Cognitive insight in individuals at ultra-high risk for psychosis compared to patients with first-episode psychosis and non-psychotic help-seeking youths

Asian J Psychiatr. 2022 Jul:73:103107. doi: 10.1016/j.ajp.2022.103107. Epub 2022 Apr 9.

Abstract

Background: Defective insight is a hallmark of schizophrenia. Less is known about insight in emerging psychosis. In this study a widely used measure of cognitive insight, the Beck Cognitive Insight Scale (BCIS), has been applied to a sample including patients with first-episode psychosis (FEP), at ultra-high risk (UHR) for psychosis, and help-seeking youths without psychotic symptoms.

Methods: The Comprehensive Assessment of At-Risk Mental State (CAARMS) interview was used to classify patients. Enrolled patients were assessed with the General Health Questionnaire-12 (GHQ-12), the Prodromal Questionnaire-16 (PQ-16), the Social and Occupational Functioning Assessment Scale (SOFAS), and the BCIS.

Results: The sample included 212 participants (58%) with non-psychotic mental distress, 131 participants (36%) were UHR, and 22 (6%) were with FEP. Males and females were in equal proportion, mean age was 19.2 ± 2.6 years old (range: 15-25 years). Reliability (Cronbach's alpha) was good for clinical scales (>0.7) and acceptable (around 0.6) for the two BCIS subscales. The self-certainty subscale of the BCIS was more reproducible in factor analysis than the self-reflectiveness scale. Youths devoid of psychotic symptoms scored lower than UHR and FEP participants on the GHQ-12 and the PQ-16 and had better psychosocial functioning as measured by the SOFAS. Levels of cognitive insight did not differ between groups.

Conclusion: People in the early stages of psychosis may be still accessible to self-reflectiveness and more hesitant about the certainty of their beliefs than patients at more advanced stages of the illness, as those with fully displayed schizophrenia.

Keywords: Cognition; Cognitive insight; Insight; Psychosis; Schizophrenia; Ultra-high risk.

MeSH terms

  • Adolescent
  • Adult
  • Cognition
  • Female
  • Humans
  • Male
  • Psychiatric Status Rating Scales
  • Psychotic Disorders* / diagnosis
  • Reproducibility of Results
  • Schizophrenia*
  • Young Adult