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Triola M, Cobo J, González-Rodríguez A, Nieto L, Ochoa S, Usall J, García-Ribera C, Baños I, González B, Solanilla A, Massons C, Ruiz I, Ruiz AI, Oliva JC, Pousa E. Impact of Delusions and Hallucinations on Clinical Insight Dimensions in Schizophrenia Spectrum Disorders. Psychopathology 2024:1-10. [PMID: 38442692 DOI: 10.1159/000536360] [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: 07/05/2023] [Accepted: 01/07/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Insight in psychosis has been conceptualized as a continuous, dynamic, and multidimensional phenomenon. This study aims to determine the impact of delusions and hallucinations in different dimensions of clinical insight in schizophrenia spectrum disorders. METHODS Cross-sectional multicenter study including 516 patients (336 men) diagnosed with schizophrenia spectrum disorders. Based on dichotomized scores of Positive and Negative Syndrome Scale (PANSS) items P1 (delusions) and P3 (hallucinations), patients were assigned to four groups according to current clear presence of delusions (scores 4 or above 4 in PANSS item P1) and/or hallucinations (scores 4 or above 4 in PANNS item P3). Insight was assessed using the three main dimensions of the Scale of Unawareness of Mental Disorder (SUMD). RESULTS Around 40% of patients showed unawareness of illness; 30% unawareness of the need for treatment; and 45% unawareness of the social consequences of the disorder. Patients with current clear presence of delusions had higher overall lack of awareness, regardless of current clear presence of hallucinations. Similarly, the clear presence of delusions showed a greater predictive value on insight than the presence of hallucinations, although the implication of both in the prediction was modest. CONCLUSIONS Our results confirm that lack of insight is highly prevalent in schizophrenia spectrum disorders, particularly when patients experience delusions. This study adds insight-related data to the growing symptom-based research, where specific types of psychotic experiences such as hallucinations and delusions could form different psychopathological patterns, linking the phenomenology of delusions to a lack of clinical insight.
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Affiliation(s)
- Maria Triola
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
| | - Jesus Cobo
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospìtal, Terrassa, Spain
- University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Lourdes Nieto
- Department of Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico D.F., Mexico
| | - Susana Ochoa
- Research and Development Unit, Parc Sanitari San Joan de Dèu, MERITT Group, Institut de Recerca Sant Joan de Déu - CIBERSAM - ISCIII, Sant Boi de Llobregat, Barcelona, Spain
| | - Judith Usall
- Research and Development Unit, Parc Sanitari San Joan de Dèu, MERITT Group, Institut de Recerca Sant Joan de Déu - CIBERSAM - ISCIII, Sant Boi de Llobregat, Barcelona, Spain
| | - Carles García-Ribera
- Department of Psychiatry, Hospital de La Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau, IIB-Sant Pau, CIBERSAM, Barcelona, Spain
| | - Iris Baños
- Research and Development Unit, Parc Sanitari San Joan de Dèu, MERITT Group, Institut de Recerca Sant Joan de Déu - CIBERSAM - ISCIII, Sant Boi de Llobregat, Barcelona, Spain
| | - Beatriz González
- Mental Health Department, Hospital Benito Menni, Sant Boi de Llobregat, Barcelona, Spain
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Ariadna Solanilla
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
| | - Carmina Massons
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
| | - Isabel Ruiz
- Department of Health and Clinical Psychology, Research Unit, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ada I Ruiz
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | | | - Esther Pousa
- Department of Psychiatry, Hospital de La Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau, IIB-Sant Pau, CIBERSAM, Barcelona, Spain
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Barbalat G, Maréchal L, Plasse J, Chéreau-Boudet I, Gouache B, Legros-Lafarge E, Massoubre C, Guillard-Bouhet N, Haesebaert F, Franck N. Functioning, clinical severity, education and sex moderate the inverse relationship between insight and quality of life in patients with schizophrenia. Schizophr Res 2024; 264:149-156. [PMID: 38141352 DOI: 10.1016/j.schres.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/09/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life, a phenomenon that has been described as the "insight paradox". Here, we aimed to determine whether certain socio-demographic and clinical characteristics strengthen or weaken this negative relationship. METHODS We used data from the French network of rehabilitation centers REHABase (N = 769). We explored mean differences in quality-of-life scores between patients with good insight vs. poor insight. We also explored modifying effects of socio-demographic and clinical characteristics (sex, education, age, functioning, clinical severity, duration of illness). RESULTS Patients with good insight had a decreased quality-of-life total score. Similar effects were found for the following sub-dimensions of quality of life: autonomy, physical and psychological well-being, and self-esteem. The negative effect of insight on quality of life was attenuated for people who had >12 years of education and for people with a higher level of functioning. By contrast, the negative effect of insight on quality of life was accentuated in people with greater clinical severity. Functioning and clinical severity showed similar modifying effects for other quality-of-life dimensions: autonomy, physical and psychological well-being, and self-esteem. Finally, males demonstrated an increased negative association between insight and self-esteem. CONCLUSIONS The relationship between insight and quality of life is moderated by socio-demographic and clinical circumstances. Future inquiries may utilize our findings by integrating socio-demographic and clinical factors in treatment programs designs to conjointly improve insight and quality of life.
