Abstract
Background: This study examines whether cognitive insight is impaired in high-risk individuals with attenuated psychotic symptoms (APS) and explores the relationship between cognitive and clinical insight at different durations of untreated attenuated psychotic symptoms (DUAPS).Methods: The Structured Interview for Psychosis high-risk Syndrome (SIPS) was used to identify APS individuals. APS (n = 121) and healthy control (HC, n = 87) subjects were asked to complete the Beck Cognitive Insight Scale (BCIS). Clinical insight of APS individuals was evaluated using the Schedule for Assessment of Insight (SAI). APS individuals were classified into four subgroups based on DUAPS, including 0–3, 4–6, 7–12, and >12 months. Power analysis for significant correlation was conducted using the WebPower package in R.Results: Compared with HC subjects, APS individuals showed poorer cognitive insight, with lower scores on BCIS self-reflectiveness and composite index (BCIS self-reflectiveness minus BCIS self-certainty). Only when DUAPS was longer than 12 months did the significant positive correlation between cognitive and clinical insight obtain the power about 0.8, including the associations between self-reflectiveness and awareness of illness, self-reflectiveness and the total clinical insight, and composite index and awareness of illness. The positive associations of composite index with awareness of illness within 0–3 months DUAPS and with the total score of SAI when DUAPS > 12 months were significant but failed to obtain satisfactory power.Conclusions: APS individuals may have impaired cognitive insight, demonstrating lower self-reflectiveness. The correlation between cognitive and clinical insight is associated with the duration of untreated attenuated psychotic symptoms.
Highlights
Insight is a multi-dimensional concept [1]
The independent samples t-test revealed that attenuated psychotic symptoms (APS) individuals had significantly lower scores than HC subjects (p < 0.05) on self-reflectiveness, self-certainty, and the composite index
The results showed no significant differences among the subgroups in terms of age, gender distribution, years of education, cognitive and clinical insight, and the total score of each dimension of Scale of Psychosis-risk Syndromes (SOPS) (p > 0.05)
Summary
Insight into an illness or clinical insight includes awareness into mental illness, recognition of specific symptoms or relabeling, and acceptance of the need for treatment [2]. A metacognitive conceptualization of insight or cognitive insight includes selfreflectiveness and self-certainty [3]. Cognitive insight can be assessed using the Beck Cognitive Insight Scale (BCIS), with a high score on BCIS selfreflectiveness or a low score on BCIS self-certainty indicating good cognitive insight, which demonstrated sufficient convergent validity with the Scale to Assess Unawareness of Mental Disorder (SUMD) [3, 4]. Cognitive insight does not involve judgment about psychiatric challenges but includes awareness of alterations in thought processes and reasoning styles, which differs from clinical insight [5] and has a complementary relationship with clinical insight [6, 7]. This study examines whether cognitive insight is impaired in high-risk individuals with attenuated psychotic symptoms (APS) and explores the relationship between cognitive and clinical insight at different durations of untreated attenuated psychotic symptoms (DUAPS)
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