Establishing Clinical Cutoff Values for the Beck Cognitive Insight Scale

The Italian Validation of the Beck Cognitive Insight Scale: Underlying Factor Structure in Psychotic Patients and the General Population

Cognitive insight refers to the ability to question one's judgments and cognitive biases and is underpinned by specific metacognitive processes. The Beck Cognitive Insight Scale was developed to assess cognitive insight and includes two subscales, Self-Reflectiveness and Self-Certainty (SC). The present study aimed to investigate the underlying factor structure of the Italian version of the BCIS in patients with schizophrenia (SZ) and in the general population (GP) for the first time. A cross-sectional design was adopted and a GP sample of 624 subjects and an SZ sample of 130 patients were enrolled. In the SZ group, a two-factor solution was supported. The internal reliability of each factor was satisfactory. Two items were eliminated and one item moved from the SC to the SR subscale. In the GP group, a two-factor solution was highlighted. The internal reliability of each factor was satisfactory. However, four items of the SR subscale were deleted. The Italian-validated version of the BCIS shows different structures for the SZ and the GP and is characterized by different features concerning previous studies. This evidence suggests new interpretations of metacognitive processes in the two populations and implies specific therapeutic approaches.

Hindi Adaptation and Psychometric Validation of the Affiliate Stigma Scale

BACKGROUND

The Affiliate Stigma Scale (ASS) is a widely used tool to measure affiliate stigma in the caregivers of individuals with various types of mental illnesses. However, the Hindi adaptation of this scale with evident psychometric properties is not available. This study aimed to adapt the ASS in the Hindi language and, further, to validate it in the Indian setting.

METHODS

Translation and back-translation methods were used to translate the original items of the ASS to the Hindi language. After completion of translations and linguistic adaptation process, the Hindi translated version of the ASS, WHO Quality of Life-BREF (WHOQOL-BREF), General Health Questionnaire-12 (GHQ-12), and Hospital Anxiety and Depression Scale (HADS) were administered to 140 caregivers of persons with mental illness. Purposive sampling method was adopted. The age range of the participants was 17-60 years. Psychometric properties, as well as the factor structures of the scale, were evaluated.

RESULTS

The Hindi version of the ASS has adequate internal consistencies (r = 0.87-0.93) and test-retest reliability (r = 0.78, P < 0.001). The concurrent validity of this scale was also high, as the correlation coefficients among the Hindi version of the ASS, WHOQOL-BREF, GHQ-12, and HADS were ranging from 0.23 to 0.35. The exploratory factor analysis revealed three underlying factors, namely, cognition, affect, and behavior.

CONCLUSIONS

The Hindi version of the ASS is a reliable and valid psychometric tool to measure affiliate stigma in caregivers of patients with mental illness.

Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia-Spectrum Disorders: Relationship to Metacognitive Deficits

People diagnosed with schizophrenia have been broadly observed to experience deficits in clinical and cognitive insight; however, less is understood about how these deficits are related. One possibility is that these deficits co-occur among people when other deficits in cognition are present, such as in executive function, social cognition, and metacognition, which may either promote the development of both forms of poor insight or allow one to negatively influence the other. To explore this possibility, we conducted a cluster analysis using assessments of clinical and cognitive insight among 95 adults with a schizophrenia spectrum disorder. As predicted, this analysis yielded a group with concurrently poor clinical and cognitive insight (n = 36). Additional groups were found with concurrently good clinical and cognitive insight (n = 28) and poor clinical insight and good cognitive insight (n = 31). Groups were then compared on assessments of executive function, social cognition, and metacognition. The group with concurrently lower levels of cognitive and clinical insight had significantly poorer metacognition relative to the other groups. In particular, they tended to form more fragmented and less integrated ideas about themselves and others. No differences were found for executive function or social cognition. The result may suggest that while clinical and cognitive insight is partially orthogonal phenomena, relatively lower levels of metacognition, or difficulties forming integrated ideas about oneself and others, maybe a condition leading to the confluence of lower clinical and cognitive insight. Interventions targeting metacognition may be of particular use for this group.