title: Insight and awareness as related to psychopathology and cognition.
abstract: BACKGROUND
  Insight affects adherence and treatment outcome and relates to cognitive impairment and psychopathology. We investigated the relationship of insight with cognition in patients with major depression, schizophrenia and bipolar disorder in acute psychiatric care, long-term inpatient, and outpatient settings.
  
  
  METHODS
  Eighty-one patients (women, 59.5%; age, 45.9 ± 13.5 years; 27 in each setting group; 33.3% with DSM-IV bipolar disorder, 39.5% with unipolar major depression, and 27.2% with schizophrenia) underwent the Wisconsin Card Sorting Test (WCST) to test flexibility, clinician-rated Scale to Assess Unawareness of Mental Disorder (SUMD), and self-rated Insight Scale (IS) to assess insight/awareness.
  
  
  RESULTS
  Poor performance on the WCST correlated with higher SUMD scores such as current psychiatric illness unawareness, impaired symptom attribution, unawareness of medication effect, or of social consequences, but not with IS scores. The latter correlated with days on continuous treatment. Patients receiving psycho-education showed greater symptom awareness compared to patients treated with drugs alone. Cognitive flexibility and diagnostic category did not correlate. Poor insight corresponded with severe mental illness, particularly acute psychosis.
  
  
  CONCLUSIONS
  Treatment setting specificity reflects psychopathology and severity. Insight is inversely proportional to illness severity and cognitive flexibility, which is also affected by psychopathology. Limitations comprise group heterogeneity, cross-sectional design, and limited sample size.
authors.affiliation: Department of Neurosciences, Mental Health, and Sensory Functions (NESMOS), 2nd Medical School, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Trevisi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Talamo
authors.forename: Pier Luca
authors.initials: PL
authors.lastname: Bandinelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ducci
authors.forename: Giorgio D
authors.initials: GD
authors.lastname: Kotzalidis
authors.forename: Chiara
authors.initials: C
authors.lastname: Santucci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Manfredi
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Girardi
authors.forename: Roberto
authors.initials: R
authors.lastname: Tatarelli
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology*; D003071:Cognition; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012559:Schizophrenia / Q000175:diagnosis; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index