Assessing cognitive insight in nonpsychiatric individuals and outpatients with schizophrenia in Taiwan: an investigation using the Beck Cognitive Insight Scale

Abstract

BackgroundThe Beck Cognitive Insight Scale (BCIS) was designed for the assessment of the cognitive processes involved in self-reflection and the ability to modify erroneous beliefs and misinterpretations. Studies investigating the factor structure of the BCIS have indicated a two-factor model in the psychotic population. The factor structure of the BCIS, however, has not received much consideration in the nonpsychiatric population. The present study examined the factor structure and validity of the BCIS and compared its scores between nonpsychiatric individuals and outpatients with psychosis.MethodThe Taiwanese version of the BCIS was administered to 507 nonpsychiatric individuals and 118 outpatients with schizophrenia. The psychometric properties of the BCIS were examined through the following analyses: exploratory and confirmatory factor analyses, reliability, correlation analyses, and discriminative validity.ResultsThe BCIS showed adequate internal consistency and stability over time. Exploratory and confirmatory factor analyses on the 15-item measure indicated a two-factor solution that supported the two dimensions of the Taiwanese BCIS, which was also observed with the original BCIS. Following the construct validation, we obtained a composite index (self-reflectiveness minus self-certainty) of the Taiwanese BCIS that reflected cognitive insight. Consistent with previous studies, our results indicated that psychosis is associated with low self-reflectiveness and high self-certainty, which possibly reflect lower cognitive insight. Our results also showed that better cognitive insight is related to worse depression in patients with schizophrenia spectrum disorders, but not in nonpsychiatric individuals. The receiver operating characteristic (ROC) analyses revealed that the area under the curve (AUC) was 0.731. A composite index of 3 was a good limit, with a sensitivity of 87% and a specificity of 51%.ConclusionThe BCIS proved to be useful for measuring cognitive insight in Taiwanese nonpsychiatric and psychotic populations.

The relationship between cognitive insight and depression in psychosis and schizophrenia: A review and meta-analysis

“…Correlation Scale Granholm et al (2005) −0.04 HDRS Pedrelli et al (2004) −0.04 HDRS Gilleen et al (2011) 0 BDI-II Lepage et al (unpublished) 0.01 CDS González-Blanch et al (2014) 0.101 CDS Tastet et al (2012) 0.155 BDI-II Beck et al (2004) 0.17 BDI-II Greenberger and Serper (2010) 0.18 CDS Wiffen (2011) 0.18 PANSS Colis et al (2006) 0.192 BDI-II Warman et al (2007) 0.194 BDI-II Mass et al (2012) 0.23 BDI-II Ekinci et al (2012b) 0.267 CDS Raffard et al (2013) 0.274 BDI-II Misdrahi et al (2014) 0.35 BDI-II Kao et al (2011) 0.378 BDI-II considering decisions to a greater degree than when mood is not low or elevated (Takano and Tanno, 2009;Orfei et al, 2011). In support of this is the notion that individuals with low mood are more likely to adopt a systematic thinking style that relies on attention to the details at hand rather than pre-existing knowledge, whereas those with elevated mood are more likely to use pre-existing beliefs and self-knowledge Schwarz, 2000;Schwarz and Clore, 1996).…”

The metabolic basis of cognitive insight in psychosis: A positron emission tomography study

“…Indeed subjects with better cognitive insight (higher R-C index) show a higher awareness of illness, but the two measures are not equivalent, because they represent two different dimensions of insight [42]. The BCIS R-C index could represent a satisfactory measure of cognitive insight in patients with psychosis, as several studies have previously demonstrated [41,43,44,45]. Interestingly, reduced self-reflectiveness and overconfidence of experiences interpretation may be a form of neuropsychological deficit [46] that, from a neurobiological point of view, could be related to neuroimaging abnormalities.…”

Cognitive insight and dynamics of indicators of ultra-high risk for schizophrenia in young patients with non-psychotic forms of mental disorders

“…Механизмы формирования когнитивного инсайта при непсихотических расстройствах в группе ультравысокого риска манифестации шизофрении. В полном соответствии с гипотезами, хотя и в противоречие существующим данным [24,25], мы выявили не снижение, а нарастание уровня когнитивного инсайта (как в отношении нарастания саморефлексивности, так и снижения самоуверенности) по мере утяжеления психопатологической симптоматики, характерной для ультравысокого риска манифестации шизофрении, симптомов межличностной тревожности, тревоги и депрессии. Иными словами, получено подтверждение, что когнитивный инсайт может формироваться вторично как проявление или следствие психопатологической симптоматики -если человек становится особенно внимательным к своим необычным симптомам.…”

“…Кроме того, в норме когнитивный инсайт положительно связан с жалобами на обсессивно-компульсивную симптоматику, межличностную тревожность, тревогу и депрессию [18], а при депрессивном расстройстве -с депрессивной симптоматикой [10]. Более того, по некоторым данным [24], положительная корреляция депрессии и когнитивного инсайта характерна и для шизофрении. С другой стороны, ряд данных свидетельствует в пользу снижения когнитивного инсайта при непсихотических расстройствах по сравнению с нормой [24,25], хотя при депрессиях он выше, нежели при шизофрении и биполярном аффективном расстройстве [26], а некоторые исследования указывают на отсутствие связи между депрессией и когнитивным инсайтом в норме [24] и при шизофрении [10].…”