Negative symptoms and self-reflection increase alienation in individuals at clinical high-risk for psychosis.

OBJECTIVE

To assess stigma and cognitive insight, and their interplay with symptoms in individuals at clinical high risk for psychosis (CHR).

METHODS

Individuals were screened for CHR status and then assessed with the Internalized Stigma of Mental Illness, Beck Cognitive Insight Scale and Perceived Devaluation and Discrimination Scale. Spearman's rho correlations were used to analyze data on scales and symptoms. Mediation analysis models were performed.

RESULTS

56 CHR and 18 controls were drawn from the general population. CHRs showed lower perceived discrimination and greater cognitive insight than controls. CHR individuals showed a positive correlation between alienation and both positive and negative symptoms, a positive correlation between cognitive insight and both negative and general symptoms. Strong correlations between cognitive insight and internalized stigma were observed. In the mediation analysis, alienation had an influence of negative symptoms and self-reflection. Also, alienation had the influence of negative symptoms via self-reflection.

CONCLUSIONS

Our data highlights the importance of identifying pronounced negative symptoms in CHR individuals as a reinforcer of internalized stigma. In this sense, addressing stigma in CHR should carefully consider negative symptoms, given their influence on alienation both directly and indirectly via self-reflection.