Experimental Psychological Evaluation of Lack of Insight in Paranoid Schizophrenia Patients: Cognitive Function Assessment.

The study attempted to experimentally evaluate cognitive correlates of lack of insight (understood as a metacognitive function — ability to recognize and correct erroneous decisions). The sample of patients with paranoid schizophrenia (N=100, mean age 33.2±8.1 years) was divided into two groups based on clinical indicators of insight: data about patients’ attitude to their erroneous decisions, personality and symptoms. Group characteristic: high insight n=61; low insight n=39. The assumption about factor structure of insight was made and factors were constructed by confirmatory factor analysis. The final model included 9 quantitative parameters of insight. The first factor included: Diligence, Interest to the Results, Adequate Understanding of purpose of survey, Response to comment, Response to help. The second — External control, Response to errors, Perception of instruction, Awareness to symptoms. Cognitive functioning were assessed by: Standard battery of neuropsychological assessment (subtests “Clock faces”, “Portraits”, series of plot pictures “Apple tree”, “Involuntary recall”, Poppelreuter Overlapping figures test, “Incomplete images”); Schulte table; Amatuni–Vasserman Digit cancellation test; The Wechsler adult intelligence scale (WAIS) (subtests “Similarities”, “Digit span”, “Digit symbol coding”); Zeigarnik Exclusion of items; Trail making test (TMT); Brief assessment of cognition in schizophrenia battery (BACS) (subtests “Verbal memory”, “Digit sequencing”, “Verbal fluency”, “Symbol coding”); Rey–Osterrieth Complex figure (ROCF); Hopkins verbal learning test (HVLT). The low insight patients showed poorer performance in various cognitive domains. Such as verbal learning and visual-motor memory, attention shifting, processing speed, executive function. In addition, the severity of lack of insight was significant for differences in number of distortions in visual perception task and severity of formal thought disorder. These results could be used in process of experimental insight assessment tools development and therapeutic interventions targeted on metacognitive deficit of schizophrenia patients.

1. Bleykher V.M., Kruk I.V. Tolkovyy slovar' psikhiatricheskikh terminov [Glossary of psychiatrical terms]. Voronezh: NPO «Modek», 1995. 638 p. (In Russ.).
2. Vasserman L.I., Dorofeyeva S.A., Meyerson Y.A. Metody neyropsikhologicheskoy diagnostiki: Prakticheskoye rukovodstvo [Methods of neuropsychological diagnostics: Practical guideline]. Saint-Petersburg: Ctroylespechat', 1997. 303 p. (In Russ.).
3. Vasserman L.I., Cherednikova T. V. Psikhologicheskaya diagnostika neirokognitivnogo defitsita: Restandartizatsiya i aprobatsiya metodiki «Kompleksnaya figura Reya-Osterrita». Metodicheskie rekomendatsii. [Psychological assessment of neurocognitive deficit: Restandartization and approbation of of The Rey–Osterrieth complex figure test. Methodical recommendations]. Saint-Petersburg, 2011. 68 p. (In Russ.).
4. Vasserman L.I., Cherednikova T.V., Vasserman M.V. et al. Psikhodiagnostika narushenii prostranstvennogo vnimaniya [Psychological assessment of spatial attention] Saint-Petersburg: Publ. of Saint-Petersburg University, 2018. 92 p. (In Russ.).
5. Gil'yasheva I.N. Prakticheskoye ispol'zovaniye adaptirovannogo testa intellekta pri klinike nervno-psikhicheskikh zabolevaniy. Metodicheskiye rekomendatsii [Practical use of adapted version of intelligence test in neuro-psychic diseases clinic]. Leningrad: Publ. of Leningradskiy nauchno-issledovatel'skiy psikhonevrologicheskiy institut im. V.M. Bekhtereva, 1987. 30 p. (In Russ.).
6. Ershov B.B. Narusheniya pertseptivnoi organizatsii psikhicheskoi deyatel'nosti bol'nykh shizofreniei [Perceptive organization impairment in schizophrenia patients]. Vestnik YuurGU=South-Ural State University Herald, 2010, vol. 4, no. 5, pp. 107–114. (In Russ., abstr. in Engl.).
7. Zeigarnik B.V. Patopsikhologiya [Pathopsychology]. 3rd ed. Moscow: Akademiya, 2005. 208 p. (In Russ.).
8. Irzhevskaya V.P., Rupchev G.E., Tkhostov A.Sh. et al. Problema insaita v sovremennoi patopsikhologii [The problem of insight in modern abnormal psychology]. Voprosy psikhologii=Questions of Psychology, 2008, no. 2, pp. 145–153. (In Russ.).
