2.6 years old (range: 15-25 years). Reliability (Cronbach's alpha) was good for clinical scales (>0.7) and acceptable (around 0.6) for the two BCIS subscales. The self-certainty subscale of the BCIS was more reproducible in factor analysis than the self-reflectiveness scale. Youths devoid of psychotic symptoms scored lower than UHR and FEP participants on the GHQ-12 and the PQ-16 and had better psychosocial functioning as measured by the SOFAS. Levels of cognitive insight did not differ between groups.

CONCLUSION

People in the early stages of psychosis may be still accessible to self-reflectiveness and more hesitant about the certainty of their beliefs than patients at more advanced stages of the illness, as those with fully displayed schizophrenia.

Dynamics of hidden brain states when people solve verbal puzzles

When people try to solve a problem, they go through distinct steps (encoding, ideation, evaluation, etc.) recurrently and spontaneously. To disentangle different cognitive processes that unfold throughout a trial, we applied an unsupervised machine learning method to electroencephalogram (EEG) data continuously recorded while 39 participants attempted 153 Compound Remote Associates problems (CRA). CRA problems are verbal puzzles that can be solved in either insight-leaning or analysis-leaning manner. We fitted a Hidden Markov Model to the time-frequency transformed EEG signals and decoded each trial as a time-resolved state sequence. The model characterizes hidden brain states with spectrally resolved power topography. Seven states were identified with distinct activation patterns in the theta (4-7 Hz), alpha (8-9 Hz and 10-13 Hz), and gamma (25-50 Hz) bands. Notably, a state featuring widespread activation only in alpha-band frequency emerged, from this data-driven approach, which exhibited dynamic characteristics associated with specific temporal stages and outcomes (whether solved with insight or analysis) of the trials. The state dynamics derived from the model overlap and extend previous literature on the cognitive function of alpha oscillation: the "alpha-state" probability peaks before stimulus onset and decreases before response. In trials solved with insight, relative to solved with analysis, the alpha-state is more likely to be visited and maintained during preparation and solving periods, and its probability declines more sharply immediately preceding a response. This novel paradigm provides a way to extract dynamic features that characterize problem-solving stages and potentially provide a novel window into the nature of the underlying cognitive processes.

Neuroimaging correlates of insight in non-affective psychosis: A systematic review and meta-analysis

OBJECTIVE

Neurological correlates of impaired insight in non-affective psychosis remain unclear. This study aimed to review and meta-analyze the studies assessing the grey matter volumetric correlates of impaired insight in non-affective psychosis.

METHODS

This study consisted of a systematic review of 23 studies, and a meta-analysis with SDM-PSI of the 11 studies that were whole-brain and reported maps or peaks of correlation of studies investigating the grey matter volumetric correlates of insight assessments of non-affective psychosis, PubMed and OVID datasets were independently reviewed for articles reporting neuroimaging correlates of insight in non-affective psychosis. Quality assessment was realized following previous methodological approaches for the ABC quality assessment test of imaging studies, based on two main criteria: the statistical power and the multidimensional assessment of insight. Study peaks of correlation between grey matter volume and insight were used to recreate brain correlation maps.

RESULTS

A total of 418 records were identified through database searching. Of these records, twenty-three magnetic resonance imaging (MRI) studies that used different insight scales were included. The quality of the evidence was high in 11 studies, moderate in nine, and low in three. Patients with reduced insight showed decreases in the frontal, temporal (specifically in superior temporal gyrus), precuneus, cingulate, insula, and occipital lobes cortical grey matter volume. The meta-analysis indicated a positive correlation between grey matter volume and insight in the right insula (i.e., the smaller the grey matter, the lower the insight).

CONCLUSION

Several brain areas might be involved in impaired insight in patients with non-affective psychoses. The methodologies employed, such as the applied insight scales, may have contributed to the considerable discrepancies in the findings.

Momentary severity of psychotic symptoms predicts overestimation of competence in domains of everyday activities and work in schizophrenia: An ecological momentary assessment study

OBJECTIVES

Schizophrenia participants generate self-reports of their competencies that differ from objective information. They may base their reports on momentary moods or experiences rather than objective data. Theories of delusion formation implicate overconfidence during self-assessment as a cause.

METHODS

Ecological momentary assessment (EMA) was used to sample activities and experiences in 101 participants with schizophrenia up to 3 times a day for 30 days. Each survey asked where and with whom they were, what they were doing, and moods and psychotic symptoms they were experiencing. Self-reports and observer ratings of competence in work and everyday activities were collected.

RESULTS

Being home was associated with self-reports of better functioning in activities and work skills (p<.001) and being alone correlated with better self-reported functioning in activities (p<.001). Participants who reported more occurrences of hearing voices, paranoid ideation, and other psychotic symptoms reported their functioning as better (p<.001).

IMPLICATIONS

Schizophrenia was marked by a disconnect between momentary activities and self-assessments. Being home more was associated with better self-reported functioning on tasks that are only performed away from home. Psychotic  symptoms were associated with overestimation, consistent with previous theories positing that overconfidence and suspension of plausibility assessment may be associated with psychotic experiences.

Clinical insight and cognitive functioning as mediators in the relationships between symptoms of psychosis, depression, and suicide ideation in first-episode psychosis

First-episode psychosis (FEP) is a particularly high-risk period for suicide. Literature suggests poor cognitive functioning may serve as a protective factor, while investigations of clinical insight reveal a complex relationship with suicide outcomes. This study examined the mediating role of cognition and clinical insight in the relationships between positive and negative symptoms, depression, and subsequent suicide ideation among individuals in FEP. Data were obtained from the Recovery After an Initial Schizophrenia Episode project. Participants (n = 404) included adolescents and adults in FEP between the ages of 15 and 40. Measurement utilized the Calgary Depression Rating Scale, Positive and Negative Syndrome Scale, and Brief Assessment of Cognition in Schizophrenia. Structural equation modeling was used to examine the mediation model. The likelihood of experiencing suicide ideation was significantly decreased when working memory was stronger (b = -0.034, SE = 0.02, OR = 0.967, p < .05), and significantly increased when clinical insight was stronger (b = 0.191, SE = 0.08, OR = 1.21, p < .01), positive symptoms were greater (b = 0.422, SE = 0.20, OR = 1.52, p < .05) and depressive symptoms were greater (b = 0.545, SE = 0.15, OR = 1.70, p < .001). Clinical insight and working memory functioned as mediators in the relationships between depression, positive symptoms, negative symptoms, and suicide ideation. Findings suggest it is essential that clinicians have awareness of insight being a risk factor for suicide ideation and balance therapeutic efforts to strengthen clinical insight and cognition in psychosocial treatments with suicide risk assessment and prevention methods.