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Affiliation(s)
- Guillaume Barbalat
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université de Lyon, Lyon, France.
| | - Lisa Maréchal
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, CHU et faculté de médecine de Poitiers, Poitiers, France
| | - Julien Plasse
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université de Lyon, Lyon, France
| | - Isabelle Chéreau-Boudet
- Centre Référent Conjoint de Réhabilitation (CRCR), Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Benjamin Gouache
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
| | | | - Catherine Massoubre
- REHALise, Centre de Réhabilitation Psychosociale, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Nathalie Guillard-Bouhet
- Centre de REhabilitation d'Activités Thérapeutiques Intersectoriel de la Vienne (CREATIV), Centre Hospitalier Laborit, Poitiers, France
| | - Frédéric Haesebaert
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université de Lyon, Lyon, France
| | - Nicolas Franck
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université de Lyon, Lyon, France
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Orfei MD, Porcari DE, Spalletta G, Assogna F, Piras F, Banaj N, Ricciardi E. The Italian Validation of the Beck Cognitive Insight Scale: Underlying Factor Structure in Psychotic Patients and the General Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6634. [PMID: 37681774 PMCID: PMC10487986 DOI: 10.3390/ijerph20176634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
Cognitive insight refers to the ability to question one's judgments and cognitive biases and is underpinned by specific metacognitive processes. The Beck Cognitive Insight Scale was developed to assess cognitive insight and includes two subscales, Self-Reflectiveness and Self-Certainty (SC). The present study aimed to investigate the underlying factor structure of the Italian version of the BCIS in patients with schizophrenia (SZ) and in the general population (GP) for the first time. A cross-sectional design was adopted and a GP sample of 624 subjects and an SZ sample of 130 patients were enrolled. In the SZ group, a two-factor solution was supported. The internal reliability of each factor was satisfactory. Two items were eliminated and one item moved from the SC to the SR subscale. In the GP group, a two-factor solution was highlighted. The internal reliability of each factor was satisfactory. However, four items of the SR subscale were deleted. The Italian-validated version of the BCIS shows different structures for the SZ and the GP and is characterized by different features concerning previous studies. This evidence suggests new interpretations of metacognitive processes in the two populations and implies specific therapeutic approaches.
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Affiliation(s)
- Maria Donata Orfei
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco, 19, 55100 Lucca, Italy; (D.E.P.); (E.R.)
| | - Desirée Estela Porcari
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco, 19, 55100 Lucca, Italy; (D.E.P.); (E.R.)
| | - Gianfranco Spalletta
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179 Rome, Italy (F.A.); (F.P.); (N.B.)
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, USA
| | - Francesca Assogna
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179 Rome, Italy (F.A.); (F.P.); (N.B.)
| | - Fabrizio Piras
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179 Rome, Italy (F.A.); (F.P.); (N.B.)
| | - Nerisa Banaj
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179 Rome, Italy (F.A.); (F.P.); (N.B.)
| | - Emiliano Ricciardi
- Molecular Mind Laboratory (MoMiLab), IMT School for Advanced Studies Lucca, Piazza S. Francesco, 19, 55100 Lucca, Italy; (D.E.P.); (E.R.)
