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

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. 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. 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. 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.