S51. SEX DIFFERENCES IN COGNITIVE INSIGHT AMONG INDIVIDUALS WITH FIRST-AND-MULTIPLE EPISODE PSYCHOSIS

Abstract

Background: Cognitive insight represents the ability and willingness to reflect on and criticize the validity of one's beliefs and thoughts, to recognize when beliefs may be inaccurate, and to then rely on external feedback to make correct assessments. Impairments in cognitive insight are prevalent in schizophrenia and related psychoses, however it remains unclear whether sex differences exist in this construct. Sex differences in schizophrenia have been consistently reported, and of note is in the area of verbal learning, where females outperform males. Further, prior work has suggested that verbal memory deficits may contribute to lower levels of cognitive insight in individuals with psychosis. It is important to understand whether males and females do indeed differ with respect to their levels of cognitive insight, and if so, whether sex differences span both the first-and-multiple episode stages of the illness. Method(s): Four hundred and twenty-two English or French-speaking individuals with a schizophrenia spectrum disorder (219 first-episode psychosis; FEP and 203 multiple-episode psychosis; MEP patients) completed a battery of clinical and neuropsychological tests, including the Beck Cognitive Insight Scale (BCIS). The BCIS has two subscales (selfreflectiveness, self-certainty) and a composite index (self-reflectiveness-self-certainty). Independent samples t-tests were conducted on the combined FEP and MEP sample to test for overall mean differences. Analyses of variance (ANOVAs) were run on the two BCIS subscales and the composite index, using sex (female, male) and illness stage (FEP, MEP) as factors. Post hoc analyses were conducted to explore significant interactions. Result(s): Independent samples t-tests revealed no significant differences between males and females in the combined FEP and MEP sample on BCIS self-certainty scores (t(419) = 1.16, P = .245), self-reflectiveness scores (t(419) = -.66, p= .513) or on the composite index (t(419) = -.95, p = .344). A 2 x 2 (sex X illness stage) ANOVA tested the interaction of sex and illness stage on the two BCIS subscales and the composite index. A significant interaction that survived Bonferroni correction for multiple comparisons emerged only for the self-certainty subscale (F(1, 417) = 7.60, p = .006). Post-hoc simple effects tests revealed that selfcertainty scores were significantly different for males and females in FEP (p = .021), where female FEP participants had lower self-certainty than males, but not during MEP (p = .675). No significant interaction of sex and illness stage emerged for self-reflectiveness (F(1, 417) = .14, p = .933), nor was the model significant for the composite index (F(1, 417) = 1.28, p = .280). Discussion(s): Our results suggest an important sex difference between males and females in their prepotency for self-certainty across illness stages; females during a FEP are significantly less self-certain than males, but this sex difference is not present during the MEP stage of the illness. Self-certainty does not differ for males across illness stage, where females become more self-certain with illness progression, resulting in no differences between males and females following multiple episodes of psychosis. This finding has relevant clinical implications; clinicians targeting self-certainty in females during earlier stages of illness should consider early interventions to address the rigidity commonly associated with more severe forms of the illness.