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Gülcüoğlu M, İnci F, Özcan A. Evaluation of cognitive insight, social functionality, and coping attitudes of patients diagnosed with schizophrenia being followed-up in a community mental health center. Arch Psychiatr Nurs 2023; 43:143-149. [PMID: 37032007 DOI: 10.1016/j.apnu.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
AIM This study was conducted to evaluate the cognitive insight, social functionality, and coping attitudes of patients diagnosed with schizophrenia being followed-up in a Community Mental Health Center (CMHC). DESIGN AND METHODS The population of this descriptive and relationship-seeking study comprised 170 schizophrenia patients followed-up in the CMHC. Study data were collected using the Information Form, the Beck Cognitive Insight Scale (BCIS), the Social Functioning Assessment Scale (SFAS), and the Coping Orientation of Problem Experience (COPE). FINDINGS A moderately significant positive correlation between cognitive insight and social functionality was determined. It was found that participants with high cognitive insight and social functionality used more problem- and emotion-focused coping methods. APPLICATION IMPLICATIONS It is thought that practices that improve cognitive insight and social functionality will contribute to the rehabilitation of patients with schizophrenia by supporting their coping skills.
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Affiliation(s)
| | - Figen İnci
- Niğde Ömer Halisdemir University, Zübeyde Hanım Faculty of Health Sciences, Psychiatric Nursing Department, Niğde/ Türkiye
| | - Ayşegül Özcan
- Nevşehir Hacı Bektaş Veli University, Semra ve Vefa Küçük Faculty of Health Sciences, Public Health Nursing Department, Nevşehir/Türkiye
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5
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Effect of cognitive insight on clinical insight from pre-morbid to early psychosis stages. Psychiatry Res 2022; 313:114613. [PMID: 35569423 DOI: 10.1016/j.psychres.2022.114613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/12/2022] [Accepted: 04/16/2022] [Indexed: 11/20/2022]
Abstract
Poor cognitive insight, including low self-reflectiveness and high self-certainty, contributes to poor clinical insight, which includes awareness of illness, relabelling of specific symptoms, and treatment compliance. However, inconsistent results regarding cognitive insight among individuals at clinical high risk of psychosis (CHR) have been reported. This study investigated the difference in cognitive insight among groups with different severity of positive symptoms and analysed the effect of cognitive insight on clinical insight in each group. All participants, including CHR individuals with 3 or 4 points (L-Pitem, n = 85) and 5 points (H-Pitem, n = 37) on any positive-symptom item of the Scale of Prodromal Syndromes, and patients with first-episode psychosis (FEP, n = 59), were measured cognitive and clinical insight using the Beck Cognitive Insight Scale and the Schedule of Assessment of Insight, respectively. The self-reflectiveness of cognitive insight was highest in the L-Pitem group and lowest in the FEP group. Self-reflectiveness was positively associated with awareness of illness in the L-Pitem and FEP groups; both self-reflectiveness and self-certainty was positively associated with treatment compliance in the L-Pitem group. Improving self-reflectiveness of cognitive insight may conduce to good clinical insight. Self-certainty may have different implication to individuals with mild prodromal symptoms.
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Lui SSY, Lam JPY, Lam JWS, Chui WWH, Mui JHC, Siu BWM, Cheng KM, Cheung EFC, Chan RCK. Cognitive insight is correlated with cognitive impairments and contributes to medication adherence in schizophrenia patients. Asian J Psychiatr 2021; 60:102644. [PMID: 33862475 DOI: 10.1016/j.ajp.2021.102644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/28/2021] [Accepted: 04/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Cognitive insight refers to the ability to distance oneself from and evaluate one's own beliefs and interpretations. Little is known about whether cognitive insight could influence medication adherence in schizophrenia patients. This study examined the role of cognitive insight in medication adherence and how it would interact with neuropsychological functions. METHODS Ninety clinically-stable schizophrenia patients completed the Beck's Cognitive Insight Scale (BCIS) and tasks measuring prospective (PM) and other neurocognitive functions. Medication adherence was estimated using a multi-axial method comprising interview, clinician-rating, pharmacy refill record and pill counting. Correlational and regression analyses were conducted to examine whether cognitive insight and PM would be associated with mediation adherence. Post-hoc mediational analysis was performed to examine the interplay between cognitive insight, PM and medication adherence. RESULTS Clinical insight and cognitive insight together significantly influenced participants' medication adherence, after neurocognitive functions and psychopathology were accounted for. Time-based PM, compared with other neurocognitive functions, affected medication adherence more strongly. CONCLUSIONS Cognitive insight complements clinical insight in affecting medication adherence in schizophrenia patients.
