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Cognitive insight in individuals at clinical high risk for psychosis

Authors

  • David Kimhy,

    Corresponding author
    1. Department of Psychiatry, Columbia University, New York, New York, USA
    2. Center of Prevention and Evaluation, New York State Psychiatric Institute, New York, New York, USA
    • Corresponding author: Dr David Kimhy, Division of Cognitive Neuroscience, Department of Psychiatry, Unit 55, Columbia University, 1051 Riverside Drive, New York, NY 10032, USA. Email: kimhyda@nyspi.columbia.edu

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  • Lauren Jobson-Ahmed,

    1. Department of Psychiatry, Columbia University, New York, New York, USA
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  • Shelly Ben-David,

    1. Department of Psychiatry, Columbia University, New York, New York, USA
    2. Center of Prevention and Evaluation, New York State Psychiatric Institute, New York, New York, USA
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  • Lisa Ramadhar,

    1. Center of Prevention and Evaluation, New York State Psychiatric Institute, New York, New York, USA
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  • Dolores Malaspina,

    1. Department of Psychiatry, New York University Medical Center, New York, New York, USA
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  • Cheryl M. Corcoran

    1. Department of Psychiatry, Columbia University, New York, New York, USA
    2. Center of Prevention and Evaluation, New York State Psychiatric Institute, New York, New York, USA
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Abstract

Aim

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.

Method

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.

Results

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.

Conclusions

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.

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