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      Neuropsychological and psychopathological variables modulating cognitive insight in people with schizophrenia Translated title: Variables neuropsicológicas y psicopatológicas moduladoras del insight cognitivo en personas con esquizofrenia

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          Abstract

          Abstract Cognitive insight is the capacity of patients with schizophrenia to evaluate their psychotic experiences and respond to the corrective feedback. The relationship with their neuropsychological functions and the modulation exercised by mood and anxiety are still not clear. To make advances and deepen our knowledge would have an important impact on our understanding of the cognitive mechanisms and intervention programmes. Two samples were chosen, one clinical with persons suffering from schizophrenia (n = 43) and another with healthy individuals (n = 50). The Cognitive Insight Scale (BCIS), a neuropsychological battery and questionnaire concerning depression and anxiety, was applied to them. The results suggest an influence of anxiety and the deficits in cognitive flexibility on the development of the mechanisms of Self-Reflection in persons with schizophrenia, with a different pattern to that found in healthy individuals. The results are discussed with respect to the intervention programmes.

          Translated abstract

          Resumen El insight cognitivo es la capacidad de los pacientes con esquizofrenia de evaluar sus experiencias psicóticas y responder a la retroalimentación correctiva. Su relación con el funcionamiento neuropsicológico y la modulación que ejercen el estado de ánimo y la ansiedad están aún poco claras. Avanzar y profundizar en su conocimiento tendría un impacto importante sobre la comprensión de los mecanismos cognitivos y los programas de intervención. Se seleccionaron dos muestras, muestra clínica, con personas con esquizofrenia (n = 43), muestra personas sanas (n = 50), a las que se aplicó la Escala de insight cognitivo (EICB), una batería neuropsicológica y cuestionarios de depresión y ansiedad. Los resultados sugieren una influencia de la ansiedad y de los déficits de flexibilidad cognitiva en el desarrollo de los mecanismos de la Auto-Reflexión en personas con esquizofrenia, con un patrón diferente al encontrado en personas sanas. Se discuten los resultados con respecto a los programas de intervención.

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          Most cited references52

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          A new instrument for measuring insight: the Beck Cognitive Insight Scale.

          The clinical measurements of insight have focused primarily on patients' unawareness of their having a mental disorder and of their need for treatment ([Acta Psychiatr. Scand. 89 (1994) 62; Am. J. Psychiatry 150 (1993) 873]; etc.). A complementary approach focuses on some of the cognitive processes involved in patients' re-evaluation of their anomalous experiences and of their specific misinterpretations: distancing, objectivity, perspective, and self-correction. The Beck Cognitive Insight Scale (BCIS) was developed to evaluate patients' self-reflectiveness and their overconfidence in their interpretations of their experiences. A 15-item self-report questionnaire was subjected to a principle components analysis, yielding a 9-item self-reflectiveness subscale and a 6-item self-certainty subscale. A composite index of the BCIS reflecting cognitive insight was calculated by subtracting the score for the self-certainty scale from that of the self-reflectiveness scale. The scale demonstrated good convergent, discriminant, and construct validity: (a) the BCIS composite index showed a significant correlation with being aware of having a mental disorder on the Scale to Assess Unawareness of Mental Disorder (SUMD; Arch. Gen. Psychiatry 51 (1994) 826) and the self-reflectiveness subscale was significantly correlated with being aware of delusions on the SUMD, (b) the composite index score of the BCIS differentiated inpatients with psychotic diagnoses from inpatients without psychotic diagnoses, and (c) in a separate study, change scores on the BCIS were significantly correlated with change scores on positive and negative symptoms. The results provided tentative support for the validity of the BCIS. Suggestions were made for further investigation of the cognitive processes involved in identifying and correcting erroneous beliefs and misinterpretations.
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            The continuity of psychotic experiences in the general population.

            Schizophrenia is a severe mental illness that affects 1% of the population. The diagnosis is made according to current diagnostic systems of DSM-IV (American Psychiatric Association, 1994) and ICD-10 (World Health Association, 1992) on the basis of characteristic 'positive' and 'negative' symptoms. The traditional medical model assumes a categorical view of the schizophrenia syndrome and its core symptoms, in which differences between psychotic symptoms and their normal counterparts are considered to be qualitative. An alternative, dimensional approach assumes that schizophrenia is not a discrete illness entity, but that psychotic symptoms differ in quantitative ways from normal experiences and behaviours. This paper reviews evidence for the continuity of psychotic symptoms with normal experiences, focusing on the symptoms of hallucinations and delusions. It concludes by discussing the theoretical and treatment implications of such a continuum.
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              Identification of separable cognitive factors in schizophrenia.

              One of the primary goals in the NIMH initiative to encourage development of new interventions for cognitive deficits in schizophrenia, Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS), has been to develop a reliable and valid consensus cognitive battery for use in clinical trials. Absence of such a battery has hampered standardized evaluation of new treatments and, in the case of pharmacological agents, has been an obstacle to FDA approval of medications targeting cognitive deficits in schizophrenia. A fundamental step in developing such a battery was to identify the major separable cognitive impairments in schizophrenia. As part of this effort, we evaluated the empirical evidence for cognitive performance dimensions in schizophrenia, emphasizing factor analytic studies. We concluded that seven separable cognitive factors were replicable across studies and represent fundamental dimensions of cognitive deficit in schizophrenia: Speed of Processing, Attention/Vigilance, Working Memory, Verbal Learning and Memory, Visual Learning and Memory, Reasoning and Problem Solving, and Verbal Comprehension. An eighth domain, Social Cognition, was added due to recent increased interest in this area and other evidence of its relevance for clinical trials aiming to evaluate the impact of potential cognitive enhancers on cognitive performance and functional outcome. Verbal Comprehension was not considered appropriate for a cognitive battery intended to be sensitive to cognitive change, due to its resistance to change. The remaining seven domains were recommended for inclusion in the MATRICS-NIMH consensus cognitive battery and will serve as the basic structure for that battery. These separable cognitive dimensions also have broader relevance to future research aimed at understanding the nature and structure of core cognitive deficits in schizophrenia.
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                Author and article information

                Journal
                ap
                Anales de Psicología
                Anal. Psicol.
                Universidad de Murcia (Murcia, Murcia, Spain )
                0212-9728
                1695-2294
                April 2022
                : 38
                : 1
                : 46-54
                Affiliations
                [2] Cáceres Extremadura orgnameUniversidad de Extremadura orgdiv1Faculty of Teacher Trainning Spain
                [1] Madrid orgnameGroup 5 Action and Social Management orgdiv1Clinical Psychology Spain
                Article
                S0212-97282022000100006 S0212-9728(22)03800100006
                10.6018/analesps.471061
                98ccc35d-0f41-404b-86cb-700289bbf31b

                This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

                History
                : 01 March 2021
                : 14 September 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 52, Pages: 9
                Product

                SciELO Spain

                Categories
                Clinical and Health Psychology

                Ansiedad,Metacognición,Déficit neurocognitivo,Insight cognitivo,Depression,Anxiety,Schizophrenia,Depresión,Metacognition,Neurocognitive deficit,Cognitive insight,Esquizofrenia

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