Schizophrenia Research
Volume 86, Issue 1 , Pages 54-70 , September 2006

Insight and frontal cortical function in schizophrenia: A review

Received 24 February 2006 ,Revised 30 May 2006 ,Accepted 5 June 2006.

References 

  1. Amador XF, Gorman JM. Psychopathologic domains and insight in schizophrenia. Psychiatric Clinics of North America. 1998;21:27–42(Review)
  2. Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM. Assessment of insight in psychosis. American Journal of Psychiatry. 1993;150:873–879
  3. Amador X, Flaum M, Andresaon NC, Strauss DH, Yale SA, Clark SC. Awareness of illness in schizophrenia, schizoaffective and mood disorders. Archives of General Psychiatry. 1994;51:826–836
  4. Ammons CH, Ammons RB. The Quick Test (QT): provisional manual. Psychological Reports. 1962;11:111–161
  5. Anderson SW, Damasio H, Jones RD, Tranel D. Wisconsin Card Sorting Test performance as a measure of frontal lobe damage. Journal of Clinical Experiment and Neuropsychology. 1991;13:909–922
  6. Arduini L, Kalyvoka A, Stratta P, Rinaldi O, Daneluzzo E, Rossi A. Insight and neuropsychological function in patients with schizophrenia and bipolar disorder with psychotic features. Canadian Journal of Psychiatry. 2003;48:338–341
  7. Army Individual Test Battery . Manual of Directions and Scoring. Washington, DC: War Department, Adjutant General's Office; 1944;
  8. Babinski MJ. Contribution a l'etude des troubles mentaux dans l'hemiplgie organique cerebrale. Revue Neurologique. 1914;1:845–848
  9. Baddeley A, Emslie H, Nimmo-Smith I. The Spot-the-Word test: a robust estimate of verbal intelligence based on lexical decisions. Behaviour Research and Therapy. 1993;32:331–341
  10. Barcelo F, Rubia FJ. Non-frontal P3b-like activity evoked by the Wisconsin Card Sorting Test. NeuroReport. 1998;9:747–751
  11. Benton AL, Hamsher KD, Varney NR, Spreen O. Contributions to Neuropsychological Assessment: A Clinical Manual. New York, NY: Oxford University Press; 1983;
  12. Berman KF, Ostrem JL, Randolph C, Gold J, Goldberg TE, Coppola R, et al. Physiological activation of a cortical network during performance of the Wisconsin Card Sorting Test: a positron emission tomography study. Neuropsychologia. 1995;33:1027–1046
  13. Birchwood M, Smith J, Drury V, Healy J, Macmillan F, Slade M. A self-report Insight Scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica. 1994;89:62–67
  14. Brownell HH, Potter HH, Michelow D. Sensitivity to lexical denotation and connotation in brain damaged patients: a double dissociation?. Brain and Language. 1984;22:253–265
  15. Buchsbaum BR, Greer S, Chang WL, Berman KF. Meta-analysis of neuroimaging studies of the Wisconsin card-sorting task and component processes. Human Brain Mapping. 2005;25:35–45
  16. Buckley PF, Hasan S, Friedman L, Cerny C. Insight and schizophrenia. Comprehensive Psychiatry. 2001;42:39–41
  17. Burgess PW, Shallice T. Bizarre responses, rule detection, and frontal lobe lesions. Neuropsychologia. 1996;34:263–273
  18. Catafau AM, Parellada E, Lomena FJ, Bernardo M, Pavia J, Ros D, et al. Prefrontal and temporal blood flow in schizophrenia: resting and activation technetium-99 m-HMPAO SPECT patterns in young neuroleptic-naive patients with acute disease. Journal of Nuclear Medicine. 1994;35:935–941
  19. Chen EY, Kwok CL, Chen RY, Kwong PP. Insight changes in acute psychotic episodes: a prospective study of Hong Kong Chinese patients. Journal of Nervous and Mental Disease. 2001;189:24–30
