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Neurocognitive insight in people with schizophrenia


Cognitive impairment is a core component of schizophrenia. Cognitive training is a promising behavioral treatment, with current research examining factors influencing treatment utilization and effectiveness. Insight is one proposed moderator that includes awareness of mental illness (clinical insight), self-certainty about beliefs (cognitive insight), and awareness of neuropsychological impairment (neurocognitive insight). Despite the known cognitive dysfunction associated with schizophrenia, individuals' awareness of impairment and whether that affects treatment use and outcome is unclear. This research explored metacognitive abilities (cognitive and neurocognitive insight) among individuals diagnosed with schizophrenia, the relationships between insight and objective cognitive performance, and whether insight affects treatment adherence and/or outcome. This project encompassed three studies. The first study investigated clinical and cognitive insight in 69 individuals enrolled in a compensatory cognitive training intervention. The second study (n=214) examined neurocognitive insight among participants with objectively measured cognitive impairment, and its relationship to executive functioning, functional capacity, and psychiatric symptoms. The third study evaluated the relationship between neurocognitive insight and treatment utilization and outcome in 69 cognitive treatment-seeking participants. Study 1 demonstrated that better clinical insight was related to better executive functioning and less severe negative symptoms; cognitive insight was not related to any measures. Study 2 found that 54% of participants with cognitive impairment showed impaired neurocognitive insight. Those individuals reported significantly fewer positive symptoms and depressive symptoms; the groups did not significantly differ on other measures. Study 3 found a lower percentage of participants with impaired neurocognitive insight (28%); participants did not differ on treatment utilization variables. Moreover, participants with impaired neurocognitive insight in the treatment condition showed improvements in verbal memory and functional capacity. These studies supported the multidimensional nature of insight and differential relationships with cognition, functioning, and symptoms. A substantial number of cognitively impaired participants minimally reported cognitive problems. Neurocognitive insight was not related to executive functioning and was equivocally related to positive and depressive symptoms. As there were no differences between the neurocognitive insight groups on treatment utilization, and participants with impaired neurocognitive insight showed gains in verbal memory and functional capacity, clinicians need not exclude people with impaired insight from cognitive training treatment

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