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Construct validity and factor structure of Tamil version of Beck Cognitive Insight Scale to assess cognitive insight of patients with schizophrenia

  • Thanka Jemi Merlin (a1), Anto P. Rajkumar (a1) (a2), S. Reema (a1), Sherab Tsheringla (a1), S. Velvizhi (a1) and K. S. Jacob (a1)...


Objective: The ability to reflect rationally on one's own anomalous experiences and to recognise that their conclusions are incorrect is called as cognitive insight. It influences the delusion proneness of patients with schizophrenia. Structured instruments to assess cognitive insight have not been validated in any Indian languages so far. Hence, we aimed to evaluate the validity and factor structure of Tamil version of Beck Cognitive Insight Scale (BCIS-T).

Methods: One hundred and fifty consecutive patients with schizophrenia completed BCIS-T. We assessed their clinical insight with the reference standard, Schedule for Assessment of Insight-Expanded version (SAI-E). An independent psychiatrist evaluated their psychopathology using Brief Psychiatric Rating Scale (BPRS).

Results: BCIS-T was internally consistent with Cronbach's α 0.67 and Guttman's split-half coefficient as 0.63. BCIS-T composite index documented convergent validity with SAI-E total score (ρ = 0.38; p < 0.001) and discriminant validity with BPRS (ρ = −0.02; p = 0.85). Factor analysis showed a four-factor structure, namely self-certainty, self-reflectiveness, openness to external feedback and infallibility of self-reflection. BCIS-T composite index had significant linear relationship with clinical insight and treatment compliance on multivariate analyses (p < 0.01).

Conclusion: Our findings support the validity of BCIS-T to assess cognitive insight of the patients with schizophrenia. We suggest addressing the intricacies of cognitive insight beyond the traditional two-dimensional models in cross-cultural settings.


Corresponding author

Anto P. Rajkumar, Center for Psychiatric Research, Aarhus University Hospital, Risskov 8240, Denmark. Tel: 45 7789 3548; Fax: 45 7789 3549; E-mail:


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1.Lewis, A.The psychopathology of insight. Br J Med Psychol 1934;14:332348.
2.Jablensky, A, Sartorius, N, Ernberg, G, Anker, N, Koften, A, Cooper, JE.Schizophrenia: manifestations, incidence and course in different cultures. World Health Organization ten country study. Psychol Med 1992;20:197.
3.David, AS. In: Amador, XF, David, AS, eds. The clinical importance of insight. Insight and psychosis. New York: Oxford University Press, 1998: 332351.
4.David, AS.Insight and psychosis. Br J Psychiatry 1990;156: 798808.
5.Saravanan, B, Jacob, KS, Prince, M, Bhugra, D, David, AS.Culture and insight revisited. Br J Psychiatry 2004;184: 107109.
6.Saravanan, B, David, AS, Bhugra, D, Prince, M, Jacob, KS.Insight in people with psychosis: the influence of culture. Int Rev Psychiatry 2005;17:8387.
7.Saravanan, B, Jacob, KS, Johnson, S, Prince, M, Bhugra, D, David, AS.Assessing insight in schizophrenia: East meets West. Br J Psychiatry 2007;190:243247.
8.Beck, AT, Baruch, E, Balter, JM, Steer, RA, Warman, DM.A new instrument for measuring insight: the Beck Cognitive Insight Scale. Schizophr Res 2004;68:319329.
9.Pedrelli, P, McQuaid, JR, Granholm, E et al. Measuring cognitive insight in middle-aged and older patients with psychotic disorders. Schizophr Res 2004;71:297305.
10.Engh, J, Friis, S, Birkenaes, A et al. Measuring cognitive insight in schizophrenia and bipolar disorder: a comparative study. BMC Psychiatry 2007;7:71.
11.Engh, JA, Friis, S, Birkenaes, AB et al. Delusions are associated with poor cognitive insight in schizophrenia. Schizophr Bull 2010;36:830835.
12.Buchy, L, Czechowska, Y, Chochol, C et al. Toward a model of cognitive insight in first-episode psychosis: verbal memory and hippocampal structure. Schizophr Bull 2010;36:10401049.
13.Lepage, M, Buchy, L, Bodnar, M, Bertrand, MC, Joober, R, Malla, A.Cognitive insight and verbal memory in first episode of psychosis. Eur Psychiatry 2008;2: 368374.
14.Kao, YC, Liu, YP.The Beck Cognitive Insight Scale (BCIS): translation and validation of the Taiwanese version. BMC Psychiatry 2010;10:27.
15.Uchida, T, Matsumoto, K, Kikuchi, A et al. Psychometric properties of the Japanese version of the Beck Cognitive Insight Scale: relation of cognitive insight to clinical insight. Psychiatry Clin Neurosci 2009;63:291297.
16.Favrod, J, Zimmermann, G, Raffard, S, Pomini, V, Khazaal, Y.The Beck Cognitive Insight Scale in outpatients with psychotic disorders: further evidence from a French-speaking sample. Can J Psychiatry 2008;53: 783787.
17.Schoonjans, F, Zalata, A, Depuydt, CE, Comhaire, FH.MedCalc: a new computer program for medical statistics. Comput Methods Programs Biomed 1995;48:257262.
18World Health Organization. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: WHO, 1992.
19.Sanz, M, Constable, G, Lopez-Ibor, I, Kemp, R, David, AS.A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychol Med 1998;28:437446.
20.Kemp, R, David, AS. In: Blackwell, B, ed. Insight and compliance. Treatment compliance and the therapeutic alliance. Newark: Gordon and Breach Publishing Group, 1997: 6184.
21.Overall, JE, Gorham, DR.The brief psychiatric rating scale. Psychol Rep 1962;10:799812.
22.Warman, DM, Martin, JM.Cognitive insight and delusion proneness: an investigation using the Beck Cognitive Insight Scale. Schizophr Res 2006;84:297304.
23.Thara, R, Rajkumar, S.Gender differences in schizophrenia. Results of a follow-up study from India. Schizophr Res 1992;7:6570.


Construct validity and factor structure of Tamil version of Beck Cognitive Insight Scale to assess cognitive insight of patients with schizophrenia

  • Thanka Jemi Merlin (a1), Anto P. Rajkumar (a1) (a2), S. Reema (a1), Sherab Tsheringla (a1), S. Velvizhi (a1) and K. S. Jacob (a1)...


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