Baseline Clinical Insight and Cognitive Functioning as Correlates of Treatment Engagement in Naturalistic Psychiatric Treatment for Psychosis
Victoria Lisowski (1), Heather Muir (1,2), Ali Sendil (1), Kelsey Johnson (1), Nicolas Raymond (1), Raquelle Mesholam-Gately (1,3), Matcheri Keshavan (1,2,3), Sarah Herold (1,3), Paulo Lizano (1,3,4)
1. Advancing Services for Psychosis Integration and Recovery (ASPIRE) Clinic, Beth Israel Deaconess Medical Center,
2. Massachusetts Department of Mental Health,
3. Department of Psychiatry, Harvard Medical School,
4. Division of Translational Neuroscience, Beth Israel Deaconess Medical Center
Abstract
Background: Over 50% of psychosis patients lack clinical insight into their illness. Poorer insight is associated with worse psychotic symptomatology and cognitive decline. Moreover, studies examining clinical insight and cognition in psychosis have largely been conducted in the context of clinical trials, but not in naturalistic settings for the treatment of early psychosis. Thus, it is important to elucidate the associations between insight, cognition, sociodemographic, and treatment outcomes in the naturalistic treatment of early psychosis patients. The present study aims to examine whether patients with higher versus lower baseline clinical insight differ in their treatment engagement.
Methods: Data was collected from intake assessments (starting September 2021) used in support of naturalistic early psychosis treatment at Beth Israel Deaconess Medical Center. Intake assessments include a self-report measure of clinical insight (BIS; Birchwood Insight Scale) and a brief neuropsychological assessment (BACS; Brief Assessment of Cognition in Schizophrenia), among other clinical tools. Patients (N >11) have a mean age of 26, and hold a variety of psychotic spectrum diagnoses, including schizophrenia spectrum disorders, major depression, or substance-induced psychosis.
Results: As data collection is ongoing, analyses will be completed closer to the date of the conference. However, the BIS total scores will be median-split to derive an index of high versus low baseline clinical insight. Independent t-tests and chi-square analyses will be used to determine whether high versus low clinical insight groups significantly differ in their baseline sociodemographic, cognitive functioning, and treatment engagement (i.e., medication adherence, attended follow-up appointments). In a small subset of individuals, longitudinal changes in insight and cognition will be examined.
Conclusions: Findings will help clarify the associations between clinical insight, cognitive functioning, and treatment engagement in naturalistic settings for patients with early psychosis and, thus, could inform treatment within this population, such as metacognitive therapy.