Wels Linda, Dalkner Nina, Lenger Melanie, Fellendorf Frederike T, Schönthaler Elena M D, Harvey Philip D, Reininghaus Eva Z
Medical University of Graz, Department of Psychiatry and Psychotherapeutical Medicine, Graz, Austria.
University of Miami, Department of Psychiatry and Behavioral Sciences, Miami, USA.
Neurosci Appl. 2023 Aug 19;2:101132. doi: 10.1016/j.nsa.2023.101132. eCollection 2023.
Within the framework of metacognition, cognitive insight (CI) refers to the ability to distance oneself from distorted beliefs and misinterpretations, and to reevaluate thoughts, beliefs, and interpretations, while also considering external feedback from others, in order to make well-considered conclusions. Similarly, introspective accuracy (IA) refers to the capacity to accurately assess one's skills, capabilities, and interpretations. CI and IA may be impaired in individuals with psychiatric disorders, as extensively documented in individuals with schizophrenia. However, there is a shortage of studies examining introspective accuracy in bipolar disorder. This scoping review aimed to provide an overview of the existing literature on CI and IA in individuals with bipolar disorder, as well as to examine their associations with clinical variables including cognitive performance.
PubMed was systematically searched with the terms "cognitive insight", "introspective accuracy", "self estimation", "self assessment", "bipolar", and "bipolar disorder". Studies were included if they performed cognitive measures.
Five studies (2015-2023) met the inclusion criteria and were further analyzed. Patients with bipolar disorder generally overestimate their cognitive performance, especially in numerical tasks. In a depressive episode, the performance was underestimated and related to impaired functioning. Manic symptoms and cognitive performance have been found to be predictors for low insight. The study results indicated that introspective accuracy is positively correlated with cognitive performance.
Recent studies demonstrate the importance of cognitive insight and introspective accuracy measures for functional outcome parameters. Although there is little research in the field of cognitive insight in bipolar disorder so far, there are many factors that still need to be addressed. Most importantly, it is needed to address the differences between the types of bipolar disorder and the impact of current mood symptoms and medication on cognitive insight or introspective accuracy in these patients.
在元认知框架内，认知洞察力（CI）是指能够使自己与扭曲的信念和错误解读保持距离，并重新评估思想、信念和解读，同时考虑他人的外部反馈，以便得出深思熟虑的结论的能力。同样，内省准确性（IA）是指准确评估自己的技能、能力和解读的能力。CI和IA在患有精神疾病的个体中可能受损，正如在精神分裂症患者中所广泛记录的那样。然而，在双相情感障碍患者中，研究内省准确性的研究较少。本范围综述旨在概述双相情感障碍患者中关于CI和IA的现有文献，并研究它们与包括认知表现在内的临床变量之间的关联。
使用“认知洞察力”、“内省准确性”、“自我估计”、“自我评估”、“双相”和“双相情感障碍”等术语对PubMed进行系统检索。如果研究进行了认知测量，则纳入研究。
五项研究（2015 - 2023年）符合纳入标准并进行了进一步分析。双相情感障碍患者通常高估自己的认知表现，尤其是在数字任务中。在抑郁发作期间，表现被低估且与功能受损有关。躁狂症状和认知表现已被发现是洞察力低下的预测因素。研究结果表明，内省准确性与认知表现呈正相关。
最近的研究表明认知洞察力和内省准确性测量对功能结局参数的重要性。尽管到目前为止在双相情感障碍的认知洞察力领域研究较少，但仍有许多因素需要解决。最重要的是，需要解决双相情感障碍类型之间的差异以及当前情绪症状和药物对这些患者认知洞察力或内省准确性的影响。
