Impaired cognitive insight linked to delusions in psychosis risk

By Eleanor McDermid, Senior medwireNews Reporter

High levels of self-certainty, one aspect of cognitive insight, are associated with the presence of delusional symptoms in people with at-risk mental states (ARMS), a study shows.

The researchers, led by Tomohiro Uchida (Tohoku University Graduate School of Medicine, Sendai, Japan), suggest that “interventions that reduce overconfidence in their judgments or beliefs may be beneficial for individuals with ARMS.”

In particular, they say that studying the effect of cognitive behavioral therapy on cognitive insight in ARMS patients “would be intriguing.”

The study involved 60 ARMS patients, almost all of whom had attenuated psychotic symptoms, rather than brief, limited intermittent symptoms or state and trait risk factors. Their overall average score on the Japanese version of the Beck Cognitive Insight Scale was similar to that of 200 healthy controls of a similar age, and their scores for the self-reflectiveness subscale also did not differ.

However, ARMS patients had a significantly higher score than controls for self-certainty, at 5.78 versus 4.37. And this correlated with the presence of attenuated delusional symptoms, assessed using the Japanese version of the Comprehensive Assessment of At-Risk Mental States.

Patients who had delusional symptoms that were close to the threshold for a clinical diagnosis had significantly higher self-certainty scores than those who did not, at 7.90 versus 5.36, whereas their self-reflectiveness scores did not differ.

This suggests that self-certainty specifically, rather than cognitive insight in general, is linked to delusions, say the researchers. They cite a previous study showing normal self-certainty but impaired self-reflectiveness in patients who had psychosis but no delusions, which, in keeping with the current findings, shows “the importance of a balance between self-reflectiveness and self-certainty.”

There was also evidence that high self-certainty could be linked to the risk for transition to psychosis. The average score was higher, albeit nonsignificantly, in the five patients who transitioned during 22 months of follow-up than in those who did not, at 8.20 versus 5.56, whereas self-reflectiveness score was similar in both groups.

“These findings indicate that overconfidence in one’s own beliefs or judgments might be related to the formation and maintenance of attenuated delusions in people with ARMS,” the team concludes in Psychiatry Research.

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