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

Table 1 Comparison of demographic, neurocognitive, and positive symptoms among groups, mean ± SD

		IIL (n = 151)	IIH (n = 161)	χ2/t value	P value	Cramér’s V/Cohen’s d/Cohen’s f2
Sex	Male	72	70	0.399	0.528	0.042
	Female	79	91
Age		18.76 ± 4.88	19.19 ± 5.41	0.727	0.468	0.082
Education (years)		10.44 ± 2.44	10.58 ± 3.00	0.451	0.652	0.051
TMT		31.58 ± 10.74	34.98 ± 14.40	0.760	0.448	0.017
BACS-SC		59.06 ± 9.82	55.60 ± 10.92	-2.600	0.010	0.030
HVLT-R		24.31 ± 4.91	22.78 ± 5.31	-2.196	0.029	0.023
WMS-III-SS		15.95 ± 2.96	15.21 ± 3.07	-2.378	0.018	0.014
NAB-Mazes		17.09 ± 6.35	15.88 ± 6.44	-1.519	0.130	0.007
BVMT-R		27.56 ± 6.43	25.35 ± 6.00	-3.090	0.002	0.032
Fluency		19.54 ± 5.16	19.33 ± 5.32	-0.433	0.665	0.001
CPT-IP		2.54 ± 0.78	2.38 ± 0.79	-2.023	0.044	0.013
P-Total		8.27 ± 2.64	11.47 ± 3.02	9.605	< 0.001	0.325
Medication	Combination	26	13	12.254	0.007	0.198
	Antipsychotics	92	122
	Antidepressants	12	4
	No medication	21	22

The effect sizes are reported as Cramér’s V (for χ² tests), Cohen’s d (for t-tests), and Cohen’s f² (for robust regression). Low-impairment insight group: The 12^th general psychopathology symptom item of the Positive and Negative Syndrome Scale, G12, scored as less than 3; High-impairment insight group: G12 scored as 3 or higher. IIL: Low-impairment insight group; IIH: High-impairment insight group; TMT: Trail Making Test; BACS-SC: Brief Assessment of Cognition in Schizophrenia: Symbol Coding; HVLT-R: Hopkins Verbal Learning Test-Revised; WMS-III-SS: Wechsler Memory Scale-3^rd Ed: Spatial Span; NAB-Mazes: Neuropsychological Assessment Battery; BVMT-R: Brief Visuospatial Memory Test-Revised; CPT-IP: Continuous Performance Test-Identical Pairs; P-Total: Total score of positive symptoms on the Scale of Psychotic-Risk Syndromes.

Table 2 Role of neurocognition in differentiating levels of impaired insight

Model	β	SE	Wald	P value	OR	95%CI for OR
						Lower	Upper
Model 1 (enter)
Sex	-0.165	0.229	0.520	0.471	0.848	0.540	1.328
Age	0.015	0.030	0.253	0.615	1.015	0.958	1.078
Education	0.002	0.056	0.001	0.974	1.002	0.897	1.118
Model 2 (backward: LR)
Sex	-0.261	0.237	1.209	0.272	0.770	0.482	1.225
Age	-0.02	0.032	0.408	0.523	0.980	0.920	1.044
Education	0.054	0.059	0.846	0.358	1.056	0.941	1.186
z-BACS-SC	-0.265	0.132	4.004	0.045	0.767	0.589	0.991
z-BVMT-R	-0.285	0.136	4.407	0.036	0.752	0.574	0.979
Model 3 (backward: LR)
Sex	-0.121	0.274	0.195	0.659	0.886	0.517	1.517
Age	0.008	0.037	0.048	0.826	1.008	0.938	1.085
Education	0.041	0.067	0.377	0.539	1.042	0.914	1.189
z-BACS-SC	-0.180	0.153	1.397	0.237	0.835	0.616	1.124
z-BVMT-R	-0.364	0.155	5.504	0.019	0.695	0.510	0.939
P-Total	0.407	0.054	57.686	< 0.001	1.503	1.360	1.679

OR: Odds ratio; CI: Confidence interval; LR: Likelihood ratio; 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; P-Total: Total score of positive symptoms on the Scale of Psychotic-Risk Syndromes.

Table 3 The role of impaired insight and z-score for the Brief Visuospatial Memory Test-Revised in predicting conversion status among clinical high-risk individuals with attenuated positive symptoms

Model	β	SE	Wald	P value	HR	95%CI for HR
						Lower	Upper
Model 1 (enter)
Sex	0.556	0.201	7.629	0.006	1.745	1.175	2.589
Age	0.049	0.022	5.04	0.025	1.051	1.006	1.097
Education	-0.085	0.045	3.549	0.060	0.918	0.841	1.003
Model 2 (backward: LR)
Sex	0.631	0.202	9.791	0.002	1.88	1.266	2.791
Age	0.017	0.023	0.516	0.473	1.017	0.972	1.064
Education	-0.064	0.046	1.938	0.164	0.938	0.857	1.027
Impaired insight	0.456	0.207	4.858	0.027	1.577	1.052	2.366
z-BVMT-R	-0.452	0.105	18.438	< 0.001	0.636	0.518	0.782

HR: Hazard ratio; CI: Confidence interval; LR: Likelihood ratio; z-BVMT-R: Z-score for the Brief Visuospatial Memory Test-Revised.