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Domínguez M, Sánchez-Balcells S, Vila-Badia R, Bergadà-Sánchez E, Vilaplana M, Ochoa S, Huerta-Ramos ME, Del Cacho N, Usall J, Peláez T, Coromina M. Perspective of patients with first-episode psychosis, their relatives, and mental health professionals on the design and usability of an app in clinical practice. Early Interv Psychiatry 2024; 18:355-365. [PMID: 37743354 DOI: 10.1111/eip.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/18/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
AIM Therapeutic non-compliance remains the main difficulty for people with psychotic disorders, standing around 50% in people with schizophrenia. Lack of treatment adherence, either partial or total, to medication has economic and clinical consequences. E-health technologies may be a promising therapeutic tool to improve adherence, with the subsequent reduction in clinical and economic burden. Our aims were to know the preferences on how technologies in mental health treatment should be for use in clinical practice, and to learn about the opinion and preferences on the use of technologies in mental health treatment from the perspectives of patients with FEP, their relatives, and mental health professionals. METHODS Forty-one patients with a diagnosis of first-episode psychosis (FEP), 18 relatives and 49 mental health professionals were included in the study. They completed an online survey related to the use, availability and user-skill of online platforms and apps created by a group of experts in psychosis and in the use of technologies. Data were summarized in frequencies, percentages, and means, and Chi-square tests were used to calculate differences between-groups. RESULTS An app directed to people with psychosis would be well received by users if it contains psychoeducational material, offers reminders for scheduled visits and treatment and allows online consultations. CONCLUSIONS Co-creating an app with users, their families and mental health professionals allows incorporating their preferences to increase its use, improve outpatient care and creating an app that is viable in clinical practice.
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Affiliation(s)
- Marta Domínguez
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Sara Sánchez-Balcells
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
| | - Regina Vila-Badia
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Esther Bergadà-Sánchez
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
| | - Miriam Vilaplana
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Maria Elena Huerta-Ramos
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Nuria Del Cacho
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Trini Peláez
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Marta Coromina
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
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Hardman JR, Gleeson JFM, González‐Blanch C, Alvarez‐Jimenez M, Fraser MI, Yap K. The role of insight, social rank, mindfulness and self-compassion in depression following first episode psychosis. Clin Psychol Psychother 2023; 30:1393-1406. [PMID: 37438084 PMCID: PMC10946724 DOI: 10.1002/cpp.2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/04/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
Gaining awareness of psychosis (i.e., insight) is linked to depression, particularly in the post-acute phase of psychosis. Informed by social rank theory, we examined whether the insight-depression relationship is explained by reduced social rank related to psychosis and whether self-compassion (including uncompassionate self-responding [UCS] and compassionate self-responding [CSR]) and mindfulness buffered the relationship between social rank and depression in individuals with first episode psychosis during the post-acute phase. Participants were 145 young people (Mage = 20.81; female = 66) with first episode psychosis approaching discharge from an early psychosis intervention centre. Questionnaires and interviews assessed insight, depressive symptoms, perceived social rank, self-compassion, mindfulness and illness severity. Results showed that insight was not significantly associated to depression and thus no mediation analysis was conducted. However, lower perceived social rank was related to higher depression, and this relationship was moderated by self-compassion and, more specifically, UCS. Mindfulness was related to depression but had no moderating effect on social rank and depression. Results supported previous findings that depressive symptoms are common during the post-acute phase. The role of insight in depression for this sample is unclear and may be less important during the post-acute phase than previously considered. Supporting social rank theory, the results suggest that low perceived social rank contributes to depression, and reducing UCS may ameliorate this effect. UCS, social rank and possibly mindfulness may be valuable intervention targets for depression intervention and prevention efforts in the recovery of psychosis.
