Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-25T10:44:26.857Z Has data issue: false hasContentIssue false
  • English
  • Français

Dissociating self-reported cognitive complaint from clinical insight in schizophrenia

Published online by Cambridge University Press:  16 April 2020

Sophie Bayard ,
Delphine Capdevielle ,
Jean-Philippe Boulenger  and
Stéphane Raffard
Sophie Bayard*
Affiliation:
Sleep Disorder Unit, University Department of Neurology, University of Montpellier 1, 34295 Montpellier, Cedex 5, France
Delphine Capdevielle
Affiliation:
University Department of adult Psychiatry, University of Montpellier 1, Montpellier, France INSERM U-888, Montpellier, France
Jean-Philippe Boulenger
Affiliation:
University Department of adult Psychiatry, University of Montpellier 1, Montpellier, France INSERM U-888, Montpellier, France
Stéphane Raffard
Affiliation:
University Department of adult Psychiatry, University of Montpellier 1, Montpellier, France INSERM U-888, Montpellier, France University Department of Clinical Psychology and Neuropsychology, EA 4210, University of Montpellier 3, France
*
*Corresponding author. E-mail address: bayardsophie@yahoo.fr
Get access

Abstract

Whereas new pharmacological treatments are developed for cognitive impairments in schizophrenia, self-assessment of cognitive dysfunctioning besides their objective validity could be of interest in evaluating patients' motivation to engage in rehabilitation program. Nevertheless insight into symptoms is severely impaired in schizophrenia and is negatively linked with poor compliance. But it is yet unknown if patients with poor insight into their symptoms could have some insight into their cognitive impairments. The aim of this study was to explore the relationships existing between the cognitive complaint and the level of awareness of the disease in patients with schizophrenia. A total of 101 patients with DSM-IV schizophrenia or schizoaffective disorder and 60 control participants were recruited. Insight was assessed using the Scale to assess Unawareness of Mental Disorder (SUMD) and cognitive complaint intensity was assessed with the Scale to Investigate Cognition in Schizophrenia (SSTICS). Participants with schizophrenia displayed the same level of cognitive complaint when compared to healthy controls. Strong correlations were observed between SSTICS total score and duration of illness, levels of depression and state anxiety. Patients with a good insight into the therapeutic effects achieved with medication expressed a more important cognitive complaint. No correlations were found between the four others SUMD insight dimensions and total SSTICS score. The partial overlap of insight into illness and cognitive complaint suggests that insight is modular in schizophrenia. Assessment of cognitive complaint and awareness of illness need to be assessed before engagement in rehabilitation program.