9. Isaeva E.R., Lebedeva G.G. Sovremennyye podkhody i metody korrektsii narusheniy kognitivnogo i sotsial'nogo funktsionirovaniya bol'nykh shizofreniyey [Modern approaches to correction and assessment to cognitive and social functioning of schizophrenia patients]. Obozrenie psikhiatrii i meditsinskoi psikhologii im. Bekhtereva=Bekhterev Medical Psychology and Psychiatry Review, 2008, no. 1, pp. 4–8. (In Russ.).
10. Kozhukhovskaya I. I. Narushenie kritichnosti u psikhicheski bol'nykh [Lack of insight in mental illness]. Moskow: publ. of MSU, 1985. 80 p. (In Russ.).
11. Lisaker P., Chernov N.V., Karpenko O.A. et al. Izuchenie i lechenie fragmentatsii pri shizofrenii s primeneniem kontseptsii metapoznaniya [Metacognition as a pathway to the study and treatment of fragmentation in schizophrenia]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova=Korsakov S.S. Psychiatry and Neurology Journal, 2021, vol. 121, no. 3,
    pp. 160–164. DOI: 10.17116/jnevro2021121031160 (In Russ., abstr. in Engl.).
12. Meshcheryakova, K.V., Ryazanova A.Y. Psikhodiagnosticheskiye kriterii narusheniy kritichnosti podrostkov pri sudebno-psikhiatricheskiy i sudebno-psikhologicheskoy ekspertize. [Psychodiagnostic criteria of lack of insight of adolescents in psychological and psychiatric forensic examination]. Vestnik YuurGU=South-Ural State University Herald, 2010, no. 4, pp. 77–81. (In Russ., abstr. in Engl.).
13. Rasskazova E.I., Pluzhnikov I.V. Psikhodiagnostika urovnya kognitivnogo insaita: rezul'taty aprobatsii russkoyazychnoi versii shkaly kognitivnogo insaita A. Beka [Psychological diagnostics of cognitive insight: the results of approbation of Russian version of Beck’s Cognitive Insight Scale]. Psikhologicheskie issledovaniya=Psychological Researches, 2013, vol. 6, no. 28, p. 6. URL: https://psystudy.ru/index.php/num/article/ view/711 (Accessed: 10.03.2022) (In Russ.).
14. Rubinshtein S.Ya. Eksperimental'nye metody patopsikhologii i opyt primeneniya ikh v klinike. Prakticheskoe rukovodstvo [Experimental methods of abnormal psychology and experience of clinical use. Practical guidance]. Moscow: Aprel'-Press, 2004. 224 p. (In Russ.).
15. Sarkisyan G.R., Gurovich I.Y, Kif R.S. Normativnye dannye dlya rossiiskoi populyatsii i standartizatsiya shkaly «Kratkaya otsenka kognitivnykh funktsiy u patsiyentov s shizofreniyey» (BACS) [Normative data of russian population and standardization of Brief Assessement of Cognition in Schizophrenia scale (BACS)]. Sotsial'naya i klinicheskaya psikhiatriya=Social and Clinical Psychiatry, 2010, vol. 20, no. 3, pp. 13–19. (In Russ., abstr. in Engl.).
16. Austin S.F., Mors O., Nordentoft M. et al. Schizophrenia and metacognition: An investigation of course of illness and metacognitive beliefs within a first episode psychosis. Cognitive Therapy and Research, 2015, vol. 39, no. 1, pp. 61–69. DOI: 10.1007/s10608-014-9633-9
17. Beck A.T., Baruch, E., Balter, J.M. et al. A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophrenia Research, 2004, vol. 68, no. 2, pp. 319–329. DOI:10.1016/s0920-9964(03)00189-0
18. Benedict R., Brandt. J. Hopkins verbal learning test-revised. Brief visuospatial memory test – revised. Professional manual supplement. Odessa, FL: Psychological Assessment Resources, Inc, 1997. 57 p.
19. Bowie C., Harvey P.D. Cognitive deficits and functional outcome in schizophrenia. Neuropsychiatric Disease and Treatment, 2006, vol. 2, no. 4, pp. 531–536. DOI: 10.2147/ nedt.2006.2.4.531
20. Cooke M.A., Peters E.R., Fannon D. et al. Cognitive insight in psychosis: The relationship between self-certainty and selfreflection dimensions and neuropsychological measures. Psychiatry Research, 2010, vol. 178, no. 2, pp. 284–289. DOI: 10.1016/j.psychres. 2009.05.009
21. Flavell J.H. Metacognitive Aspects of Problem Solving. In L.B. Resnick (ed.), The Nature of Intelligence. N.Y.: Hillsdale, 1976, pp. 231–235.