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Affiliation(s)
- Jamie R. Hardman
- School of Behavioural and Health SciencesAustralian Catholic UniversityStrathfieldNew South WalesAustralia
| | - John F. M. Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health SciencesAustralian Catholic UniversityFitzroyVictoriaAustralia
| | - César González‐Blanch
- Centre for Youth Mental HealthUniversity of MelbourneMelbourneVictoriaAustralia
- Mental Health CentreUniversity Hospital “Marqués de Valdecilla”SantanderSpain
| | | | - Madeleine I. Fraser
- School of Behavioural and Health SciencesAustralian Catholic UniversityStrathfieldNew South WalesAustralia
- Healthy Brain and Mind Research Centre, School of Behavioural and Health SciencesAustralian Catholic UniversityFitzroyVictoriaAustralia
| | - Keong Yap
- School of Behavioural and Health SciencesAustralian Catholic UniversityStrathfieldNew South WalesAustralia
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Mariño CV, Estévez MLB, Cañizares IC, García EB. Evaluating the inter-rater reliability of the Scale to Assess Unawareness of Mental Disorder using the DOMENIC method. Schizophr Res 2023; 260:37-38. [PMID: 37549496 DOI: 10.1016/j.schres.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 05/15/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Carmen Vidal Mariño
- Department of Psychiatry, University Hospital Rey Juan Carlos, Móstoles, Spain; Department of Psychiatry, University Hospital Complex Montecelo, Pontevedra, Spain.
| | | | | | - Enrique Baca García
- Department of Psychiatry, University Hospital Rey Juan Carlos, Móstoles, Spain; Psychiatry Department, Autonoma University, Madrid, Spain; Department of Psychiatry, IIS-Jimenez Diaz Foundation, Madrid, Spain; Department of Psychiatry, General Hospital of Villalba, Madrid, Spain; Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain; CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain; Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
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4
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Cognitive insight in individuals at ultra-high risk for psychosis compared to patients with first-episode psychosis and non-psychotic help-seeking youths. Asian J Psychiatr 2022; 73:103107. [PMID: 35461034 DOI: 10.1016/j.ajp.2022.103107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Defective insight is a hallmark of schizophrenia. Less is known about insight in emerging psychosis. In this study a widely used measure of cognitive insight, the Beck Cognitive Insight Scale (BCIS), has been applied to a sample including patients with first-episode psychosis (FEP), at ultra-high risk (UHR) for psychosis, and help-seeking youths without psychotic symptoms. METHODS The Comprehensive Assessment of At-Risk Mental State (CAARMS) interview was used to classify patients. Enrolled patients were assessed with the General Health Questionnaire-12 (GHQ-12), the Prodromal Questionnaire-16 (PQ-16), the Social and Occupational Functioning Assessment Scale (SOFAS), and the BCIS. RESULTS The sample included 212 participants (58%) with non-psychotic mental distress, 131 participants (36%) were UHR, and 22 (6%) were with FEP. Males and females were in equal proportion, mean age was 19.2 ± 2.6 years old (range: 15-25 years). Reliability (Cronbach's alpha) was good for clinical scales (>0.7) and acceptable (around 0.6) for the two BCIS subscales. The self-certainty subscale of the BCIS was more reproducible in factor analysis than the self-reflectiveness scale. Youths devoid of psychotic symptoms scored lower than UHR and FEP participants on the GHQ-12 and the PQ-16 and had better psychosocial functioning as measured by the SOFAS. Levels of cognitive insight did not differ between groups. CONCLUSION People in the early stages of psychosis may be still accessible to self-reflectiveness and more hesitant about the certainty of their beliefs than patients at more advanced stages of the illness, as those with fully displayed schizophrenia.
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Kam TK, Lui TT, Lau FC, Chan KW, Lee HM, Hui LM, Suen YN, Lui SY, Chen E, Chang WC. Clinical and psychological correlates of insight dimensions in patients with early psychosis. Early Interv Psychiatry 2022; 16:527-532. [PMID: 34309188 DOI: 10.1111/eip.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/23/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate correlates of insight dimensions in Chinese adult patients with early psychosis. METHODS Insight dimensions including awareness of mental disorder (AMD), illness consequences (AIC) and medication effect (AME) were measured. A wide array of variables encompassing demographics, premorbid adjustment, onset profiles, symptomatology, treatment characteristics and psychological factors were comprehensively assessed. RESULTS Of 130 participants, 53.1%, 47.7% and 56.2% were categorized with good AMD, AIC and AME, respectively. Good AMD was associated with female gender, fewer positive and disorganization symptoms, more severe depression and greater self-stigma. Good AIC was related to female gender, more severe depression and greater self-stigma. Younger age of onset, fewer positive symptoms and greater service satisfaction associated with good AME. CONCLUSIONS Poor insight is prevalent in early psychosis. Differential relationships of insight dimensions with other illness variables underscore the importance of multidimensional approach in insight evaluation, and suggest potential treatment target for insight enhancement.
