Published: 2017-01-02

A comparative study of cognitive insight in schizophrenia patients with and without depression

Vijay Choudhary, Girish Chandra Baniya, Sanjay Jain


Background: Lack of insight has been linked to disorganized symptoms or symptoms of formal thought disorder which is often seen in schizophrenia. The main aim of our study was to assess cognitive insight in patients of schizophrenia with and without depression and relation of cognitive insight with psychopathology of schizophrenia.

Methods: The Present study was carried out on 60 patients in both groups. After randomization, assessment of Socio demographic details was done with the help of semi-structured performa.

Results: There was no significant difference was found in both groups in socio demographic data. Better cognitive insight was found in schizophrenia patients with depression. The cognitive insight and psychopathology were not found significantly correlated to the age of the patient, age of onset of the illness and the total duration of the illness. There was significant difference among groups in relation to the PANSS-P, PANSS-G, with cognitive insight SR, SC, RC (p value 0.000).  No significant difference was found for the PANSS-N (p=0.156) among both groups.

Conclusions: Cognitive insight may impact negative symptoms directly via a rigid reasoning style that fosters disengagement in constructive activity as well as reduced interpersonal expressivity.



Cognitive insight, Schizophrenia, Depression

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Raffard S, Fond G, Brittner M, Bortolon C, Macgregor A, Boulenger JP, et al. Cognitive insight as an indicator of competence to consent to treatment in schizophrenia. Schizophrenia research. 2013;144:118-21.

Amador XF, Gorman JM. Psychopathologic domains and insight in schizophrenia. The Psychiatric clinics of North America. 1998;21:27-42.

Crumlish N, Whitty P, Kamali M, Clarke M, Browne S, McTigue O, et al. Early insight predicts depression and attempted suicide after 4 years in first episode schizophrenia and schizophreniform disorder. Acta psychiatrica Scandinavica. 2005;112:449-55.

Beck AT, Baruch E, Balter JM, Steer RA, Warman DM. A new instrument for measuring insight: the beck cognitive insight scale. Schizophrenia research. 2004;68:319-29.

Riggs SE, Grant PM, Perivoliotis D, Beck AT. Assessment of cognitive insight: a qualitative review. Schizophrenia bulletin. 2012; 38:338-50.

Siris SG, Addington D, Azorin JM, Falloon IR, Gerlach J, Hirsch SR. Depression in schizophrenia: recognition and management in the USA. Schizophrenia research. 2001;47:185-97.

Zisook S, McAdams LA, Kuck J, Harris MJ, Bailey A, Patterson TL, et al. Depressive symptoms in schizophrenia. The American journal of psychiatry. 1999;156:1736-43.

Addington D, Addington J, Maticka-Tyndale E. Assessing depression in schizophrenia: the Calgary Depression Scale. The British journal of psychiatry Supplement. 1993:39-44.

Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia bulletin. 1987;13:261-76.

Kanahara N, Yoshida T, Oda Y, Yamanaka H, Moriyama T, Hayashi H, et al. Onset pattern and long-term prognosis in schizophrenia: 10 year longitudinal follow up study. PloS one. 2013;8:e67273.

Collins AA, Remington GJ, Coulter K, Birkett K. Insight neurocognitive function and symptom clusters in chronic schizophrenia. Schizophrenia research. 1997;27:37-44.

Tharyan A, Saravanan B. Insight and psychopathology in schizophrenia. Indian J Psychiatry. 2000;42:421-6.

Mintz AR, Dobson KS, Romney DM. Insight in schizophrenia: a meta-analysis. Schizophrenia research. 2003;61:75-88.

Cavelti M, Beck EM, Kvrgic S, Kossowsky J, Vauth R. The role of subjective illness beliefs and attitude toward recovery within the relationship of insight and depressive symptoms among people with schizophrenia spectrum disorders. J Clin Psychol. 2012;68:462-76.

Ampalam P, Deepthi R, Vadaparty P. Schizophrenia: insight, depression: a correlation study. Indian J Psychol Med. 2012;34:44-8.

Fanous AH, Kendler KS. Genetic heterogeneity, modifier genes, and quantitative phenotypes in psychiatric illness: searching for a framework. Molecular psychiatry. 2005;10:6-13.

Danki D, Dilbaz N, Okay IT, Telci S. Insight in schizophrenia: relationship to family history, and positive and negative symptoms. Turk Psikiyatri Derg. 2007;18:129-36.

Granholm E, McQuaid JR, McClure FS, Auslander LA, Perivoliotis D, Pedrelli P, et al. A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. Am J Psychiatry. 2005;162:520-9.

Bora E, Erkan A, Kayahan B, Veznedaroglu B. Cognitive insight and acute psychosis in schizophrenia. Psychiatry Clin Neurosci. 2007;61:634-9.

Buchy L, Malla A, Joober R, Lepage M. Delusions are associated with low self-reflectiveness in first episode psychosis. Schizophrenia research. 2009;112:187-91.

Engh JA, Friis S, Birkenaes AB, Jonsdottir H, Klungsoyr O, Ringen PA, et al. Delusions are associated with poor cognitive insight in schizophrenia. Schizophrenia bulletin. 2010;36:830-5.

Ekinci O, Ekinci A. Association between insight, cognitive insight, positive symptoms and violence in patients with schizophrenia. Nord J Psychiatry. 2013;67:116-23.

Greenberger C, Serper MR. Examination of clinical and cognitive insight in acute schizophrenia patients. J Nerv Ment Dis. 2010;198:465-9.

Ritsner MS, Blumenkrantz H. Predicting domain-specific insight of schizophrenia patients from symptomatology, multiple neurocognitive functions, and personality related traits. Psychiatry research. 2007;149:59-69.

Kuipers E, Garety P, Fowler D, Dunn G, Bebbington P, Freeman D, et al. London-east anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. I: effects of the treatment phase. Br J Psychiatry. 1997;171:319-27.

Sensky T, Turkington D, Kingdon D, Scott JL, Scott J, Siddle R, et al. A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Archives of general psychiatry. 2000;57:165-72.

Chadwick PD, Lowe CF. A cognitive approach to measuring and modifying delusions. Behaviour research and therapy. 1994;32:355-67.

Engh JA, Friis S, Birkenaes AB, Jonsdottir H, Ringen PA, Ruud T, et al. Measuring cognitive insight in schizophrenia and bipolar disorder: a comparative study. BMC psychiatry. 2007;7:71.

Favrod J, Zimmermann G, Raffard S, Pomini V, Khazaal Y. The beck cognitive insight scale in outpatients with psychotic disorders: further evidence from a french-speaking sample. Can J Psychiatry. 2008;53:783-7.

Uchida T, Matsumoto K, Kikuchi A, Miyakoshi T, Ito F, Ueno T, et al. Psychometric properties of the japanese version of the beck cognitive insight scale: relation of cognitive insight to clinical insight. Psychiatry and clinical neurosciences. 2009;63:291-7.

Tranulis C, Lepage M, Malla A. Insight in first episode psychosis: who is measuring what? Early intervention in psychiatry. 2008;2:34-41.

Pedrelli P, McQuaid JR, Granholm E, Patterson TL, McClure F, Beck AT, et al. Measuring cognitive insight in middle aged and older patients with psychotic disorders. Schizophrenia research. 2004;71:297-305.