Does Insight Improve during the Course of Psychosis?

P Seif (1), K Hamada (1), R Trotti (1), C Tamminga (2), G Pearlson (3), B Clementz (4),S Keedy (5), E Gershon (5), EC DelRe (1), MS Keshavan (1)

Introduction: Insight and cognition are critical aspects of psychiatric disorders. We assessed the course of insight and cognition over the duration of psychosis and examined the correlation between insight and cognition in psychosis.

Methods: We screened patients using the Structured Clinical Interview for DSM-5 (SCID-5) to determine various DSM diagnoses. Cognitive performance was evaluated using the Brief Assessment of Cognition in Schizophrenia (BACS). Insight was measured using item G12 of the Positive and Negative Syndrome Scale (PANSS).

Results: The study found that insight, as measured by PANSS G12 scores, was significantly correlated with the duration of illness (r = -0.083, p = 0.005). In the schizophrenia (SZ) group, illness duration significantly influenced insight (F(12, 430) = 2.205, p = 0.011, η² = 0.058) and was also a significant predictor of poorer cognitive performance (F(12, 428) = 2.305, p = 0.007, η² = 0.061). However, no significant impact of illness duration on insight or cognitive performance was observed in the bipolar disorder with psychosis (BP) or schizoaffective disorder (SAD) groups. Additionally, poorer insight was associated with lower cognitive performance (r = -0.089, p = 0.003) and more severe negative (r = 0.280, p < 0.001) and positive symptoms (r = 0.385, p < 0.001). Despite significant models for predicting symptom severity in SZ, the duration of illness was not a significant predictor of either positive or negative symptoms. Finally, BT2 showed significant improvement in insight from a mean PANSS G12 score of 4.00 to 2.59 over the first three years of illness (F(1, 19) = 5.382, p = .032), while BT1 and BT3 showed no significant improvement.

Conclusion: The study concludes that in schizophrenia, the duration of illness significantly influences both insight and cognitive performance, highlighting the importance of early intervention in this population. Poorer insight is associated with lower cognitive performance and more severe symptoms, yet the duration of illness does not significantly predict changes in positive or negative symptoms over time. The improvement observed in insight within the first three years for the BT2 group underscores the potential for targeted therapeutic strategies to enhance insight early in the course of illness. Conversely, the lack of significant improvement in BT1 and BT3 suggests the need for further research into the factors that contribute to sustained deficits in insight across different biotypes.