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Affiliation(s)
- Tze Kwan Kam
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Pokfulam, Hong Kong
| | - Tsz Ting Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Fu Chun Lau
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kit Wa Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ho Ming Lee
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lai Ming Hui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sai Yu Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Eric Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
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Hodgins S, Moulin V. Le nouveau défi des services destinés aux personnes présentant un premier épisode de psychose : intégrer des interventions pour prévenir et réduire les agressions physiques. SANTÉ MENTALE AU QUÉBEC 2022. [DOI: 10.7202/1094146ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Elowe J, Ramain J, Solida A, Conus P, Golay P. Dynamics between insight and medication adherence in first-episode psychosis: Study of 3-year trajectories. Eur Psychiatry 2022; 65:e49. [PMID: 35968709 PMCID: PMC9486827 DOI: 10.1192/j.eurpsy.2022.2305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background While specialized early intervention programs represent the gold standard in terms of optimal management of first-episode psychosis (FEP), poor medication adherence remains a predominant unmet need in the treatment of psychosis. In this regard, an interaction between insight and adherence in FEP patients has been hypothesized but has been challenged by multiple pitfalls. Methods Latent profile analysis and trajectory modeling techniques were used to evaluate insight and adherence of 331 FEP patients engaged at the beginning, middle, and end of a 3-year specialized early psychosis program. A Bayesian model comparison approach was used to compare scores of clinical, functional, and socioeconomic outcomes at the end point of the study. Results Nearly one-third of the patients maintain a high level of insight and adherence during the entire program. At the end of the 3-year follow-up, more than three-quarters of patients are considered adherent to their medication. Patients with low levels of insight and adherence at the beginning of the program improve first in terms of adherence and then of insight. Furthermore, patients with high levels of insight and adherence are most likely to reach functional recovery and to experience an increase in environmental quality of life. Conclusions Latent FEP subpopulations can be identified based on insight and adherence. Medication adherence was the first variable to improve, but a gain in insight possibly plays a role in the reinforcement of adherence.
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López-Díaz Á, Ayesa-Arriola R, Ortíz-García de la Foz V, Suárez-Pinilla P, Ramírez-Bonilla ML, Vázquez-Bourgon J, Ruiz-Veguilla M, Crespo-Facorro B. Predictors of diagnostic stability in brief psychotic disorders: Findings from a 3-year longitudinal study. Acta Psychiatr Scand 2021; 144:578-588. [PMID: 34431080 DOI: 10.1111/acps.13364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Brief psychotic disorder (BPD) is a relatively uncommon and underexplored psychotic condition. Even though BPD has been related to a more favorable outcome than other schizophrenia spectrum disorders (SSD), current knowledge of its predictive factors remains scant. This study aimed to examine its prevalence and find early predictors of BPD diagnostic stability. METHODS SSD diagnosis following Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria was explored in a large epidemiological cohort (n = 569) of non-affective first-episode psychosis (FEP) patients enrolled in a three-year longitudinal intervention program (PAFIP). Premorbid, sociodemographic, and clinical information was collected to characterize BPD patients and determine factors predictive of diagnostic stability. Multivariate analysis included predictors selected from clinical knowledge and also those that had achieved marginal significance (p ≤ 0.1) in univariate analysis. RESULTS A total of 59 patients enrolled in the PAFIP program (10.4% of the whole cohort) met DSM-IV criteria for BPD, of whom 40 completed the three-year follow-up. The temporal stability of BPD in our sample was as high as 40% (n = 16). Transition from BPD to schizophrenia occurred in 37% (n = 15) of patients. Fewer hallucinations at baseline and better insight independently significantly predicted BPD diagnostic stability over time. CONCLUSION Our findings confirm that BPD is a clinical condition with moderate-to-low temporal stability and demonstrate that approximately two-thirds of FEP individuals experiencing BPD will develop a long-lasting psychotic disorder during follow-up, mainly schizophrenia.
