Abstract
Cognitive insight represents the ability to reflect on and criticize beliefs and thoughts, and is impaired in individuals with psychosis, relative to healthy controls. The Beck Cognitive Insight Scale is the most widely used tool to assess cognitive insight. While some studies have attempted to develop diagnostic cutoffs, clinical cutoffs differentiating levels of cognitive insight have not yet been established. We identified two clinical profiles within our psychosis sample (N = 385). Profiles represented low and high cognitive insight and were based on functioning and IQ. Composite index scores at the 33rd percentile in the low cluster and the 66th percentile in the high cluster were calculated. Composite index scores of three or lower represent low cognitive insight, between four and nine is considered moderate, and ten or above represents good cognitive insight. Clinical cutoffs will better orient clinicians and will facilitate the development of targeted interventions to improve cognitive insight.
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References
Addington, D., Addington, J., & Schissel, B. (1990). A depression rating scale for schizophrenics. Schizophrenia Research, 3(4), 247–251. https://doi.org/10.1016/0920-9964(90)90005-r.
Andreasen, N. C. (1984a). Scale for the assessment of negative symptoms (SANS). Iowa City: Department of Psychiatry, College of Medicine, The University of Iowa.
Andreasen, N. C. (1984b). Scale for the assessment of positive symptoms (SAPS). Iowa City: The University of Iowa.
Andreasen, N. C., Carpenter, W. T., Kane, J. M., Lasser, R. A., Marder, S. R., & Weinberger, D. R. (2005). Remission in schizophrenia: Proposed criteria and rationale for consensus. American Journal of Psychiatry, 162(3), 441–449. https://doi.org/10.1176/appi.ajp.162.3.441.
Beck, A. T., Baruch, E., Balter, J. M., Steer, R. A., & Warman, D. M. (2004). A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophrenia Research, 68(2), 319–329.
Beck, A., Rector, N., Stolar, N., & Grant, P. (2008). Cognitive theory, research, and therapy. New York: Guilford Press.
Béland, S., & Lepage, M. (2017). The relative contributions of social cognition and self-reflectiveness to clinical insight in enduring schizophrenia. Psychiatry Research, 258, 116–123.
Benoit, A., Harvey, P.-O., Bherer, L., & Lepage, M. (2016). Does the Beck Cognitive Insight Scale predict response to cognitive remediation in schizophrenia? Schizophrenia Research and Treatment, 2016, 1–6. https://doi.org/10.1155/2016/6371856.
Bora, E., Erkan, A., Kayahan, B., & Veznedaroglu, B. (2007). Cognitive insight and acute psychosis in schizophrenia. Psychiatry and Clinical Neurosciences, 61(6), 634–639. https://doi.org/10.1111/j.1440-1819.2007.01731.x.
Bredemeier, K., Beck, A. T., & Grant, P. M. (2018). Exploring the temporal relationship between cognitive insight and neurocognition in schizophrenia: A prospective analysis. Clinical Psychological Science, 6(1), 76–89.
Buchy, L., Czechowska, Y., Chochol, C., Malla, A., Joober, R., Pruessner, J., & Lepage, M. (2009a). Toward a model of cognitive insight in first-episode psychosis: Verbal memory and hippocampal structure. Schizophrenia Bulletin, 36(5), 1040–1049. https://doi.org/10.1093/schbul/sbp015.
Buchy, L., Malla, A., Joober, R., & Lepage, M. (2009b). Delusions are associated with low self-reflectiveness in first-episode psychosis. Schizophrenia Research, 112(1–3), 187–191. https://doi.org/10.1016/j.schres.2009.03.019.
Colis, M. J., Steer, R. A., & Beck, A. T. (2006). Cognitive insight in inpatients with psychotic, bipolar, and major depressive disorders. Journal of Psychopathology and Behavioral Assessment, 28(4), 242–249. https://doi.org/10.1007/s10862-005-9012-7.
de Vos, A. E., Pijnenborg, G. H. M., Aleman, A., & van der Meer, L. (2015). Implicit and explicit self-related processing in relation to insight in patients with schizophrenia. Cognitive Neuropsychiatry, 20(4), 311–329. https://doi.org/10.1080/13546805.2015.1040151.
Engh, J. A., Friis, S., Birkenaes, A. B., Jonsdottir, H., Klungsoyr, O., Ringen, P. A., … Andreassen, O. A. (2009). Delusions are associated with poor cognitive insight in schizophrenia. Schizophrenia Bulletin, 36(4), 830–835. https://doi.org/10.1093/schbul/sbn193.
