Cognitive insight in individuals at clinical high risk for psychosis
Article first published online: 24 JAN 2013
© 2013 Wiley Publishing Asia Pty Ltd
Early Intervention in Psychiatry
Volume 8, Issue 2, pages 130–137, May 2014
How to Cite
Kimhy, D., Jobson-Ahmed, L., Ben-David, S., Ramadhar, L., Malaspina, D. and Corcoran, C. M. (2014), Cognitive insight in individuals at clinical high risk for psychosis. Early Intervention in Psychiatry, 8: 130–137. doi: 10.1111/eip.12023
- Issue published online: 15 APR 2014
- Article first published online: 24 JAN 2013
- Manuscript Accepted: 10 NOV 2012
- Manuscript Received: 7 DEC 2011
- National Institute of Mental Health, Bethesda, MD. Grant Numbers: 1K23MH077653 (DK), 1K23MH66279 (CC), 1K24MH01699 (DM)
- psychosis prodrome;
Reduced cognitive insight has been associated with psychotic symptoms, in particular with the presence of delusions; however, there is little information about whether such reductions are present in at-risk individuals prior to the onset of threshold psychotic symptoms.
We conducted a cross-sectional comparison of cognitive insight (as indexed by the Beck Cognitive Insight Scale) in 62 help-seeking individuals at clinical high risk for psychosis, Fifty-nine individuals with schizophrenia-spectrum disorders and 37 healthy controls (HC). In patients, we evaluated associations of insight with positive symptoms, including later transition to psychosis in high-risk patients.
Individuals with schizophrenia reported significantly higher self-certainty scores than the at-risk patients and HCs, with the at-risk patients scoring intermediate to the individuals with schizophrenia andcontrols. Similarly, individuals with schizophrenia scored significantly higher on self-reflectiveness, with no differences between the at-risk patients and controls. In individuals with schizophrenia, delusions were significantly correlated with self-certainty. In at-risk patients, cognitive insight was not associated with positive symptom severity and did not differentiate those at-risk patients who later developed psychosis from those who did not. However, post hoc analyses suggested that at-risk patients with marked unusual thought content (approaching threshold psychosis) had lower self-reflectiveness; whereas those with high suspiciousness had significantly higher self-certainty.
The findings are discussed in the context of normal developmental processes occurring during adolescence, their putative links to neurobiological functioning, and their implications for treatment and future research.