439. Clinical Insight and Introspective Accuracy in Severe Mental Illness

Abstract

Background: Clinical insight and introspective accuracy are distinct yet interconnected constructs. Despite their significance in functional and treatment outcomes, their relationship remains unclear. Methods: The Scale to Assess Unawareness of Mental Disorder and Positive and Negative Syndrome Scale were used to evaluate clinical insight. Introspective accuracy (IA) was operationalized using task-wise discrepancy scores of actual vs. self-reported correct responses in Social Cognitive and Neurocognitive tasks. The sample (N = 379) includes individuals with bipolar disorder (BD, n = 200) and schizophrenia (SSD, n = 179). Results: Small positive correlations were found between clinical insight and composite scores for both Social Cognitive IA (r =.13) and Neurocognitive IA (r =.19). This pattern persisted in SSD (r =.13, r =.19). However, in BD, clinical insight exhibited a significant correlation only with Neurocognitive IA (r=0.15), showing no significant relationship with IA in Social Cognition. At the task level, clinical insight showed small significant relationships with IA for the Hinting task (r =.21 –.25), Letter-Number Span (r =.21 –.24), and Trails A (r =.11 –.16). All other tasks showed non-significant relationships. Conclusions: Despite statistical significance, the correlations between clinical insight and introspective accuracy were uniformly weak, underscoring the relative independence of these constructs in both schizophrenia and bipolar disorder. Findings thus suggest that both constructs should be targeted via specialized treatments. Keywords: Introspective Accuracy, Insight into illness, Severe Mental Illness