Keywords

SchizophreniaInsightCognitive complaintScale to Investigate Cognition in SchizophreniaScale to assess Unawareness of Mental Disorder
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 4 , May 2009 , pp. 251 - 258
Copyright
Copyright © Elsevier Masson SAS 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amador, X.F., Flaum, M., Andreasen, N.C., Strauss, D.H., Yale, S.A., Clark, S.C.et al.Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry 1994;51(10):826–836CrossRefGoogle ScholarPubMed
Amador, X.F., Strauss, D.H., Yale, S.A., Flaum, M.M., Endicott, J., Gorman, J.M.Assessment of insight in psychosis. Am J Psychiatry 1993;150(6):873–879Google ScholarPubMed
Amador, X.F., Strauss, D.H.The scale to assess unawareness of mental disorder New YorkColumbia University and New York Psychiatric Institute 1990Google Scholar
American Psychiatric Association, Practice guidelines for the treatment of patients with schizophrenia Washington (DC)American Psychiatric Press 1997Google Scholar
Antikainen, R., Hänninen, T., Honkalampi, K., Hintikka, J., Koivumaa-Honkanen, H., Tanskanen, A.et al.Mood improvement reduces memory complaints in depressed patients. Eur Arch Psychiatry Clin Neurosci 2001;251(1):6–11CrossRefGoogle ScholarPubMed
Beck, A.T., Steer, R.A., Brown, G.K.Inventaire de dépression de Beck Paris, FranceEditions du Centre de Psychologie Appliquée 1998Google Scholar
Bell, M., Bioty, S.Cognitively disorganized schizophrenia: a taxometric analysis of PANSS ratings. Schizophr Res 1997;42:98Google Scholar
Bell, M., Fiszdon, J., Richardson, R., Lysaker, P., Bryson, G.Are self-reports valid for schizophrenia patients with poor insight? Relationship of unawareness of illness to psychological self-report instruments. Psychiatry Res 2007;151(1–2):37–46CrossRefGoogle ScholarPubMed
Bentall, R.Madness explained: why we must reject the Kraepelinian paradigm and replace it with a ‘complaint-orientated’ approach to understanding mental illness. Med Hypotheses 2006;66(2):220–233CrossRefGoogle ScholarPubMed
Blazer, D.G., Hays, J.C., Fillenbaum, G.G., Gold, D.T.Memory complaint as a predictor of cognitive decline: a comparison of African American and White elders. J Aging Health 1997;9(2):171–184CrossRefGoogle ScholarPubMed
Bozikas, V.P., Kosmidis, M.H., Kioperlidou, K., Karavatos, A.Relationship between psychopathology and cognitive functioning in schizophrenia. Compr Psychiatry 2004;45(5):392–400CrossRefGoogle Scholar
Brébion, G., David, A.S., Bressan, R.A., Pilowsky, L.S.Role of processing speed and depressed mood on encoding, storage, and retrieval memory functions in patients diagnosed with schizophrenia. J Int Neuropsychol Soc 2007;13(1):99–107CrossRefGoogle ScholarPubMed
Brébion, G., Gorman, J.M., Malaspina, D., Sharif, Z., Amador, X.Clinical and cognitive factors associated with verbal memory task performance in patients with schizophrenia. Am J Psychiatry 2001;158(5):758–764CrossRefGoogle ScholarPubMed
Bryson, G., Bell, M., Greig, T., Kaplan, E.Internal consistency, temporal stability and neuropsychological correlates of three cognitive components of the Positive and Negative Syndrome Scale (PANSS). Schizophr Res 1999;38(1):27–35CrossRefGoogle Scholar
Buckley, P.F., Wirshing, D.A., Bhushan, P., Pierre, J.M., Resnick, S.A., Wirshing, W.C.Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs 2007;21(2):129–141CrossRefGoogle ScholarPubMed
Chandler, J.D., Gerndt, J.Memory complaints and memory deficits in young and old psychiatric inpatients. J Geriatr Psychiatry Neurol 1988;1(2):84–88Google Scholar
Derouesné, C., Alperovitch, A., Arvay, N., Migeon, P., Moulin, F., Vollant, M.et al.Memory complaints in the elderly: a study of 367 community-dwelling individuals from 50 to 80 years old. Arch Gerontol Geriatr Suppl 1989;1:151–163Google ScholarPubMed
Drake, R.J., Pickles, A., Bentall, R.P., Kinderman, P., Haddock, G., Tarrier, N.et al.The evolution of insight, paranoia and depression during early schizophrenia. Psychol Med 2004;34(2):285–292CrossRefGoogle ScholarPubMed
First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W.Structured clinical interview for DSM-IV (SCID) axis I disorders Washington (DC)American Psychiatric Press 1997Google Scholar
Frank, A.F., Gunderson, J.G.The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Arch Gen Psychiatry 1990;47(3):228–236CrossRefGoogle ScholarPubMed
Green, M.F.Stimulating the development of drug treatments to improve cognition in schizophrenia. Annu Rev Clin Psychol 2007;3:159–180CrossRefGoogle ScholarPubMed
Harvey, P.D., Serper, M.R., White, L., Parrella, M.J., McGurk, S.R., Moriarty, P.J.et al.The convergence of neuropsychological testing and clinical ratings of cognitive impairment in patients with schizophrenia. Compr Psychiatry 2001;42(4):306–313CrossRefGoogle ScholarPubMed
Hofer A, Niedermayer B, Kemmler G, Rettenbacher MA, Trebo E, Widschwendter CG, et al. Cognitive impairment in schizophrenia: clinical ratings are not a suitable alternative to neuropsychological testing. Schizophr Res 2007;92:126–131.CrossRefGoogle Scholar
Hori, H., Noguchi, H., Hashimoto, R., Nakabayashi, T., Omori, M., Takahashi, S.et al.Antipsychotic medication and cognitive function in schizophrenia. Schizophr Res 2006;86(1–3):138–146CrossRefGoogle Scholar