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Affiliation(s)
- Álvaro López-Díaz
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain
| | - Rosa Ayesa-Arriola
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Víctor Ortíz-García de la Foz
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Paula Suárez-Pinilla
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Luz Ramírez-Bonilla
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Javier Vázquez-Bourgon
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel Ruiz-Veguilla
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,UGC Salud Mental, Hospital Universitario Virgen del Rocío, Seville, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain
| | - Benedicto Crespo-Facorro
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,UGC Salud Mental, Hospital Universitario Virgen del Rocío, Seville, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain
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Brasso C, Cisotto M, Ghirardini C, Pennazio F, Villari V, Rocca P. Accuracy of self-reported adherence and therapeutic drug monitoring in a psychiatric emergency ward. Psychiatry Res 2021; 305:114214. [PMID: 34587569 DOI: 10.1016/j.psychres.2021.114214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
The aims of the study were: (1) the evaluation of the agreement between therapeutic drug monitoring (TDM) and a self-assessment of adherence to psychopharmacological treatments; (2) the identification of predictors of TDM results.Adherence in patients admitted into a psychiatric emergency service (PES) for a relapse of a schizophrenia spectrum disorder (SSD) or a bipolar disorder (BD; DSM-5) was assessed both directly with TDM and indirectly with a self-reported measure (Medication Adherence Report Scale -MARS- 10 items). The agreement between TDM and MARS was evaluated. Fifty-seven patients with SSD and 76 people with BD participated in the study. TDM was in range in about 50% of the global sample. No evidence of an association between MARS total scores and TDM results was found. Sensitivity, specificity, positive and negative predictive values of almost all MARS total scores were near to 50%. Smoking was strongly associated with a reduction of TDM results within the reference range. In the BD group, female sex was a predictor of TDM in range. In this clinical setting, self-assessment of adherence is neither reliable nor predictive. Furthermore, smoking is a strong predictor of poor adherence to psychopharmacological therapy.
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Affiliation(s)
- Claudio Brasso
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, Turin 10126, Italy.
| | - Marta Cisotto
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, Turin 10126, Italy; Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - Camilla Ghirardini
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - Filippo Pennazio
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - Vincenzo Villari
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy.
| | - Paola Rocca
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, Turin 10126, Italy.
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Raucher-Chéné D, Bodnar M, Lavigne KM, Malla A, Joober R, Lepage M. Dynamic Interplay Between Insight and Persistent Negative Symptoms in First Episode of Psychosis: A Longitudinal Study. Schizophr Bull 2021; 48:211-219. [PMID: 34230974 PMCID: PMC8781342 DOI: 10.1093/schbul/sbab079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Persistent negative symptoms (PNS) are an important factor of first episode of psychosis (FEP) that present early on in the course of illness and have a major impact on long-term functional outcome. Lack of clinical insight is consistently associated with negative symptoms during the course of schizophrenia, yet only a few studies have explored its evolution in FEP. We sought to explore clinical insight change over a 24-month time period in relation to PNS in a large sample of FEP patients. Clinical insight was assessed in 515 FEP patients using the Scale to assess Unawareness of Mental Disorder. Data on awareness of illness, belief in response to medication, and belief in need for medication were analyzed. Patients were divided into 3 groups based on the presence of negative symptoms: idiopathic (PNS; n = 135), secondary (sPNS; n = 98), or absence (non-PNS; n = 282). Secondary PNS were those with PNS but also had clinically relevant levels of positive, depressive, or extrapyramidal symptoms. Our results revealed that insight improved during the first 2 months for all groups. Patients with PNS and sPNS displayed poorer insight across the 24-month period compared to the non-PNS group, but these 2 groups did not significantly differ. This large longitudinal study supported the strong relationship known to exist between poor insight and negative symptoms early in the course of the disorder and probes into potential factors that transcend the distinction between idiopathic and secondary negative symptoms.
