Neuropsychological correlates of insight in obsessive–compulsive disorder

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Objective:There are limited data on neuropsychological correlates of poor insight in obsessive–compulsive disorder (OCD). We hypothesize that poor insight may be associated with greater impairment in tasks of conflict resolution/response inhibition and possibly impairment in a task of verbal learning and memory.Method:Insight and neuropsychological functions were assessed in 150 subjects with DSM-IV OCD. The neuropsychological data of 177 healthy control subjects were used for comparison.Results:Insight score correlated significantly with the Stroop Interference Test for conflict resolution/response inhibition (P = 0.002), and showed trends for significance with the Controlled Oral Word Association (COWA) average for verbal fluency (P = 0.021) and delayed recall on the Auditory Verbal Learning Test (AVLT) for verbal memory (P = 0.015). On regression analysis, the AVLT delayed recall, the COWA average, the Matrix score, the Yale-Brown Obsessive–Compulsive Scale total score, and current antipsychotic use emerged as significant predictors of poorer insight.Conclusion:Poor insight is associated with greater impairments in conflict resolution/response inhibition, verbal memory, and fluency. Individuals with poorer insight may have difficulty in appropriately processing conflicting information, updating their memory with corrective information, and then accessing this corrective information to modify their irrational beliefs.

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