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Affiliation(s)
- Simon S Y Lui
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region, China; Castle Peak Hospital, Hong Kong Special Administrative Region, China.
| | - Jessica P Y Lam
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Joanna W S Lam
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - William W H Chui
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Jolene H C Mui
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Bonnie W M Siu
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - K M Cheng
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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7
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Faivre N, Roger M, Pereira M, de Gardelle V, Vergnaud JC, Passerieux C, Roux P. Confidence in visual motion discrimination is preserved in individuals with schizophrenia. J Psychiatry Neurosci 2021; 46:E65-E73. [PMID: 33009905 PMCID: PMC7955841 DOI: 10.1503/jpn.200022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Metacognition is the set of reflexive processes that allows humans to evaluate the accuracy of their mental operations. Metacognitive deficits have been described in people with schizophrenia using mostly narrative assessment, and they have been linked to several key symptoms. METHODS We assessed metacognitive performance objectively by asking people with schizophrenia or schizoaffective disorder (n = 20) and matched healthy participants (n = 21) to perform a visual discrimination task and report their confidence in their performance. Metacognitive performance was defined as the adequacy between visual discrimination performance and confidence. RESULTS Bayesian analyses revealed equivalent metacognitive performance in the 2 groups, despite a weaker association between confidence and trajectory tracking during task execution among people with schizophrenia. We reproduced these results using an evidence accumulation model, which showed similar decisional processes in the 2 groups. LIMITATIONS These results from a relatively small study sample cannot be generalized to other perceptual and nonperceptual tasks. To meet this purpose, ecological tasks are needed. As well, the role of antipsychotic medication and design deserves greater attention in the future. CONCLUSION We found similar decisional and metacognitive capabilities between people with schizophrenia and healthy controls in a visual discrimination task.
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Affiliation(s)
- Nathan Faivre
- From the Université Grenoble Alpes, Grenoble, France (Faivre, Pereira); the Centre d'Economie de la Sorbonne, Paris, France (Faivre, de Gardelle, Vergnaud); the Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, INSERM UMR1018, Centre de recherche en Épidémiologie et Santé des Populations, Equipe DevPsy, Villejuif, France (Roger, Passerieux, Roux); the Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de psychiatrie d'adultes et d'addictologie, Le Chesnay, France (Roger, Passerieux, Roux); and the Fondation Fondamental, Créteil, France (Passerieux, Roux)
| | - Matthieu Roger
- From the Université Grenoble Alpes, Grenoble, France (Faivre, Pereira); the Centre d'Economie de la Sorbonne, Paris, France (Faivre, de Gardelle, Vergnaud); the Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, INSERM UMR1018, Centre de recherche en Épidémiologie et Santé des Populations, Equipe DevPsy, Villejuif, France (Roger, Passerieux, Roux); the Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de psychiatrie d'adultes et d'addictologie, Le Chesnay, France (Roger, Passerieux, Roux); and the Fondation Fondamental, Créteil, France (Passerieux, Roux)
| | - Michael Pereira
- From the Université Grenoble Alpes, Grenoble, France (Faivre, Pereira); the Centre d'Economie de la Sorbonne, Paris, France (Faivre, de Gardelle, Vergnaud); the Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, INSERM UMR1018, Centre de recherche en Épidémiologie et Santé des Populations, Equipe DevPsy, Villejuif, France (Roger, Passerieux, Roux); the Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de psychiatrie d'adultes et d'addictologie, Le Chesnay, France (Roger, Passerieux, Roux); and the Fondation Fondamental, Créteil, France (Passerieux, Roux)
| | - Vincent de Gardelle