  20. Cinan S, Tanor OO. An attempt to discriminate different types of executive functions in the Wisconsin Card Sorting Test. Memory. 2002;10:277–289
  21. Collins AA, Remington GJ, Coulter K, Birkett K. Insight, neurocognitive function and symptom clusters in chronic schizophrenia. Schizophrenia Research. 1997;27:37–44
  22. Corcoran R, Upton D. A role for the hippocampus in card sorting?. Cortex. 1993;29:293–304
  23. Corcoran R, Cahill C, Frith CD. The appreciation of visual jokes in people with schizophrenia: a study of ‘mentalizing’ ability. Schizophrenia Research. 1997;319–327
  24. Cuesta JM, Peralta V, Caro F, Leon JD. Is poor insight in psychotic disorders associated with poor performance on the Wisconsin Card Sorting Test?. American Journal of Psychiatry. 1995;152:1380–1382
  25. Cutting J, Murphy D. Preference for denotative as opposed to connotative meanings in schizophrenics. Brain and Language. 1990;39:459–468
  26. David A. Insight and psychosis. British Journal of Psychiatry. 1990;156:798–808
  27. David A, Buchanan A, Reed A, Almeida O. The assessment of insight in psychosis. British Journal of Psychiatry. 1992;161:599–602
  28. David A, van OS J, Jones P, Harvey I, Foerster A, Fahy T. Insight and psychotic illness: cross-sectional and longitudinal associations. British Journal of Psychiatry. 1995;167:621–628
  29. Davidhizar RE. Beliefs, feelings, and insight of patients with schizophrenia about taking medications. Journal of Advanced Nursing. 1987;12:177–182
  30. Debowska G, Grzywa A, Kucharska-Pietura K. Insight in paranoid schizophrenia—its relationship to psychopathology and premorbid adjustment. Comprehensive Psychiatry. 1998;39:255–260
  31. Demakis GJ. A meta-analytic review of the sensitivity of the Wisconsin Card Sorting Test to frontal and lateralized frontal brain damage. Neuropsychology. 2003;17:255–264
  32. Dickerson FB, Boronow JJ, Ringel N, Parente F. Lack of insight among outpatients with schizophrenia. Psychiatric Services. 1997;48:195–199
  33. Drake RJ, Lewis SW. Insight and neurocognition in schizophrenia. Schizophrenia Research. 2002;62:165–173
  34. Endicott J, Spitzer RL. A diagnostic interview: the schedule for affective disorders and schizophrenia. Archives of General Psychiatry. 1978;35:837–844
  35. Ettlin T, Kischka U. The frontal lobe score. In:  Miller BL,  Cummings JL editor. The Human Frontal Lobes Functions and Disorders. New York, NY: The Guilford Press; 1999;
  36. Flashman LA, McAllister TW, Johnson SC, Rick JH, Green RL, Saykin AJ. Specific frontal lobe subregions correlated with unawareness of illness in schizophrenia: a preliminary study. Journal of Neuropsychiatry and Clinical Neurosciences. 2001;13:255–257
  37. Freudenreich O, Deckersbach T, Goff DC. Insight into current symptoms of schizophrenia. Association with frontal cortical function and affect. Acta Psychiatrica Scandinavica. 2004;110:14–20
  38. Gerstmann J. Problem of imperception of disease and of impaired body territories with organic lesions. Archives of Neurology and Psychiatry. 1942;48:890–913
  39. Ghaemi SN, Rosenquist KJ. Is insight in mania state-dependent?: a meta-analysis. Journal of Nervous and Mental Disease. 2004;192:771–775
  40. Goldberg RW, Green-Paden LD, Lehman AF, Gold JM. Correlates of insight in serious mental illness. Journal of Nervous and Mental Disease. 2001;189:137–145
  41. Golden CJ. A standardized version of Luria's neuropsychological tests. In:  Filskov S,  Boll TJ editor. Handbook of Neuropsychology. vol. 2:New York, NY: Wiley; 1981;
