The Beck Cognitive Insight Scale (BCIS): translation and validation of the Taiwanese version

Yu-Chen Kao,Yia-Ping Liu

doi:10.1186/1471-244x-10-27

Abstract

BackgroundOver the last few decades, research concerning the insight of patients with schizophrenia and its relationships with other clinical variables has been given much attention in the clinical setting. Since that time, a series of instruments assessing insight have been developed. The purpose of this study was to examine the reliability and validity of the Taiwanese version of the Beck Cognitive Insight Scale (BCIS). The BCIS is a self-administered instrument designed to evaluate cognitive processes that involves reevaluating patients' anomalous experiences and specific misinterpretations.MethodsThe English language version of the BCIS was translated into Taiwanese for use in this study. A total of 180 subjects with and without psychosis completed the Taiwanese version of the BCIS and additional evaluations to assess researcher-rated insight scales and psychopathology. Psychometric properties (factor structures and various types of reliability and validity) were assessed for this translated questionnaire.ResultsOverall, the Taiwanese version of the BCIS showed good reliability and stability over time. This translated scale comprised a two-factor solution corresponding to reflective attitude and certain attitude subscales. Following the validation of the internal structure of the scale, we obtained an R-C (reflective attitude minus certain attitude) index of the translated BCIS, representing the measurement of cognitive insight by subtracting the score of the certain attitude subscale from that of the reflective attitude subscale. As predicted, the differences in mean reflective attitude, certain attitude and R-C index between subjects with and without psychosis were significant. Our data also demonstrated that psychotic patients were significantly less reflective, more confident in their beliefs, and had less cognitive insight compared with nonpsychotic control groups.ConclusionsIn light of these findings, we believe that the Taiwanese version of BCIS is a valid and reliable instrument for the assessment of cognitive insight in psychotic patients.

Highlights

Over the last few decades, research concerning the insight of patients with schizophrenia and its relationships with other clinical variables has been given much attention in the clinical setting
A total of 60 outpatients with schizophrenia and schizoaffective disorder, 60 outpatients with major depressive disorder (MDD) without psychotic features, and 60 healthy controls participated in the study
Exploratory factor analysis (EFA) of the Taiwanese version of the Beck Cognitive Insight Scale (BCIS) in the current study identified two factors that accounted for 46.03% of the variance, which resembled the two-factor structure of the original version

Summary

Introduction

Over the last few decades, research concerning the insight of patients with schizophrenia and its relationships with other clinical variables has been given much attention in the clinical setting. To fully understand the issues related to the clinical course of schizophrenia, patients' perspectives, beliefs, and values should be taken into consideration when assessing something as complex as insight. This will provide the clinician and researcher with a better understanding of the different models of psychotic illness, helpseeking, and mental health care acceptability [1,2]. Clinicians have been measuring insight in psychotic patients for many years, there are still various problems and limitations associated with clinically-oriented insight scales These clinically-oriented insight scales do not clarify the patients' limited capacity to access their anomalous experiences and misattributions [9]. The essential cognitive problem in schizophrenic patients centres on the consistent

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