Clinical insight appears comparable across both schizophrenia and bipolar I patients in a small sample, but its relationship to symptoms and social cognition differs in the two disorders, a recent study showed.
"Social cognition was found to be associated with clinical insight in schizophrenia but not bipolar I disorder," reported Anja Vaskinn, Ph.D., of Oslo University Hospital and her associates in the June issue of the Journal of Nervous and Mental Disease. In bipolar I disorder, symptoms appear more meaningful in clinical insight than emotion recognition, the aspect of social cognition explored in this study.
Because both clinical insight and emotion perception require observation from an outside perspective, Dr. Vaskinn and her colleagues hypothesized that the constructs would be related to one another. The investigators used the Face/Voice Emotion Identification and Discrimination Test to measure emotion perception (visual and auditory with photographs and recordings). They used Birchwood’s Insight Scale to assess clinical insight, including subscales for awareness of illness, relabeling of symptoms as attributable to the illness, and recognizing the need for treatment (J. Nerv. Ment. Dis. 2013;201:445-51).
Among the 48 participants in the study, 29 had schizophrenia, and 19 had bipolar I disorder – including 13 bipolar patients who had experienced psychotic symptoms. Only schizophrenia patients with a score below 6 on the Positive and Negative Symptom Scale (PANSS) were included. Functioning of the participants was assessed with the Global Assessment Functioning Scale-split version, and depressive and mania symptoms also were assessed. All of the participants were white.
As the researchers had found in a previous study using controls, the participants with schizophrenia performed more poorly on the auditory emotion perception, compared with the participants with bipolar. Clinical insight, however, was about the same among patients in both groups. Not surprisingly, the patients with schizophrenia experienced greater positive and negative symptoms and poorer functioning than did the patients with bipolar disorder.
Across the whole group, no association appeared to exist between clinical insight and emotion recognition with the assessment tools used, but a subsample analysis showed some significant associations. Among the participants with bipolar, no link was found between overall social cognition (based on emotion recognition) and clinical insight, but those with greater PANSS positive symptoms or with greater depressive symptoms had poorer clinical insight (r = –0.54 with P less than .05 and r = –0.61 with P less than .01, respectively), Dr. Vaskinn and her associates said.
Those with greater mania symptoms had poorer scores on the subscale related to need for treatment (r = 0.37) while greater PANSS negative symptoms were moderately associated with both the relabeling of symptoms (–0.36) and the need for treatment (r = 0.30). Greater symptoms in general among the patients with bipolar were linked to lower clinical insight, they reported.
Among the patients with schizophrenia, overall clinical insight as well as relabeling of symptoms had a moderate to large association (r = 0.44) with the auditory emotion recognition test. Relabeling of symptoms also was moderately, positively associated with visual emotional recognition (r = 0.36). Clinical insight among schizophrenia participants was poorer in those with greater PANSS negative symptoms (r = –0.33).
The authors noted that it appears reasonable for the relabeling of symptoms subscale of the clinical insight tool to be most strongly associated with social cognition. "This subscale specifically addresses the degree to which someone can detach oneself from one’s own symptoms, observing them from an outside perspective," they wrote. "This observer’s eye on emotionally salient information is also at play in emotion perception."
One implication of the study’s findings is that "social cognition may be a potential treatment target in efforts to reduce the negative consequences of limited clinical insight in schizophrenia, whereas interventions aimed at reducing symptoms will be more appropriate for bipolar disorder," Dr. Vaskinn and her associates wrote.
The investigators reported no disclosures.