  42. Goldstein JM, Goodman JM, Seidman LJ, Kennedy DN, Makris N, Lee H, et al. Cortical abnormalities in schizophrenia identified by structural magnetic resonance imaging. Archives of General Psychiatry. 1999;56:537–547
  43. Goldstein B, Obrzut JE, John C, Ledakis G, Armstrong CL. The impact of frontal and non-frontal brain tumor lesions on Wisconsin Card Sorting Test performance. Brain and Cognition. 2004;54:110–116
  44. Grafman J, Jonas B, Salazar A. Wisconsin Card Sorting Test performance based on location and size of neuroanatomical lesion in Vietnam veterans with penetrating head injury. Perception of Motor Skills. 1990;71:1120–1122
  45. Gur RE, Cowell PE, Latshaw A, Turetsky BI, Grossman RI, Arnold SE, et al. Reduced dorsal and orbital prefrontal gray matter volumes in schizophrenia. Archives of General Psychiatry. 2000;57:761–768
  46. Guy W, Ban T. The AMDP System. Manual for the Assessment and Documentation of Psychopathology. Berlin, Germany: Springer-Verlag; 1982;
  47. Hamilton M. A rating scale for depression. Journal of Neurological and Neuro-Surgical Psychiatry. 1960;23:56–62
  48. Haro MJ, Ochoa S, Cabrero L. Insight and use of health resources in patients with schizophrenia. Actas Españolas de Psiquiatría. 2001;29:103–108
  49. Haut MW, Cahill J, Cutlip WD, Stevenson JM, Makela EH, Bloomfield SM. On the nature of Wisconsin Card Sorting Test performance in schizophrenia. Psychiatry Research. 1996;65:15–22
  50. Heaton R. Wisconsin Card Sorting Test Manual. Odessa, FL: Psychological Assessment Resources, Incorporated; 1981;
  51. Hermann BP, Wyler AR. Effects of anterior temporal lobectomy on language function: a controlled study. Annals of Neurology. 1988;23:585–588
  52. Hirayasu Y, Tanaka S, Shenton ME, Salisbury DF, DeSantis MA, Levitt JJ, et al. Prefrontal Gray Matter Volume Reduction in First Episode Schizophrenia. Cerebral Cortex. 2001;11:374–3211
  53. Horner MD, Flashman LA, Freides D, Epstein CM, Bakay RA. Temporal lobe epilepsy and performance on the Wisconsin Card Sorting Test. Journal of Clinical and Experimental Neuropsychology. 1996;18:310–313
  54. Iqbal Z, Birchwood M, Chadwick P, Trower P. Cognitive approach to depression and suicidal thinking in psychosis. 2. Testing the validity of a social ranking model. British Journal of Psychiatry. 2000;177:522–528
  55. Kashiwa Y, Kitabayashi Y, Narumoto J, Nakamura K, Ueda H, Fukui K. Anosognosia in Alzheimer's disease: association with patient characteristics, psychiatric symptoms and cognitive deficits. Psychiatry and Clinical Neurosciences. 2005;59:697–704
  56. Kay SR, Fiszbein A, Opler L. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin. 1987;13:261–276
  57. Kelly BD, Clarke M, Browne S, McTigue O, Kamali M, Gervin M, et al. Clinical predictors of admission status in first episode schizophrenia. European Psychiatry. 2004;19:67–71
  58. Kemp R, David A. Insight and compliance. In:  Blackwell B editors. Compliance and the Treatment Alliance in Serious Mental Illness. Newark, NJ: Gordon & Breach; 1996;
  59. Kemp R, David A. Psychological predictors of insight and compliance in psychotic patients. British Journal of Psychiatry. 1996;169:444–450
  60. Keshavan MS, Rabinowitz J, DeSmedt G, Harvey PD, Schooler N. Correlates of insight in first episode psychosis. Schizophrenia Research. 2004;70:187–194
  61. Kim CH, Jayathilake K, Meltzer HY. Hopelessness, neurocognitive function, and insight in schizophrenia: relationship to suicidal behavior. Schizophrenia Research. 2003;60:71–80
