The Role of Cognitive Insight in Reduction of Positive Symptoms in Youth with Ultra-high Risk for Psychosis

IntroductionCognitive insight was shown to be impaired in schizophrenia while its high level predicts improvement of psychotic symptoms. However, later studies demonstrated that in other mental disorders and healthy subjects cognitive insight might play ambiguous role being related to anxiety and lack of self-confidence.ObjectivesDevelopment of clinical criteria for high and ultra-high risk for psychosis allows to study the role of cognitive insight in these patients.AimsThe aim was to examine the role of cognitive insight in different clinical groups of youth with ultra-high risk for psychosis.MethodsSeventy-six male patients 16–25 years old with non-psychotic mental disorders (with preliminary diagnoses of mood disorders – 30, personality disorders – 25, schizotypal disorder – 21 patients) meeting criteria of ultra-high risk for psychosis and 55 healthy male controls filled Beck Cognitive Insight Scale, Symptom Checklist 90-R. The Scale of Prodromal Symptoms was used twice upon hospitalization and after 1-month period.ResultsModeration analysis reveals that in patients with preliminary diagnoses of mood disorders and schizotypal disorder cognitive insight is related to higher anxiety and obsessiveness and to poorer improvement on SOPS and positive symptoms. In patients with symptoms of personality disorders, it predicts better symptoms improvement.ConclusionsResults demonstrate importance of differentiation of the functions of cognitive insight in different patients with ultra-high risk for psychosis both in clinical psychological assessments and CBT.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Interview and questionnaire assessment of cognitive impairment in subjects at ultra-high risk for psychosis: Associations with cognitive test performance, psychosocial functioning, and positive symptoms

Psychiatry Research ◽

10.1016/j.psychres.2020.113498 ◽

2020 ◽

Vol 294 ◽

pp. 113498

Author(s):

Lasse Randers ◽

Birgitte Fagerlund ◽

Jens Richardt M Jepsen ◽

Dorte Nordholm ◽

Kristine Krakauer ◽

...

Keyword(s):

Cognitive Impairment ◽

High Risk ◽

Test Performance ◽

Psychosocial Functioning ◽

Cognitive Test ◽

Positive Symptoms ◽

Questionnaire Assessment ◽

Ultra High Risk ◽

Cognitive Test Performance

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Normative adolescent experiences may confound assessment of positive symptoms in youth at ultra-high risk for psychosis

Schizophrenia Research ◽

10.1016/j.schres.2015.04.043 ◽

2015 ◽

Vol 166 (1-3) ◽

pp. 358-359 ◽

Cited By ~ 7

Author(s):

Emily E. Carol ◽

Vijay A. Mittal

Keyword(s):

High Risk ◽

Positive Symptoms ◽

Ultra High Risk

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Checking the predictive accuracy of basic symptoms against ultra high-risk criteria and testing of a multivariable prediction model: Evidence from a prospective three-year observational study of persons at clinical high-risk for psychosis

European Psychiatry ◽

10.1016/j.eurpsy.2017.05.026 ◽

2017 ◽

Vol 45 ◽

pp. 27-35 ◽

Cited By ~ 10

Author(s):

M.P. Hengartner ◽

K. Heekeren ◽

D. Dvorsky ◽

S. Walitza ◽

W. Rössler ◽

...

Keyword(s):

High Risk ◽

Prediction Model ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Predictive Accuracy ◽

Positive Symptoms ◽

Clinical High Risk ◽

Verbal Iq ◽

Basic Symptoms ◽

Ultra High Risk

AbstractBackground:The aim of this study was to critically examine the prognostic validity of various clinical high-risk (CHR) criteria alone and in combination with additional clinical characteristics.Methods:A total of 188 CHR positive persons from the region of Zurich, Switzerland (mean age 20.5 years; 60.2% male), meeting ultra high-risk (UHR) and/or basic symptoms (BS) criteria, were followed over three years. The test battery included the Structured Interview for Prodromal Syndromes (SIPS), verbal IQ and many other screening tools. Conversion to psychosis was defined according to ICD-10 criteria for schizophrenia (F20) or brief psychotic disorder (F23).Results:Altogether n = 24 persons developed manifest psychosis within three years and according to Kaplan–Meier survival analysis, the projected conversion rate was 17.5%. The predictive accuracy of UHR was statistically significant but poor (area under the curve [AUC] = 0.65, P < .05), whereas BS did not predict psychosis beyond mere chance (AUC = 0.52, P = .730). Sensitivity and specificity were 0.83 and 0.47 for UHR, and 0.96 and 0.09 for BS. UHR plus BS achieved an AUC = 0.66, with sensitivity and specificity of 0.75 and 0.56. In comparison, baseline antipsychotic medication yielded a predictive accuracy of AUC = 0.62 (sensitivity = 0.42; specificity = 0.82). A multivariable prediction model comprising continuous measures of positive symptoms and verbal IQ achieved a substantially improved prognostic accuracy (AUC = 0.85; sensitivity = 0.86; specificity = 0.85; positive predictive value = 0.54; negative predictive value = 0.97).Conclusions:We showed that BS have no predictive accuracy beyond chance, while UHR criteria poorly predict conversion to psychosis. Combining BS with UHR criteria did not improve the predictive accuracy of UHR alone. In contrast, dimensional measures of both positive symptoms and verbal IQ showed excellent prognostic validity. A critical re-thinking of binary at-risk criteria is necessary in order to improve the prognosis of psychotic disorders.

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