Engh, J. A., Friis, S., Birkenaes, A. B., Jónsdóttir, H., Ringen, P. A., Ruud, T., … Andreassen, O. A. (2007). Measuring cognitive insight in schizophrenia and bipolar disorder: A comparative study. BMC Psychiatry. https://doi.org/10.1186/1471-244x-7-71.
Everitt, B. S., Landau, S., Leese, M., & Stahl, D. (2011). Hierarchical clustering. In Cluster analysis (5th ed., pp. 71–110). Hoboken: Wiley.
Favrod, J., Zimmermann, G., Raffard, S., Pomini, V., & Khazaal, Y. (2008). The Beck Cognitive Insight Scale in outpatients with psychotic disorders: Further evidence from a French-speaking sample. The Canadian Journal of Psychiatry, 53(11), 783–787. https://doi.org/10.1177/070674370805301111.
Fervaha, G., Foussias, G., Agid, O., & Remington, G. (2014). Impact of primary negative symptoms on functional outcomes in schizophrenia. European Psychiatry, 29(7), 449–455.
Field, A. (2009). Discovering statistics using SPSS. London: Sage.
First, M., Spitzer, R., Gibbon, M., & Williams, J. (1997). Structured clinical interview for DSM-IV access I disorders, clinical version. New York: Columbia University Press.
Giusti, L., Mazza, M., Pollice, R., Casacchia, M., & Roncone, R. (2013). Relationship between self-reflectivity, Theory of Mind, neurocognition, and global functioning: An investigation of schizophrenic disorder. Clinical Psychologist, 17(2), 67–76.
Granholm, E., McQuaid, J. R., McClure, F. S., Auslander, L. A., Perivoliotis, D., Pedrelli, P., … Jeste, D. V. (2005). A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. American Journal of Psychiatry, 162(3), 520–529. https://doi.org/10.1176/appi.ajp.162.3.520.
Hollingshead, A. B. (1957). Two factor index of social position. New Haven: Yale University.
Iyer, S., Jordan, G., MacDonald, K., Joober, R., & Malla, A. (2015). Early intervention for psychosis: A Canadian perspective. The Journal of Nervous and Mental Disease, 203(5), 356–364.
Kao, Y.-C., Wang, T.-S., Lu, C.-W., & Liu, Y.-P. (2011). Assessing cognitive insight in nonpsychiatric individuals and outpatients with schizophrenia in Taiwan: An investigation using the Beck Cognitive Insight Scale. BMC Psychiatry. https://doi.org/10.1186/1471-244x-11-170.
Kaufman, L., & Rousseeuw, P. J. (1990). Partitioning around medoids (program pam). In Finding groups in data: An introduction to cluster analysis, pp. 68–125. Hoboken: Wiley.
Lepage, M., Buchy, L., Bodnar, M., Bertrand, M.-C., Joober, R., & Malla, A. (2008). Cognitive insight and verbal memory in first episode of psychosis. European Psychiatry, 23(5), 368–374. https://doi.org/10.1016/j.eurpsy.2008.02.003.
Mak, W. W. S., & Wu, C. F. M. (2006). Cognitive insight and causal attribution in the development of self-stigma among individuals with schizophrenia. Psychiatric Services, 57(12), 1800–1802. https://doi.org/10.1176/appi.ps.57.12.1800.
Martin, J. M., Warman, D. M., & Lysaker, P. H. (2010). Cognitive insight in non-psychiatric individuals and individuals with psychosis: An examination using the Beck Cognitive Insight Scale. Schizophrenia Research, 121(1–3), 39–45. https://doi.org/10.1016/j.schres.2010.03.028.
Milev, P., Ho, B.-C., Arndt, S., & Andreasen, N. C. (2005). Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: A longitudinal first-episode study with 7-year follow-up. American Journal of Psychiatry, 162(3), 495–506.
Misdrahi, D., Denard, S., Swendsen, J., Jaussent, I., & Courtet, P. (2014). Depression in schizophrenia: The influence of the different dimensions of insight. Psychiatry Research, 216(1), 12–16. https://doi.org/10.1016/j.psychres.2014.01.039.
Nair, A., Palmer, E. C., Aleman, A., & David, A. S. (2014). Relationship between cognition, clinical and cognitive insight in psychotic disorders: A review and meta-analysis. Schizophrenia Research, 152(1), 191–200. https://doi.org/10.1016/j.schres.2013.11.033.
Palmer, E. C., Gilleen, J., & David, A. S. (2015). The relationship between cognitive insight and depression in psychosis and schizophrenia: A review and meta-analysis. Schizophrenia Research, 166(1–3), 261–268. https://doi.org/10.1016/j.schres.2015.05.032.