  62. Koren D, Seidman LJ, Poyurovsky M, Goldsmith M, Viksman P, Zichel S, et al. The neuropsychological basis of insight in first-episode schizophrenia: a pilot metacognitive study. Schizophrenia Research. 2004;70:195–202
  63. Lager AC, Kirch DG, Wyatt RJ. A negative symptom rating scale. Psychiatry Research. 1985;16:27–36
  64. Lally SJ. “Does being in here mean there is something wrong with me”?. Schizophrenia Bulletin. 1989;15:253–265
  65. Laroi F, Fannemel M, Ronneberg U, Flekkoy K, Opjordsmoen S, Dullerud R, et al. Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests. Psychiatry Research. Neuroimaging. 2000;100:49–58
  66. Lie CH, Specht K, Marshall JC, Fink GR. Using fMRI to decompose the neural processes underlying the Wisconsin Card Sorting Test. NeuroImage. 2006;30:1038–1049
  67. Lombardi WJ, Andreason PJ, Sirocco KY, Rio DE, Gross RE, Umhau JC, et al. Wisconsin Card Sorting Test performance following head injury: dorsolateral fronto-striatal circuit activity predicts perseveration. Journal of Clinical Experiment and Neuropsychology. 1999;21:2–16
  68. Lysaker PH, Bell MD. Insight and cognitive impairment in schizophrenia: performance on repeated administrations of the Wisconsin Card Sorting Test. Journal of Nervous and Mental Disease. 1994;182:656–660
  69. Lysaker PH, Bell MD, Bryson G, Kaplan E. Neurocognitive function and insight in schizophrenia: support for an association with impairments in prefrontal function but not with impairments in global function. Acta Psychiatrica Scandinavica. 1998;9:297–301
  70. Lysaker PH, Bryson GJ, Bell MD. Insight and work performance in schizophrenia. Journal of Nervous and Mental Disease. 2002;190:142–146
  71. Lysaker PH, Bryson GJ, Lancaster RS, Evans JD, Bell MD. Insight in schizophrenia: associations with executive function and coping style. Schizophrenia Research. 2002;59:41–47
  72. Lysaker PH, Lancaster RS, Davis LW, Clements CA. Patterns of neurocognitive deficits and unawareness of illness in schizophrenia. Journal of Nervous and Mental Disease. 2003;191:38–44
  73. Marenco S, Coppola R, Daniel DG, Zigun JR, Weinberger DR. Regional cerebral blood flow during the Wisconsin Card Sorting Test in normal subjects studied by xenon-133 dynamic SPECT: comparison of absolute values, percent distribution values, and covariance analysis. Psychiatry Research. 1993;50:177–192
  74. Markova IS, Berrios GE. Assessment of insight in clinical psychiatry. A new scale. Acta Psychiatrica Scandinavica. 1992;86:159–164
  75. Marks KA, Fastenau PS, Lysaker PH, Bond GR. Self-Appraisal of Illness Questionnaire (SAIQ): relationship to researcher-rated insight and neuropsychological function in schizophrenia. Schizophrenia Research. 2000;27:203–211
  76. Matsunaga H, Kiriike N, Matsui T, Oya K, Iwasaki Y, Koshimune K, et al. Obsessive–compulsive disorder with poor insight. Comprehensive Psychiatry. 2002;43:150–157
  77. McCabe R, Quayle E, Beirne AD, Ann Duane MM. Insight, global neuropsychological functioning, and symptomatology in chronic schizophrenia. Journal of Nervous and Mental Disease. 2002;190:519–525
  78. McEvoy JP, Freter S, Everett G, Geller JL, Appelbaum PS, Apperson LJ. Insight and the clinical outcome of schizophrenia patients. Journal of Nervous and Mental Disease. 1989;177:48–51
  79. McEvoy JP, Hartman M, Gottlieb D, Godwin S, Apperson LJ, Wilson W. Common sense, insight, and neuropsychological test performance in schizophrenic patients. Schizophrenia Bulletin. 1996;22:635–641
