Exploring the nexus of cognition and insight in euthymic bipolar patients

Background and Objectives: Although the relationship between clinical and cognitive insight in individuals with bipolar disorder remains unclear, both concepts are potentially related to cognitive performance, particularly to executive function. We aimed to explore associations among cognitive variables, cognitive insight, and clinical insight. Methods: We assessed 64 clinically stable bipolar patients with a battery of clinical and cognitive tests, the Insight Scale for Affective Disorders to assess clinical insight, and the Beck Cognitive Insight Scale (BCIS) to assess cognitive insight. We used bivariate linear regression models to explore associations between cognitive insight, clinical insight, cognition, and sociodemographic and clinical variables, followed by stepwise multiple regression analyses to account for potential confounders. Results: Global (F = 4.149; B = 0.201; p = 0.047; R2=0.071) and self-reflectiveness BCIS subscale (F = 4.690; B = 0.265; p = 0.043; R2=0.153) scores were positively associated with executive functions. Self-reflectiveness was negatively associated with premorbid intelligence quotient (F = 4.156; B=-0.170; p = 0.046; R2=0.071). Clinical insight was associated only with the self-certainty subscale of the BCIS (F = 4.120; B = 0.360; p = 0.047; R2=0.063). Conclusions: Reduced cognitive insight is associated with cognitive impairment, especially diminished executive functioning. Elevated self-certainty scores are associated with diminished clinical insight.