Abstract
BackgroundThe outcome of first episode psychosis (FEP) is highly variable and difficult to predict. Cognitive insight measured at illness onset has previously been found to predict psychopathology 12-months later. The aims of this study were to examine whether the prospective relationship between cognitive insight and symptom severity is evident at four-years following FEP and to examine some psychological correlates of cognitive insight.MethodsFEP participants (n = 90) completed the Beck Cognitive Insight Scale (BCIS) at illness onset, and associations between BCIS scores with symptom severity outcomes (4-years after FEP) were assessed. The BCIS scales (self-reflectiveness and self-certainty) were examined as a composite score, and individually compared to other cognitive measures (IQ and jumping to conclusions (JTC) bias).ResultsRegression analyses revealed that the cognitive insight composite did not predict 4-year symptom remission in this study while the self-reflection subscale of the BCIS predicted severity of symptoms at 4-years. Self-certainty items of the BCIS were not associated with symptom severity. Significant correlations between the JTC bias, self-certainty and IQ were found, but self-reflection did not correlate with these other cognitive measures.ConclusionsSelf-reflective capacity is a more relevant and independent cognitive construct than self-certainty for predicting prospective symptom severity in psychosis. Improving self-reflection may be a useful target for early intervention research.
Highlights
The outcome of first episode psychosis (FEP) is highly variable and difficult to predict
In light of the current gaps in the literature as described, the aim of the current study was to examine whether cognitive insight can predict four year symptom severity in an FEP sample previously described [8] and explore how the underlying components of cognitive insight are associated with other cognitive factors (IQ and JTC)
Participants were classified into eight different diagnostic categories according to the DSM IV
Summary
The outcome of first episode psychosis (FEP) is highly variable and difficult to predict. Cognitive insight measured at illness onset has previously been found to predict psychopathology 12-months later. The study of higher-order thinking in psychosis populations has been examined using various cognitive constructs. Self-reflective capacity is a meta-cognitive construct defined as the ability to be accurately introspective, and recognise one’s own subjective fallibility [1]. The Beck Cognitive Insight Scale (BCIS) [7] examines these two theoretically driven and empirically derived factors: self-certainty, which assesses overconfidence and certainty about being right A composite index can be calculated by subtracting self-certainty from self-reflective scores. High self-reflectiveness and low self-certainty is the formula for good ‘cognitive insight’ [7]
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