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Affiliation(s)
- Delphine Raucher-Chéné
- Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada,Cognition, Health, and Society Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France,Academic Department of Psychiatry, University Hospital of Reims, EPSM Marne, Reims, France
| | - Michael Bodnar
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Katie M Lavigne
- Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada,McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada
| | - Ashok Malla
- Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Ridha Joober
- Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada,To whom correspondence should be addressed; Douglas Mental Health University Institute, Frank B Common Pavilion, F1143, 6875 LaSalle Blvd., Verdun, Quebec H4H 1R3, Canada; tel: (514) 761-6131 ext. 4393, fax: (514) 888-4064, e-mail:
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11
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Dondé C, Laprévote V, Lavallé L, Haesebaert F, Fakra E, Brunelin J. Cognitive insight in individuals with an at-risk mental state for psychosis: A meta-analysis. Early Interv Psychiatry 2021; 15:449-456. [PMID: 32452629 DOI: 10.1111/eip.12993] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/09/2020] [Accepted: 04/28/2020] [Indexed: 01/01/2023]
Abstract
AIM To compare cognitive insight abilities measured with the Beck Cognitive Insight Scale (BCIS) between individuals with an at-risk mental state (ARMS) and healthy controls. METHOD Review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A search for articles investigating cognitive insight in ARMS in the MEDLINE and ScienceDirect databases revealed five studies including 303 ARMS and 376 controls. Regarding BCIS subscales, ARMS individuals displayed significant higher scores for self-certainty than controls with a small-to-moderate effect size (ESg = 0.45 [0.23;0.67], P < .005), whereas no significant difference was observed for self-reflectiveness (ESg = -0.56 [-0.18;1.29], P = .14). No significant differences were observed between ARMS and controls for overall cognitive insight abilities as indexed by the BCIS composite score (ESg = -0.24 [-0.43;0.91], P = .45). CONCLUSIONS Self-certainty abnormalities seem to predate the expression of full-blown psychotic episode and to be higher in ARMS than in healthy controls. By contrast, ARMS did not display abnormal self-reflectiveness and overall cognitive insight abilities.
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Affiliation(s)
- Clément Dondé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Vincent Laprévote
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France.,Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Layla Lavallé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Frédéric Haesebaert
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Eric Fakra
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jerome Brunelin
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
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12
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Hasson-Ohayon I, Scholte-Stalenhoef AN, Schirmbeck F, de Haan L, Cahn W, Pijnenborg GHM, Boyette LL. Insight, personality, and symptoms among individuals with psychosis: Cross-sectional and longitudinal relationships. Schizophr Res 2020; 222:243-250. [PMID: 32527677 DOI: 10.1016/j.schres.2020.05.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 03/19/2020] [Accepted: 05/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Reports on the relationship between clinical insight and psychotic symptoms have shown inconsistent results, and the association between clinical insight and personality has rarely been addressed. The aim of this study was to examine whether personality is correlated cross-sectionally with insight level, and longitudinally with change in insight, beyond symptoms. METHODS Participants were a sub-sample of the Dutch Genetic Risk and Outcome of Psychosis (GROUP) project. Two hundred and eleven participants diagnosed with non-affective psychotic disorders took part in the cross-sectional part of the study, of whom 136 took part in the three-year follow-up assessment. They were administered with self-report Birchwood insight scale and NEO-Five Factor Inventory, and clinicians assessed them according to PANSS and CDS symptoms scales. RESULTS Cross-sectional analysis showed baseline self-report insight was positively related to neuroticism and agreeableness and negatively related to extraversion. Longitudinal analysis showed change in level of self-reported insight was predicted by baseline-insight and change in symptoms of disorganization. Personality factors did not predict insight change (as measured either by self-report or by clinician assessment). DISCUSSION The cross-sectional findings showed self-report insight (as opposed to clinician-rated) is associated with personality traits, suggesting negative affect is related to higher level of insight and that having insight may be influenced by the wish to comply with views of professionals, or a tendency to cover up problems. The longitudinal findings imply that not personality but change in severity of symptoms of disorganization, and possibly other variables, predicts change in insight.
