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World J Psychiatry. May 19, 2026; 16(5): 113866
Published online May 19, 2026. doi: 10.5498/wjp.v16.i5.113866
Published online May 19, 2026. doi: 10.5498/wjp.v16.i5.113866
Visuospatial memory modulates insight and its predictive value for 6-year psychosis risk in clinical high-risk individuals
Li-Hua Xu, Hui-Ru Cui, Yan-Yan Wei, Xiao-Chen Tang, Zhen-Ying Qian, Dan Zhang, Wen-Si Zheng, Tian-Yuan Zhu, Xiang-Fei Hong, Jun-Juan Zhu, Ye-Gang Hu, Xu Liu, Xiong Jiao, Ying-Ying Tang, Tian-Hong Zhang, Ji-Jun Wang, Neuromodulation Center, Shanghai Mental Health Center, Shanghai 200030, China
Ying Qing, Student Innovation Center, Shanghai Jiao Tong University, Shanghai 200030, China
Xiao-Chen Chen, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Co-first authors: Li-Hua Xu and Hui-Ru Cui.
Co-corresponding authors: Tian-Hong Zhang and Ji-Jun Wang.
Author contributions: Xu LH wrote the first draft of the manuscript; Cui HR reviewed and revised the manuscript; Xu LH, Cui HR, Wei YY, and Qian ZY collected the data; Zhang D, Zheng WS, Zhu TY, and Zhu JJ conducted follow-up work; Xu LH, Tang XC, Hu YG, Liu X, Jiao X, and Tang YY analyzed the data; Chen XC provided an independent review of the analytical methods; Xu LH, Hong XF, Qing Y, Tang YY, and Zhang TH interpreted the results; Zhang TH and Wang JJ designed the study; Wang JJ supervised data collection, analysis, and interpretation; all authors have approved the final manuscript.
Supported by the Ministry of Science and Technology of China, National Key RD Program of China, No. 2023YFC2506800; Science and Technology Commission of Shanghai Municipality, No. 23Y11900500, No. 23Y11906000 and No. 23Y11906100; Shanghai Municipal Health Commission, No. 202340015; Shanghai Mental Health Center, No. CRC2018YB01 and No. 2024-QM02; 2025 Yuanshen Rehabilitation Research Institute Research Center Project of Shanghai Jiao Tong University School of Medicine (yskfl-25-1027-1).
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and was approved by the Research Ethics Committee of the Shanghai Mental Health Center (ethical approval No. 2019-41C1).
Clinical trial registration statement: This study was conducted using data from a previously registered longitudinal cohort project (Registration No. NCT04444180; Registry: Clinicaltrials.gov). The original trial registration covered the recruitment procedures, inclusion/exclusion criteria, and baseline/short-term follow-up assessments of individuals at clinical high risk for psychosis. The present manuscript represents a secondary analysis focusing on insight, neurocognition, and long-term clinical outcomes. The extended follow-up duration (up to 6 years) and the specific analytic aims reported here were not prespecified in the original trial registration, but were conducted based on prospectively collected data within the same cohort. No changes were made to the originally registered recruitment procedures or assessment protocols.
Informed consent statement: Written informed consent was obtained from all the participants. For individuals younger than 18 years, informed consent was obtained from both the adolescent and their next of kin or legal guardians.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: All the data are available upon request. The raw statistical output files are available in the Supplementary materials section of this submission and will be made available online upon publication.
Corresponding author: Ji-Jun Wang, MD, PhD, Professor, Neuromodulation Center, Shanghai Mental Health Center, No. 600 Wanping South Road, Shanghai 200030, China.
Received: September 17, 2025
Revised: December 11, 2025
Accepted: February 12, 2026
Published online: May 19, 2026
Processing time: 225 Days and 3.3 Hours
Revised: December 11, 2025
Accepted: February 12, 2026
Published online: May 19, 2026
Processing time: 225 Days and 3.3 Hours
Core Tip
Core Tip: Impaired insight predicts psychosis in individuals at clinical high risk (CHR), yet its neurocognitive underpinnings remain unclear. In a six-year follow-up of 312 CHR participants, visuospatial memory assessed via the Brief Visuospatial Memory Test-Revised (BVMT-R) emerged as the key cognitive domain differentiating low and high impaired insight groups, independent of positive symptoms. Notably, higher BVMT-R scores reduced the risk of conversion to psychosis, moderating the impact of impaired insight. These findings highlight visuospatial memory as a potential marker for identifying CHR individuals at greatest risk and suggest targeted cognitive interventions to enhance insight and mitigate psychosis onset.