  80. McGlashan TH, Carpenter WT. Postpsychotic depression in schizophrenia. Archives of General Psychiatry. 1976;33:231–239(Review)
  81. McGlashan TH, Levy ST, Carpenter WT. Integration and sealing over. Clinically distinct recovery styles from schizophrenia. Archives of General Psychiatry. 1975;32:1269–1272
  82. McGlynn SM, Schacter DL. Unawareness of deficits in neuropsychological syndromes. Journal of Clinical and Experimental Neuropsychology. 1989;11:143–205(Review)
  83. Miller E. Verbal fluency as a measure of verbal intelligence and in relation to different types of cerebral pathology. British Journal of Clinical Psychology. 1984;23:53–57
  84. Miller L. Freud's Brain: The Neuropsychodynamic Foundation of Psychoanalysis. New York, NY: Guilford; 1991;
  85. Mintz AR, Addington J, Addington D. Insight in early psychosis: a 1-year follow-up. Schizophrenia Research. 2003;67:213–217
  86. Mintz AR, Dobson KS, Romney D. Insight in schizophrenia: a meta-analysis. Schizophrenia Research. 2003;61:75–88
  87. Mohamed S, Fleming S, Penn DL, Spaulding W. Insight in schizophrenia: its relationship to measures of prefrontal functions. Journal of Nervous and Mental Disease. 1999;187:525–531
  88. Nagahama Y, Fukuyama H, Yamauchi H, Matsuzaki S, Konishi J, Shibasaki H, et al. Cerebral activation during performance of a card sorting test. Brain. 1996;119:1667–1675
  89. Nakano H, Terao T, Iwata N, Hasako R, Nakamura J. Symptomatological and cognitive predictors of insight in chronic schizophrenia. Psychiatry Research. 2004;127:65–72
  90. Nelson HE, O'Connell NA. Dementia: the estimation of the premorbid intelligence levels using the new adult reasoning test. Cortex. 1978;14:234–244
  91. Perkins DO. Predictors of noncompliance in patients with schizophrenia. Journal of Clinical Psychiatry. 2002;63(12):1121–1128(Review)
  92. Randolph C. RBANS Manual-Repeatable Battery for the Assessment of Neuropsychological Status. San Antonio, TX: Psychological Corporation (Harcourt); 1998;
  93. Raven JC, Court JH, Raven J. Manual for Raven's Progressive Matrices and Vocabulary Scales. London: H.K. Lewis; 1988;
  94. Reitan RM. Validity of trailmaking test as an indication of organic brain damage. Perceptual and Motor Skills. 1958;8:271–276
  95. Reitan RM, Wolfson D. A selective and critical review of neuropsychological deficits and the frontal lobes. Neuropsychological Review. 1994;4:161–198(Review)
  96. Rezai K, Andreasen NC, Alliger R, Cohen G, Swayze V, O'Leary DS. The neuropsychology of the prefrontal cortex. Archives of Neurology. 1993;50:636–642
  97. Rossell SL, Coakes J, Shapleske J, Woodruff PW, David AS. Insight: its relationship with cognitive function, brain volume, and symptoms in schizophrenia. Psychological Medicine. 2003;33:111–119
  98. Salmon E, Perani D, Herholz K, Marique P, Kalbe E, Holthoff V, et al. Neural correlates of anosognosia for cognitive impairment in Alzheimer's disease. Human Brain Mapping. 2005;(Electronic publication ahead of print)
  99. Sanz M, Constable G, Lopez-Ibor I, Kemp R, David AS. A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychological Medicine. 1998;28:437–446
  100. Sartorius N, Shapiro R, Kimura M, Barrett K. WHO international pilot study of schizophrenia. Psychological Medicine. 1972;2:422–425
  101. Schwartz RC, Cohen BN, Grubaugh A. Does insight affect long-term impatient treatment outcome in chronic schizophrenia?. Comprehensive Psychiatry. 1997;38:283–288
  102. Seeber K, Cadenhead KS. How does studying schizotypal personality disorder inform us about the prodrome of schizophrenia?. Current Psychiatry Reports. 2005;7:41–50