Pedrelli, P., McQuaid, J. R., Granholm, E., Patterson, T. L., McClure, F., Beck, A. T., & Jeste, D. V. (2004). Measuring cognitive insight in middle-aged and older patients with psychotic disorders. Schizophrenia Research, 71(2–3), 297–305. https://doi.org/10.1016/j.schres.2004.02.019.
Perivoliotis, D., Grant, P. M., Peters, E. R., Ison, R., Kuipers, E., & Beck, A. T. (2010). Cognitive insight predicts favorable outcome in cognitive behavioral therapy for psychosis. Psychosis, 2(1), 23–33. https://doi.org/10.1080/17522430903147520.
Phalen, P. L., Viswanadhan, K., Lysaker, P. H., & Warman, D. M. (2015). The relationship between cognitive insight and quality of life in schizophrenia spectrum disorders: Symptom severity as potential moderator. Psychiatry Research, 230(3), 839–845. https://doi.org/10.1016/j.psychres.2015.10.014.
Pietrzak, R. H., Olver, J., Norman, T., Piskulic, D., Maruff, P., & Snyder, P. J. (2009). A comparison of the CogState Schizophrenia Battery and the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Battery in assessing cognitive impairment in chronic schizophrenia. Journal of Clinical and Experimental Neuropsychology, 31(7), 848–859. https://doi.org/10.1080/13803390802592458.
Premkumar, P., Peters, E. R., Fannon, D., Anilkumar, A. P., Kuipers, E., & Kumari, V. (2011). Coping styles predict responsiveness to cognitive behaviour therapy in psychosis. Psychiatry Research, 187(3), 354–362. https://doi.org/10.1016/j.psychres.2010.12.029.
Rabinowitz, J., Garibaldi, G., Levine, S., Bugarski-Kirola, D., Berardo, C., & Kapur, S. (2011). PMH56 negative symptoms have greater impact on functioning than positive symptoms in schizophrenia: Analysis of Catie data. Value in Health, 14(7), A296–A297.
Raffard, S., Fond, G., Brittner, M., Bortolon, C., Macgregor, A., Boulenger, J.-P., … Capdevielle, D. (2013). Cognitive insight as an indicator of competence to consent to treatment in schizophrenia. Schizophrenia Research, 144(1–3), 118–121. https://doi.org/10.1016/j.schres.2012.12.011.
Tabachnick, B. (2013). In B. G. Tabachnick, & L. S. Fidell (Eds.), Using multivariate statistics (6th ed.). Boston: Pearson.
Tranulis, C., Lepage, M., & Malla, A. (2008). Insight in first episode psychosis: Who is measuring what? Early Intervention in Psychiatry, 2(1), 34–41. https://doi.org/10.1111/j.1751-7893.2007.00054.x.
Van Camp, L. S. C., Sabbe, B. G. C., & Oldenburg, J. F. E. (2017). Cognitive insight: A systematic review. Clinical Psychology Review, 55, 12–24. https://doi.org/10.1016/j.cpr.2017.04.011.
Warman, D. M., Lysaker, P. H., Martin, J. M., Davis, L., & Haudenschield, S. L. (2007). Jumping to conclusions and the continuum of delusional beliefs. Behaviour Research and Therapy, 45(6), 1255–1269. https://doi.org/10.1016/j.brat.2006.09.002.
Wechsler, D. (1997). WAIS-III administration and scoring manual. San Antonio, TX: The Psychological Corporation.
Wechsler, D. (1999). Wechsler abbreviated scale of intelligence. https://doi.org/10.1037/t15170-000.
Acknowledgements
The authors wish to thank research staff from the Martin Lepage Laboratory, especially Gabriella Buck, and PEPP-Montreal for assistance with recruitment and data collection. We are grateful to all who participated in this study.
Funding
This work was supported by the Canadian Institutes of Health Research (Grant Nos. 68961, 106634) to M.L., and the Sackler Foundation to M.L. and A.K.M. Salary awards include: the Fonds de recherche du Québec - Santé to G.S., M.L., and R.J.; the James McGill Professorship to M.L.; and the Canada Research Chairs Programme to A.K.M. M.L. reports having received financial assistance/compensation for research and educational events from Otsuka/Lundbeck Alliance.
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Danielle Penney, Geneviève Sauvé, Rhida Joober, Ashok K. Malla and Martin Lepage declare that they have no conflict of interest.
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Penney, D., Sauvé, G., Joober, R. et al. Establishing Clinical Cutoff Values for the Beck Cognitive Insight Scale. Cogn Ther Res 43, 324–334 (2019). https://doi.org/10.1007/s10608-018-9963-0
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DOI: https://doi.org/10.1007/s10608-018-9963-0