Visuospatial memory modulates insight and its predictive value for 6-year psychosis risk in clinical high-risk individuals

Figure 1 Logistic modeling of insight impairment: Variable selection, marginal effects, and risk estimates. A: Least absolute shrinkage and selection operator (LASSO) logistic model shows bootstrap inclusion frequencies from the LASSO logistic regression, identifying z-score for the Brief Visuospatial Memory Test-Revised (BVMT-R) (z-BVMT-R) and z-score for the Brief Assessment of Cognition in Schizophrenia: Symbol Coding (BACS-SC) (z-BACS-SC) as the most consistently selected predictors of impaired insight; B: Marginal effects display marginal effects of z-BVMT-R and z-BACS-SC on impaired insight across levels of total score of positive symptoms on the Scale of Psychotic-Risk Syndromes (P-Total), with shaded bands representing 95% confidence intervals; C: Johnson-Neyman plot illustrating the P-Total ranges in which the effect of z-BVMT-R remains statistically significant; D: Shows predicted probabilities of impaired insight across P-Total, stratified by high vs low z-BVMT-R, with the grey region indicating the Johnson-Neyman significant range; E: Depicts the clinical contrast absolute probability differences of impaired insight between low and high z-BVMT-R across P-Total; F: Shows the absolute predicted probability of impaired insight across combinations of P-Total and z-BVMT-R groups. LASSO: Least absolute shrinkage and selection operator; z-BVMT-R: Z-score for the Brief Visuospatial Memory Test-Revised; z-BACS-SC: Z-score for the Brief Assessment of Cognition in Schizophrenia: Symbol Coding; z-HVLT-R: Z-score for the Hopkins Verbal Learning Test-Revised; z-WMS-III-SS: Z-score for the Wechsler Memory Scale-3^rd Ed: Spatial Span; z-CPT-IP: Z-score for the Continuous Performance Test-Identical Pairs; P-Total: Total score of positive symptoms on the Scale of Psychotic-Risk Syndromes; NS: Not significant.

Figure 2 Performance of the Cox conversion prediction model: Variable selection, discrimination, calibration, and clinical utility. A: Shows bootstrap inclusion frequencies from the least absolute shrinkage and selection operator Cox model; B: Presents time-dependent receiver operating characteristic curves across 12-72 months; C and D: Show calibration plots at 3 years and 6 years, respectively. The grey dashed line represents perfect calibration; the orange line shows the apparent calibration curve; the green line shows the bias-corrected curve from bootstrap resampling; E and F: Display decision curve analyses at 3 years and 6 years, respectively. The dashed horizontal line represents the “treat-none” strategy, and the light gray solid line represents the “treat-all” strategy. LASSO: Least absolute shrinkage and selection operator; z-BVMT-R: Z-score for the Brief Visuospatial Memory Test-Revised; ROC: Receiver operating characteristic; AUC: Area under the curve.

Figure 3 Predicted effects of visuospatial memory and impaired insight on conversion risk. A: Shows predicted hazard ratios for impaired insight [high-impairment insight group (IIH) vs low-impairment insight group (IIL)] across the continuous range of z-score for the Brief Visuospatial Memory Test-Revised, based on the Cox model; B: Shows the continuous absolute 6-year conversion risk difference between IIH and IIL groups as visuospatial memory varies; C: Shows absolute 6-year risk differences between insight groups (IIL vs IIH) at representative visuospatial memory levels (-1 SD, +1 SD and mean). IIL: The 12^th general psychopathology symptom item of the Positive and Negative Syndrome Scale, G12, scored as less than 3; IIH: G12 scored as 3 or higher. IIL: Low-impairment insight group; IIH: High-impairment insight group; z-BVMT-R: Z-score for the Brief Visuospatial Memory Test-Revised.