  103. Shad MU, Muddasani S, Sahni SD, Keshavan MS. Insight and Prefrontal Cortex in First-episode Schizophrenia. NeuroImage. 2004;22:1315–1320
  104. Shad MU, Mudassani S, Keshavan MS. Insight and prefrontal sub-regions in first-episode schizophrenia—a pilot study. Psychiatry Research. Neuroimaging. 2006;146:35–42
  105. Shallice T, Evans ME. The involvement of the frontal lobes in cognitive estimation. Cortex. 1978;14:294–303
  106. Slosson R. Slosson Intelligence Test for Children and Adults. East Aurora, NY: Slosson Educational Publications; 1963;
  107. Smith TE, Hull JW, Israel LM, Willson DF. Insight, Symptoms, and Neurocognition in schizophrenia and schizoaffective disorder. Schizophrenia Bulletin. 2000;26:193–200
  108. Smith AB, Taylor E, Brammer M, Rubia K. Neural correlates of switching set as measured in fast, event-related functional magnetic resonance imaging. Human Brain Mapping. 2004;21:247–256
  109. Spaulding W, Garbin CP, Dras SR. Cognitive abnormalities in schizophrenic patients and schizotypal college students. Journal of Nervous and Mental Disease. 1989;177:717–728
  110. Startup M. Insight and cognitive deficits in schizophrenia: evidence for a curvilinear relationship. Psychological Medicine. 1996;26:1277–1281
  111. Stroop JR. Studies of interference in serial verbal reactions. Journal of Experimental Psychology. 1935;18:643–662
  112. Stuss DT, Benson DF. The Frontal Lobes. New York: Raven Press; 1986;
  113. Stuss DT, Levine B, Alexander MP, Hong J, Palumbo C, Hamer L, et al. Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: effects of lesion location and test structure on separable cognitive processes. Neuropsychologia. 2000;38:388–402
  114. Takai A, Uematsu M, Ueki H, Sone K, Kaiya H. Insight and its related factors in chronic schizophrenic patients: a preliminary study. European Journal of Psychiatry. 1992;6:159–170
  115. Upton D, Corcoran R. The role of the right temporal lobe in card sorting: a case study. Cortex. 1995;31:405–409
  116. Van Putten T, Crumpton E, Yale C. Drug refusal in schizophrenia and the wish to be crazy. Archives of General Psychiatry. 1976;33:1443–1446
  117. Voruganti LN, Heslegrave RJ, Awad AG. Neurocognitive correlates of positive and negative syndromes in schizophrenia. Canadian Journal of Psychiatry. 1997;42:1066–1071
  118. Wechsler D. Wechsler Adult Intelligence Scale-Revised. San Antonio, TX: The Psychological Corporation; 1981;
  119. Wechsler D. Wechsler Adult Intelligence Scale III. San Antonio, TX: the Psychological Corporation; 1997;
  120. Weinberger DR, Berman KF, Zec RF. Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia. I. Regional cerebral blood flow evidence. Archives of General Psychiatry. 1986;43:114–124
  121. Wilkinson GS. Wide Range Achievement Test, Administrative Manual. Wilmington, DE: Wide Range; 1993;
  122. Wing JK, Cooper JE, Sartorius N. The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press; 1974;
  123. Young DA, Davila R, Scher H. Unawareness of illness and neuropsychological performance in schizophrenia. Schizophrenia Research. 1993;10:117–124
  124. Young DA, Konstantine KZ, Bailey C, Davila R, Griese J, Sartory G, et al. Further parameters of insight and neuropsychological deficit in schizophrenia and other chronic mental disease. Journal of Nervous and Mental Disease. 1998;186:44–50

PII: S0920-9964(06)00274-X

doi: 10.1016/j.schres.2006.06.006

Schizophrenia Research
Volume 86, Issue 1 , Pages 54-70 , September 2006