- From the Université Grenoble Alpes, Grenoble, France (Faivre, Pereira); the Centre d'Economie de la Sorbonne, Paris, France (Faivre, de Gardelle, Vergnaud); the Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, INSERM UMR1018, Centre de recherche en Épidémiologie et Santé des Populations, Equipe DevPsy, Villejuif, France (Roger, Passerieux, Roux); the Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de psychiatrie d'adultes et d'addictologie, Le Chesnay, France (Roger, Passerieux, Roux); and the Fondation Fondamental, Créteil, France (Passerieux, Roux)
| | - Jean-Christophe Vergnaud
- From the Université Grenoble Alpes, Grenoble, France (Faivre, Pereira); the Centre d'Economie de la Sorbonne, Paris, France (Faivre, de Gardelle, Vergnaud); the Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, INSERM UMR1018, Centre de recherche en Épidémiologie et Santé des Populations, Equipe DevPsy, Villejuif, France (Roger, Passerieux, Roux); the Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de psychiatrie d'adultes et d'addictologie, Le Chesnay, France (Roger, Passerieux, Roux); and the Fondation Fondamental, Créteil, France (Passerieux, Roux)
| | - Christine Passerieux
- From the Université Grenoble Alpes, Grenoble, France (Faivre, Pereira); the Centre d'Economie de la Sorbonne, Paris, France (Faivre, de Gardelle, Vergnaud); the Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, INSERM UMR1018, Centre de recherche en Épidémiologie et Santé des Populations, Equipe DevPsy, Villejuif, France (Roger, Passerieux, Roux); the Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de psychiatrie d'adultes et d'addictologie, Le Chesnay, France (Roger, Passerieux, Roux); and the Fondation Fondamental, Créteil, France (Passerieux, Roux)
| | - Paul Roux
- From the Université Grenoble Alpes, Grenoble, France (Faivre, Pereira); the Centre d'Economie de la Sorbonne, Paris, France (Faivre, de Gardelle, Vergnaud); the Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, INSERM UMR1018, Centre de recherche en Épidémiologie et Santé des Populations, Equipe DevPsy, Villejuif, France (Roger, Passerieux, Roux); the Centre Hospitalier de Versailles, Service Hospitalo-Universitaire de psychiatrie d'adultes et d'addictologie, Le Chesnay, France (Roger, Passerieux, Roux); and the Fondation Fondamental, Créteil, France (Passerieux, Roux)
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Xu L, Zhang M, Wang S, Wei Y, Cui H, Qian Z, Wang Y, Tang X, Hu Y, Tang Y, Zhang T, Wang J. Relationship Between Cognitive and Clinical Insight at Different Durations of Untreated Attenuated Psychotic Symptoms in High-Risk Individuals. Front Psychiatry 2021; 12:753130. [PMID: 34867540 PMCID: PMC8637962 DOI: 10.3389/fpsyt.2021.753130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background: This study examines whether cognitive insight is impaired in high-risk individuals with attenuated psychotic symptoms (APS) and explores the relationship between cognitive and clinical insight at different durations of untreated attenuated psychotic symptoms (DUAPS). Methods: The Structured Interview for Psychosis high-risk Syndrome (SIPS) was used to identify APS individuals. APS (n = 121) and healthy control (HC, n = 87) subjects were asked to complete the Beck Cognitive Insight Scale (BCIS). Clinical insight of APS individuals was evaluated using the Schedule for Assessment of Insight (SAI). APS individuals were classified into four subgroups based on DUAPS, including 0-3, 4-6, 7-12, and >12 months. Power analysis for significant correlation was conducted using the WebPower package in R. Results: Compared with HC subjects, APS individuals showed poorer cognitive insight, with lower scores on BCIS self-reflectiveness and composite index (BCIS self-reflectiveness minus BCIS self-certainty). Only when DUAPS was longer than 12 months did the significant positive correlation between cognitive and clinical insight obtain the power about 0.8, including the associations between self-reflectiveness and awareness of illness, self-reflectiveness and the total clinical insight, and composite index and awareness of illness. The positive associations of composite index with awareness of illness within 0-3 months DUAPS and with the total score of SAI when DUAPS > 12 months were significant but failed to obtain satisfactory power. Conclusions: APS individuals may have impaired cognitive insight, demonstrating lower self-reflectiveness. The correlation between cognitive and clinical insight is associated with the duration of untreated attenuated psychotic symptoms.