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Affiliation(s)
| | | | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Arkin, Institute for Mental Health, Amsterdam, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Arkin, Institute for Mental Health, Amsterdam, the Netherlands
| | - Wiepke Cahn
- University Medical Center Utrecht, Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht University, Utrecht, the Netherlands
| | | | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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13
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Nani JV, Dal Mas C, Yonamine CM, Ota VK, Noto C, Belangero SI, Mari JJ, Bressan R, Cordeiro Q, Gadelha A, Hayashi MAF. A study in first-episode psychosis patients: does angiotensin I-converting enzyme (ACE) activity associated with genotype predict symptoms severity reductions after treatment with the atypical antipsychotic risperidone? Int J Neuropsychopharmacol 2020; 23:pyaa050. [PMID: 32696960 PMCID: PMC7745254 DOI: 10.1093/ijnp/pyaa050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Our previous studies showed increased angiotensin I-converting enzyme (ACE) activity in chronic schizophrenia (SCZ) patients compared to healthy control (HC) volunteers, and the relevance of combining ACE genotype and activity for predicting SCZ was suggested. METHODS ACE activity was measured in plasma of ACE insertion/deletion (I/D) genotyped HC volunteers (N = 53) and antipsychotic-naïve first-episode psychosis (FEP) patients (N = 45), assessed at baseline (FEB-B) and also after 2-months (FEP-2M) of treatment with the atypical antipsychotic risperidone. RESULTS ACE activity measurements showed significant differences among HC, FEP-B and FEP-2M groups (F = 5.356, df = 2, p = 0.005), as well as between HC and FEP-2M (post-hoc Tukey's multiple comparisons test, p = 0.004). No correlation was observed for ACE activity increases and symptom severity reductions in FEP as assessed by total PANSS (r = -0.131, p = 0.434). FEP subgrouped by ACE I/D genotype showed significant ACE activity increases, mainly in the DD genotype subgroup. No correlation between ACE activity and age was observed in FEP or HC groups separately (r = 0.210, p = 0.392), but ACE activity levels differences observed between these groups were influenced by age. CONCLUSIONS The importance of measuring the ACE activity in blood plasma, associated to ACE I/D genotyping to support the follow-up of FEP patients did not show correlation with general symptoms amelioration in the present study. However, new insights into the influence of age and I/D genotype for ACE activity changes in FEP individuals upon treatment was demonstrated.
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Affiliation(s)
- João V Nani
- Department of Pharmacology, Universidade Federal de São Paulo (UNIFESP), Brazil
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil
- National Institute for Translational Medicine (INCT-TM, CNPq), Brazil
| | - Caroline Dal Mas
- Department of Pharmacology, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Camila M Yonamine
- Department of Pharmacology, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Vanessa K Ota
- Department of Genetics, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Cristiano Noto
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil
- First-episode Psychosis Program, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Sintia I Belangero
- Department of Genetics, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Jair J Mari
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Rodrigo Bressan
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Quirino Cordeiro
- First-episode Psychosis Program, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Ary Gadelha
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Mirian A F Hayashi
- Department of Pharmacology, Universidade Federal de São Paulo (UNIFESP), Brazil
- National Institute for Translational Medicine (INCT-TM, CNPq), Brazil
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14
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Elowe J, Golay P, Baumann PS, Solida-Tozzi A, Conus P. Moderating role of cannabis use between insight and depression in early psychosis. Schizophr Res 2020; 215:61-65. [PMID: 31780343 DOI: 10.1016/j.schres.2019.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/02/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND A high level of insight in first episode psychosis (FEP) is positively correlated to important prognostic factors such as medication adherence and functional outcome but is associated with increased depression level and suicidal behavior. AIMS This is the first study questioning the potential moderating role of cannabis use in the relationship between insight and depression one year after a FEP. METHOD In this prospective observational study, we enrolled 214 FEP patients who had provided informed consent and been referred to a specialized early psychosis program and followed for 36 months. A series of multivariate regression models were used. Baseline insight, medication adherence and cannabis use (level of use on a continuum) were entered as independent variables, while the PANSS (positive and negative), the MADRS and the SOFAS scores after one year were alternately selected as the dependent variable. RESULTS We found a three-way interaction term between cannabis use, insight and medication adherence on depression level one year after the entry into the program. A high level of insight was significantly associated with higher MADRS scores in patients with high cannabis use, while depression decreased in high-insight patients with low cannabis use. CONCLUSIONS Cannabis use continuation during the year following a first episode psychosis may play a significant role in the development or the maintenance of post-psychotic depression in patients who present with high level of insight and adherence to medication, stressing the need for specific therapeutic strategies in this subgroup of patients.
