Relationship of poor insight to neurocognition, social cognition, and psychiatric symptoms in schizophrenia: A meta-analysis.

BACKGROUND:Poor insight (unawareness) about having a mental disorder is considered to be a core feature of the disorder. Further, poor insight has been associated with another core feature of schizophrenia, neurocognitive deficits. However, previous meta-analyses have shown that poor insight is more strongly related to positive symptoms and social cognition than to neurocognitive functioning. METHOD:A meta-analysis of 123 studies of schizophrenia patients (combined n = 14,932) was conducted to determine the magnitude of the relationship between poor insight and neurocognition, social cognition, and positive symptoms, as well as negative symptoms, disorganization, and depression. The neurocognitive constructs were defined empirically using dimensions identified by the MATRICS initiative. RESULTS:Meta-analytic findings showed that relationships were weak between poor insight and the six neurocognitive domains (r's range from -0.04 to -0.13), but that poor insight was moderately correlated with one aspect of social cognition, theory of mind (r = -0.23, p < .01). In addition, poor insight was moderately associated with reality distortion (r = 0.28, p < .01), disorganization (r = 0.29, p < .01), and negative symptoms (r = 0.20, p < .01). DISCUSSION:Organizing the neurocognitive variables using the MATRICS domains continues to demonstrate that the relationship between insight and neurocognition is relatively weak. In comparison, we found moderate correlations between insight and theory of mind and several symptom domains. These moderate relationships are generally consistent with previous meta-analyses but are demonstrated more rigorously by examining more studies within the same meta-analysis.