Kay, S.R., Fiszbein, A., Vital-Herne, M., Fuentes, L.S.The positive and negative syndrome scale–Spanish adaptation. J Nerv Ment Dis 1990;178(8):510–517CrossRefGoogle ScholarPubMed
Law, M.R., Soumerai, S.B., Ross-Degnan, D., Adams, A.S.A longitudinal study of medication nonadherence and hospitalization risk in schizophrenia. J Clin Psychiatry 2008;69(1):47–53CrossRefGoogle Scholar
Lysaker, P.H., Buck, K.D.Illness and the disruption of autobiography: accounting for the complex effect of awareness in schizophrenia. J Psychosoc Nurs Ment Health Serv 2007;45(9):39–45CrossRefGoogle Scholar
Mancini, A., Stip, E., Prouteau, A., Caron, J., Leconte, Y., Pampoulova, T.Subjective experience of cognitive of cognitive deficits in schizophrenia. Schizophr Res 2000;53:144Google Scholar
McEvoy, J.P., Freter, S., Everett, G., Geller, J.L., Appelbaum, P., Apperson, L.J.et al.Insight and the clinical outcome of schizophrenic patients. J Nerv Ment Dis 1989;177(1):48–51CrossRefGoogle ScholarPubMed
Medalia, A., Lim, R.W.Self-awareness of cognitive functioning in schizophrenia. Schizophr Res 2004;71(2–3):331–338CrossRefGoogle Scholar
Medalia, A., Thysen, J.Insight into neurocognitive dysfunction in schizophrenia. Schizophr Bull 2008;34(6):1221–1230CrossRefGoogle Scholar
Mintz, A.R., Dobson, K.S., Romney, D.M.Insight in schizophrenia: a meta-analysis. Schizophr Res 2003;61(1):75–88CrossRefGoogle ScholarPubMed
Moritz, S., Krausz, M., Gottwalz, E., Lambert, M., Perro, C., Ganzer, S.et al.Cognitive dysfunction at baseline predicts symptomatic 1-year outcome in first-episode schizophrenics. Psychopathology 2000;33(1):48–51CrossRefGoogle ScholarPubMed
Möser, C., Krieg, J.C., Zihl, J., Lautenbacher, S.Attention and memory deficits in schizophrenia: the role of symptoms of depression. Cogn Behav Neurol 2006;19(3):150–156Google ScholarPubMed
Nuechterlein, K.H., Green, M.F., Kern, R.S., Baade, L.E., Barch, D.M., Cohen, J.D.et al.The MATRICS consensus cognitive battery, part 1: test selection, reliability, and validity. Am J Psychiatry 2008;165(2):203–213CrossRefGoogle ScholarPubMed
O'Hara, M.W., Hinrichs, J.V., Kohout, F.J., Wallace, R.B., Lemke, J.H.Memory complaint and memory performance in the depressed elderly. Psychol Aging 1986;1(3):208–214CrossRefGoogle ScholarPubMed
Peralta, V., Cuesta, M.J., de Leon, J.Positive versus negative schizophrenia and basic symptoms. Compr Psychiatry 1992;33(3):202–206CrossRefGoogle ScholarPubMed
Pini, S., Cassano, G.B., Dell'Osso, L., Amador, X.F.Insight into illness in schizophrenia, schizoaffective disorder, and mood disorders with psychotic features. Am J Psychiatry 2001;158(1):122–125CrossRefGoogle ScholarPubMed
Popkin, S.J., Gallagher, D., Thompson, L.W., Moore, M.Memory complaint and performance in normal and depressed older adults. Exp Aging Res 1982;8(3–4):141–145CrossRefGoogle ScholarPubMed
Prouteau, A., Verdoux, H., Briand, C., Lesage, A., Lalonde, P., Nicole, L.et al.Self-assessed cognitive dysfunction and objective performance in outpatients with schizophrenia participating in a rehabilitation program. Schizophr Res 2004;69(1):85–91CrossRefGoogle Scholar
Raffard S, D'Argembeau A, Lardi C, Bayard S, Boulenge JP, Van der Linden M. Exploring self-defining memories in schizophrenia. Memory 2009;17(1):26–38.CrossRefGoogle Scholar
Reichenberg, A., Harvey, P.D.Neuropsychological impairments in schizophrenia: integration of performance-based and brain imaging findings. Psychol Bull 2007;133(5):833–858CrossRefGoogle ScholarPubMed
Schooler, N.R.Relapse prevention and recovery in the treatment of schizophrenia. J Clin Psychiatry 2006;67(Suppl. 5):19–23Google ScholarPubMed
Shad, M.U., Tamminga, C.A., Cullum, M., Haas, G.L., Keshavan, M.S.Insight and frontal cortical function in schizophrenia: a review. Schizophr Res 2006;86(1–3):54–70CrossRefGoogle ScholarPubMed
Spielberger, C.D.Manual for the state-trait anxiety inventory (STAI) Palo AltoConsulting Psychologists Press 1983Google Scholar
Stip, E., Caron, J., Renaud, S., Pampoulova, T., Lecomte, Y.Exploring cognitive complaints in schizophrenia: the subjective scale to investigate cognition in schizophrenia. Compr Psychiatry 2003;44(4):331–340CrossRefGoogle ScholarPubMed
Stroup, T.S.Heterogeneity of treatment effects in schizophrenia. Am J Med 2007;120(Suppl. 1):S26–S31CrossRefGoogle Scholar
Süllwold, L., Huber, G.Basic schizophrenic disorders. Monogr Gesamtgeb Psychiatr Psychiatry Ser 1986;42:1–177 [in German]Google ScholarPubMed
Swartz, M.S., Perkins, D.O., Stroup, T.S., Davis, S.M., Capuano, G., Rosenheck, R.A.et al.Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE study. Am J Psychiatry 2007;164(3):428–436CrossRefGoogle ScholarPubMed
Velligan, D.I., Lam, Y.W., Glahn, D.C., Barrett, J.A., Maples, N.J., Ereshefsky, L.et al.Defining and assessing adherence to oral antipsychotics: a review of the literature. Schizophr Bull 2006;32(4):724–742CrossRefGoogle ScholarPubMed
Watson, P.W., Garety, P.A., Weinman, J., Dunn, G., Bebbington, P.E., Fowler, D.et al.Emotional dysfunction in schizophrenia spectrum psychosis: the role of illness perceptions. Psychol Med 2006;36(6):761–770CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.