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Affiliation(s)
- Julien Elowe
- Department of Psychiatry, Lausanne University Hospital, Prangins Psychiatric Hospital (CHUV), Chemin Oscar Forel 3, 1196 Prangins, Switzerland.
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Philipp S Baumann
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Hôpital de Cery, 1008 Prilly, Switzerland
| | - Alessandra Solida-Tozzi
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Hôpital de Cery, 1008 Prilly, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Hôpital de Cery, 1008 Prilly, Switzerland
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15
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Moulin V, Palix J, Golay P, Dumais A, Gholamrezaee MM, Azzola A, Baumann PS, Alameda L, Conus P. Violent behaviour in early psychosis patients: Can we identify clinical risk profiles? Early Interv Psychiatry 2019; 13:517-524. [PMID: 29143486 DOI: 10.1111/eip.12512] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 01/29/2023]
Abstract
AIMS The objective of this study is to explore, within a sample of early psychosis patients (EPP), if subgroups regarding rate of violent behaviour (VB) against others can be identified on the basis of dynamic risk factors (treatment modifiable characteristics). METHODS In a sample of 265 EPP, treated at the Treatment and Early Intervention in Psychosis Program in Lausanne, we conducted a latent-class analysis on the basis of the main dynamic VB risk factors (substance use disorder [SUD], positive symptoms, insight, and impulsivity). VB were restricted to "serious violence" and were assessed through patients self-report, interview with relatives or forensic services and with a standardized instrument. RESULTS The analysis confirmed the heterogeneity of the sample regarding rate of VB. Patients could be stratified within 4 subgroups, 3 of which were at increased risk of VB. The two groups with the highest rates of VB displayed specific clinical profiles. The first one was characterized by high levels of impulsivity, hostility, positive symptoms and SUD, and the second, by low level of insight and low social functioning. These patterns suggest that significant difficulties in social interaction may contribute to the emergence of aggressive reactions against others. CONCLUSIONS Identification of EPP at increased risk of VB seems possible on the basis of dynamic risk factors. If confirmed prospectively, this could pave the way to the development of preventive strategies and specific interventions.
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Affiliation(s)
- Valerie Moulin
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Julie Palix
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Golay
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alexandre Dumais
- Institut Philippe-Pinel de Montréal and Department of Psychiatry, Faculty of Medicine, University of Montréal, Quebec, Canada
| | - Mohammad Mehdi Gholamrezaee
- Centre for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Agathe Azzola
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philipp S Baumann
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Luis Alameda
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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16
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van Donkersgoed RJM, de Jong S, Aan Het Rot M, Wunderink L, Lysaker PH, Hasson-Ohayon I, Aleman A, Pijnenborg GHM. Measuring empathy in schizophrenia: The Empathic Accuracy Task and its correlation with other empathy measures. Schizophr Res 2019; 208:153-159. [PMID: 31006615 DOI: 10.1016/j.schres.2019.03.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 02/12/2019] [Accepted: 03/26/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Empathy is an interpersonal process impaired in schizophrenia. Past studies have mainly used questionnaires or performance-based tasks with static cues to measure cognitive and affective empathy. We used the Empathic Accuracy Task (EAT) designed to capture dynamic aspects of empathy by using videoclips in which perceivers continuously judge emotionally charged stories. We compared individuals with schizophrenia with a healthy comparison group and assessed correlations among EAT and three other commonly used empathy measures. METHOD Patients (n = 92) and a healthy comparison group (n = 42) matched for age, gender and education completed the EAT, the Interpersonal Reactivity Index, Questionnaire of Cognitive and Affective Empathy and Faux Pas. Differences between groups were analyzed and correlations were calculated between empathy measurement instruments. RESULTS The groups differed in EAT performance, with the comparison group outperforming patients. A moderating effect was found for emotional expressivity of the target: while both patients and the comparison group scored low when judging targets with low expressivity, the comparison group performed better than patients with more expressive targets. Though there were also group differences on the empathy questionnaires, EAT performance did not correlate with questionnaire scores. CONCLUSIONS Individuals with schizophrenia benefit less from the emotional expressivity of other people than the comparison group, which contributes to their impaired empathic accuracy. The lack of correlation between the EAT and the questionnaires suggests a distinction between self-report empathy and actual empathy performance. To explore empathic difficulties in real life, it is important to use instruments that take the interpersonal perspective into account.