22. friedman n.p., miyake a., corley r.p. et al. not all Executive Functions Are Related to Intelligence. Psychological Science, 2006, vol. 17, no. 2, pp. 172–179. DOI: 10.1111/j.1467-9280.2006.01681.x
23. Harvey P.D., Keefe R.S., Eesley C. E. Neurocognition in schizophrenia. In V.A. Sadock, B.J. Sadock, P. Ruiz (eds.), Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, pp. 1531–1541.
24. Jansiewicz, E. M. The Relationship between Executive Functions and Metacognitive Strategy Learning and Application. Dissertation. Atlanta, GA: Georgia State University, 2008. URL: https://scholarworks.gsu.edu/psych_diss/42 (Accessed 10.03.2022).
25. Konstantakopoulos G. Insight across mental disorders: A multifaceted metacognitive phenomenon. Psychiatriki, 2019, vol. 30, no. 1, pp. 13–16. DOI: 10.22365/jpsych.2019.301.13
26. Kurtz M., Trask C., Rosengard R. et al. Verbal learning and memory enhancement strategies in schizophrenia: A randomized, controlled investigation. Journal of the International Neuropsychological Society, 2017, vol. 23, no. 4, pp. 352–357. DOI: 10.1017/S1355617717000042
27. Laroi F., Barr W.B., Keefe R.S. The neuropsychology of insight in psychiatric and neurological disorders. In X. Amador, A. David (eds.), Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders. 2nd ed. Oxford: Oxford University Press, 2004, pp. 119–156.
28. Le S., Josse J., Husson F. FactoMineR: An R package for multivariate analysis. Journal of Statistical Software, 2008, vol. 25, no. 1, pp. 1–18. DOI: 10.18637/jss.v025.i01
29. Li C.-H. The performance of ML, DWLS, and ULS estimation with robust corrections in structural equation models with ordinal variables. Psychological Methods, 2016, vol. 21, no. 3, pp. 369–387. DOI: 10.1037/met0000093
30. Lysaker P.H., Kukla M., Vohs J.L. et al. Metacognition and recovery in schizophrenia: From research to the development of metacognitive reflection and insight therapy. Journal of Experimental Psychopathology, 2019, vol. 10, no. 1, pp. 1–12. DOI: 10.1177/ 2043808718814992
31. Mervis J.E., Bonfils K.A., Cooper S.E. et al. Co-occurring deficits in clinical and cognitive insight in prolonged schizophrenia-spectrum disorders: Relationship to metacognitive deficits. Schizophrenia Bulletin Open, 2021, vol. 2, no. 1, sgab034. DOI: 10.1093/schizbullopen/sgab034
32. Rosseel Y. lavaan: An R package for structural equation modeling. Journal of Statistical Software, 2012, vol. 48, no. 2, pp. 1–36. DOI: 10.18637/jss.v048.i02
33. Moritz S., Ramdani N., Klass H. et al. Overconfidence in incorrect perceptual judgments in patients with schizophrenia. Schizophrenia Research: Cognition, 2014, vol. 1, no. 4, pp. 165–170. DOI: 10.1016/j.scog.2014.09.003
34. Schraw G. Promoting general metacognitive awareness. Instructional Science, 1998, vol. 26, pp. 113–125. DOI: 10.1023/A:1003044231033
35. Schreiber J.B., Stage F.K., King J. et al. Reporting structural equation modeling and confirmatory factor analysis results: A review. Journal of Educational Research, 2006, vol. 99, no. 6, pp. 323–338. DOI: 10.3200/JOER.99.6.323-338
36. Scutari M. Learning Bayesian Networks with the bnlearn R Package. Journal of Statistical Software, 2010, vol. 35, no. 1, pp. 1–22. DOI: 10.18637/jss.v035.i03
37. Subotnik K.L., Ventura J., Hellemann G.S. et al. Relationship of poor insight to neurocognition, social cognition, and psychiatric symptoms in schizophrenia: A meta-analysis. Schizophrenia research, 2020, vol. 220, pp. 164–171. DOI: 10.1016/j.schres. 2020.03.038
38. Xia Y., Yang Y. RMSEA, CFI, and TLI in structural equation modeling with ordered categorical data: The story they tell depends on the estimation methods. Behavior Research Methods, 2019, vol. 51, no. 1, pp. 409–428. DOI: 10.3758/s13428-018-1055-2