Neuropsychological correlates of cognitive insight in schizophrenia

Clinical practice has highlighted a possible discrepancy between patient's verbal assertions, called clinical insight, and the actual convictions about the illness, called emotional insight. The complementary construct of cognitive insight refers to the cognitive processes involved in self-reflection and the ability to modify erroneous beliefs and misinterpretations. The aim of this study was to determine the psychopathological and neuropsychological predictors of cognitive insight in schizophrenia. Sixty outpatients with Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) schizophrenia diagnosis were administered the Beck Cognitive Insight Scale, the Positive and Negative Symptom Scale (PANSS), and a comprehensive neuropsychological battery. Results indicate that poor global cognitive insight in schizophrenia is significantly related to lower visual working memory, while a higher self-overconfidence is significantly related to deficits in verbal and visual memory and to the failure in using external information to correct erroneous convictions. Thus, our study suggests that impaired cognitive insight depends mainly on reduced working memory and executive function performances. These findings highlight the fundamental importance of the development of specific therapeutic strategies to improve the metacognitive components of insight in order to enhance treatment adherence in schizophrenia.