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Affiliation(s)
- LiHua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mei Zhang
- Department of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, China
| | - ShuQin Wang
- Department of Chinese Language Teaching, Shanghong Middle School, Shanghai, China
| | - YanYan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - HuiRu Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - ZhenYing Qian
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - YingChan Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - XiaoChen Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - YeGang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - YingYing Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - TianHong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - JiJun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
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Alhadidi M, Abdullah KL, Tang LY, Danaee M, Al Hadid LAR. Knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among people diagnosed with schizophrenia in a long-term care facility. Perspect Psychiatr Care 2021; 57:225-234. [PMID: 32502330 DOI: 10.1111/ppc.12553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study assessed the level of knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among patients with schizophrenia in Jordan. DESIGN AND METHODS A cross-sectional survey was conducted on 135 patients diagnosed with schizophrenia, who had been admitted to the largest psychiatric hospital in Jordan. FINDINGS The participants had a low level of knowledge, insight, and a high level of internalized stigma. No correlation was found between these variables. Meanwhile, the educational level and vacation were found to be predictors of knowledge. PRACTICE IMPLICATIONS This can help psychiatric nurses to identify which area needs to be improved to ensure the best service and care is provided to patients diagnosed with schizophrenia.
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Affiliation(s)
- Majdi Alhadidi
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khatijah Lim Abdullah
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li Yoong Tang
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Department of Social and Prevention Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lourance Abdel Razzaq Al Hadid
- Nursing Department, Princess Aisha Bint Al Hussein College of Nursing and Health Sciences, Al Hussein Bin Talal University, Ma'an, Jordan
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10
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Cognitive insight in psychotic patients institutionalized and living in the community: an examination using the Beck Cognitive Insight Scale. Psychiatry Res 2021; 295:113586. [PMID: 33250207 DOI: 10.1016/j.psychres.2020.113586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/18/2020] [Indexed: 01/10/2023]
Abstract
Improving cognitive insight can reduce delusions in patients with psychotic disorders. Although institutionalized patients usually have more severe delusions than outpatients, little is known about the differences in cognitive insight between these two groups. In this study, we evaluated the psychometric properties of the Beck Cognitive Insight Scale (BCIS) for a sample of Portuguese patients with psychotic disorders and compared the cognitive insight of institutionalized patients with patients living in the community. Participants in this study were 150 patients diagnosed with psychotic disorder (78 institutionalized patients and 72 outpatients). The tested model of the BCIS was a very good fit. Our study shows that patients living in the community showed higher levels of cognitive insight (total BCIS and self-reflectiveness) than institutionalized patients. Future studies assessing cognitive insight should take into account differences between the cognitive insights of institutionalized psychotic patients and psychotic patients living in the community.
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Davis BJ, Lysaker PH, Salyers MP, Minor KS. The insight paradox in schizophrenia: A meta-analysis of the relationship between clinical insight and quality of life. Schizophr Res 2020; 223:9-17. [PMID: 32763114 DOI: 10.1016/j.schres.2020.07.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Abstract
Poor clinical insight affects people with schizophrenia and has been cited as a chief cause of poor outcomes. As such, clinical insight is often a target of intervention; however, increases in insight have shown associations with decreased quality of life in a phenomenon known as the "insight paradox." Understanding the relationship between insight and quality of life is important as clients often feel hopeless when quality of life decreases. This meta-analysis sought to clarify relationships between clinical insight, its subdomains, and quality of life in schizophrenia. Further, we explored the role of two moderators (quality of life measurement type, symptom severity) on the insight-quality of life relationship. Studies were identified according to PRISMA guidelines through a focused literature search extending to March 1, 2019. Correlations between clinical insight, its subdomains, and quality of life were extracted and used to calculate overall mean weighted effect sizes using a random-effects model. In support of the insight paradox, overall clinical insight was inversely related to quality of life. Symptom severity moderated the relationship between clinical insight and quality of life, such that greater symptom severity weakened the inverse relationship between overall insight and quality of life. Regarding subdomains of clinical insight, awareness of illness was inversely associated with quality of life; however, other subdomains failed to reach significance. Our findings support the notion that increased insight is associated with lower quality of life and highlight the need for further exploration of the role of meaning-making processes on this relationship.