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Affiliation(s)
- R J M van Donkersgoed
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Grote Kruisstraat 1/2, 9712 TS Groningen, the Netherlands; Dijk en Duin Parnassia Groep, Department of Psychotic Disorders, Westzijde 120, 1506 GB Zaandam, the Netherlands.
| | - S de Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Grote Kruisstraat 1/2, 9712 TS Groningen, the Netherlands; University of Amsterdam, Department of Clinical Psychology, Nieuwe Achtergracht 129-B, 1018 WT Amsterdam, the Netherlands
| | - M Aan Het Rot
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Grote Kruisstraat 1/2, 9712 TS Groningen, the Netherlands
| | - L Wunderink
- GGZ Friesland, Sixmastraat 2, 8932 PA Leeuwarden, the Netherlands
| | - P H Lysaker
- Roudeboush VA Medical Center, 1481 West 10th Street, Indianapolis, IN 46202, United States of America; Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN 46202, United States of America
| | - I Hasson-Ohayon
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - A Aleman
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Grote Kruisstraat 1/2, 9712 TS Groningen, the Netherlands; BCN Neuro Imaging Center, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands
| | - G H M Pijnenborg
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Grote Kruisstraat 1/2, 9712 TS Groningen, the Netherlands; GGZ Noord-Drenthe, Department of Psychotic Disorders, Dennenweg 9, 9404 LA Assen, the Netherlands
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17
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Moulin V, Palix J, Alameda L, Gholamrezaee MM, Baumann PS, Gasser J, Elowe J, Solida A, Conus P. [Insight and Violent Behavior in a Cohort of Early Psychosis Patients]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:20-29. [PMID: 28655283 PMCID: PMC5788119 DOI: 10.1177/0706743717718173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: An important proportion of patients with first episode psychosis behave in a violent, hetero-aggressive manner. This study aims to explore the association between insight and violent behavior (VB), and insight evolution in the follow-up period. METHOD: The study was carried out with a prospective cohort of 265 patients recruited from the early treatment and intervention for psychotic disorders program, and followed for a 3-year period. Insight assessing is based on a 3-item scale and the insight item in Positive and Negative Syndrome Scale (PANSS). VBs were evaluated by case managers, information from forensic services and through a record of VBs noted during hospitalization. Univariate and multivariate logistic regression analyses, t-tests and correlations were conducted. RESULTS: The significant effect of insight as a factor associated with VBs that was found in univariate analyses disappears after controlling for the effect of positive symptoms, substance addiction diagnosis, impulsivity and treatment compliance. CONCLUSION: If patient insight in their illness develops positively during treatment, our results suggest that the risk of VBs occurring is not influenced by insight level. On the other hand, it is significantly linked to substance abuse and impulsivity, which might implicate focusing on these 2 dimensions in preventive strategies. Insight impact on VB should be further explored in more focused prospective analyses.
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Affiliation(s)
- Valerie Moulin
- 1 Unité de Recherche en Psychiatrie et Psychologie Légales, Institut de Psychiatrie légale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Julie Palix
- 1 Unité de Recherche en Psychiatrie et Psychologie Légales, Institut de Psychiatrie légale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Luis Alameda
- 2 Service de Psychiatrie Générale, Service de Psychiatrie de Liaison et Centre de Neuroscience Psychiatrique, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - M Mehdi Gholamrezaee
- 3 Centre d'épidémiologie psychiatrique et psychopathologie, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Philipp S Baumann
- 4 Service de Psychiatrie Générale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Jacques Gasser
- 5 Institut de Psychiatrie légale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Julien Elowe
- 6 Secteur psychiatrique ouest, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Prangins, Suisse
| | - Alessandra Solida
- 4 Service de Psychiatrie Générale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Philippe Conus
- 4 Service de Psychiatrie Générale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
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