IRCCS Santa Lucia Foundation, via Ardeatina, Rome, Italy.
Psychiatry Res. 2010 Jun 30;178(1):51-6. doi: 10.1016/j.psychres.2009.05.013. Epub 2010 May 8.
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.
临床实践突出了患者口头断言（称为临床洞察力）与对疾病的实际信念（称为情绪洞察力）之间可能存在的差异。认知洞察力的互补结构是指自我反思所涉及的认知过程以及修正错误信念和误解的能力。本研究旨在确定精神分裂症认知洞察力的心理病理学和神经心理学预测因子。对 60 名符合《精神障碍诊断与统计手册》（DSM-IV）精神分裂症诊断标准的门诊患者进行贝克认知洞察力量表、阳性和阴性症状量表（PANSS）以及全面的神经心理学测试。结果表明，精神分裂症患者整体认知洞察力差与较低的视觉工作记忆显著相关，而自我过度自信则与言语和视觉记忆缺陷以及无法利用外部信息纠正错误信念显著相关。因此，我们的研究表明，受损的认知洞察力主要取决于工作记忆和执行功能表现的降低。这些发现强调了制定特定治疗策略以改善洞察力的元认知成分的重要性，以便提高精神分裂症的治疗依从性。
