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Review
. 2023 Aug 19:2:101132.
doi: 10.1016/j.nsa.2023.101132. eCollection 2023.

Cognitive insight and introspective accuracy in individuals with bipolar disorder: A scoping review

Linda Wels  1 , Nina Dalkner  1 , Melanie Lenger  1 , Frederike T Fellendorf  1 , Elena M D Schönthaler  1 , Philip D Harvey  2 , Eva Z Reininghaus  1
Affiliations
Review

Cognitive insight and introspective accuracy in individuals with bipolar disorder: A scoping review

Linda Wels et al. Neurosci Appl. .

Abstract

Introduction: Within the framework of metacognition, cognitive insight (CI) refers to the ability to distance oneself from distorted beliefs and misinterpretations, and to reevaluate thoughts, beliefs, and interpretations, while also considering external feedback from others, in order to make well-considered conclusions. Similarly, introspective accuracy (IA) refers to the capacity to accurately assess one's skills, capabilities, and interpretations. CI and IA may be impaired in individuals with psychiatric disorders, as extensively documented in individuals with schizophrenia. However, there is a shortage of studies examining introspective accuracy in bipolar disorder. This scoping review aimed to provide an overview of the existing literature on CI and IA in individuals with bipolar disorder, as well as to examine their associations with clinical variables including cognitive performance.

Methods: PubMed was systematically searched with the terms "cognitive insight", "introspective accuracy", "self estimation", "self assessment", "bipolar", and "bipolar disorder". Studies were included if they performed cognitive measures.

Results: Five studies (2015-2023) met the inclusion criteria and were further analyzed. Patients with bipolar disorder generally overestimate their cognitive performance, especially in numerical tasks. In a depressive episode, the performance was underestimated and related to impaired functioning. Manic symptoms and cognitive performance have been found to be predictors for low insight. The study results indicated that introspective accuracy is positively correlated with cognitive performance.

Conclusion: Recent studies demonstrate the importance of cognitive insight and introspective accuracy measures for functional outcome parameters. Although there is little research in the field of cognitive insight in bipolar disorder so far, there are many factors that still need to be addressed. Most importantly, it is needed to address the differences between the types of bipolar disorder and the impact of current mood symptoms and medication on cognitive insight or introspective accuracy in these patients.

Keywords: Bipolar disorder; Cognition; Cognitive insight; Introspective accuracy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Study inclusion process of the databases PubMed Note: Reasons for exclusion: Records excluded: 68 articles did not investigate BD or meet the inclusion criteria; Full-text articles excluded, with reasons: Two studies did not include cognitive tests, two studies did not investigate CI or IA.
See this image and copyright information in PMC

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