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Affiliation(s)
- Beshaun J Davis
- Department of Psychology, Indiana University- Purdue University Indianapolis, Indianapolis, IN, United States
| | - Paul H Lysaker
- Department of Psychology, Indiana University- Purdue University Indianapolis, Indianapolis, IN, United States; Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Michelle P Salyers
- Department of Psychology, Indiana University- Purdue University Indianapolis, Indianapolis, IN, United States
| | - Kyle S Minor
- Department of Psychology, Indiana University- Purdue University Indianapolis, Indianapolis, IN, United States.
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12
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Penney D, Joober R, Malla A, Lepage M. Understanding sex differences in cognitive insight across first-and-multiple episode psychosis. Schizophr Res 2020; 218:276-282. [PMID: 31980343 DOI: 10.1016/j.schres.2019.12.024] [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: 07/12/2019] [Revised: 11/19/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cognitive insight represents the capacity to self-reflect and consider external feedback when re-evaluating faulty beliefs. It is associated with specific cognitive capacities such as verbal memory, of which there is substantial evidence for sex differences in psychotic disorders. Like more general cognitive capacities, cognitive insight might too be modulated by sex differences. METHOD One hundred and seventy-one first episode psychosis (FEP; 123 males, 48 females), and 203 multiple episode psychosis (MEP; 147 males, 56 females) participants completed the Beck Cognitive Insight Scale (BCIS). A two-way MANOVA was conducted on the three BCIS measures (self-reflectiveness, self-certainty, composite index) with sex (male, female) and illness stage (FEP, MEP) as factors, followed by two-way ANOVAs and a post hoc test of simple effects. RESULTS The only significant interaction to emerge was between sex and illness stage in self-certainty (F(1, 373) = 5.88, p = .016). A test of simple effects revealed that self-certainty group means were significantly different for males and females in FEP, where females had lower self-certainty than males (p = .053) but not during MEP (p = .119). CONCLUSION Sex differences do not modulate cognitive insight in MEP, which may be attributable to females having greater positive symptom severity than males. In FEP however, results revealed that females were significantly less self-certain than males. Lower self-certainty relative to self-reflectiveness predicts treatment response in psychological interventions, and as such future FEP studies should explore sex differences in psychological interventions.
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Affiliation(s)
- Danielle Penney
- Douglas Mental Health University Institute, Montréal, Canada; Department of psychology, Université du Québec à Montréal, Canada
| | - Ridha Joober
- Douglas Mental Health University Institute, Montréal, Canada; Department of psychiatry, McGill University, Montréal, Canada
| | - Ashok Malla
- Douglas Mental Health University Institute, Montréal, Canada; Department of psychiatry, McGill University, Montréal, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, Montréal, Canada; Department of psychiatry, McGill University, Montréal, Canada.
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13
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França G, Laranjeira E, Silva F, Monteiro L, Moreira AM, Carvalho S. Attachment Style and Insight in Schizophrenia: a Cross-Sectional Study. Psychiatr Q 2020; 91:31-43. [PMID: 31768908 DOI: 10.1007/s11126-019-09675-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Attachment theory provides a model for understanding impairments in social and interpersonal functioning. Schizophrenia is a neuropsychiatry disorder frequently associated with compromised social functioning and limited social support networks. However, the relationship between attachment style and psychopathology dimensions, including insight, isn't fully understood To determine whether there is a relationship between the attachment style and markers for severity of schizophrenia and insight. We conducted a cross-sectional study of 41 patients with schizophrenia and 34 patients with non-psychotic disorders used as a control group. Patients were assessed using semi-structured diagnostic interviews and self-reporting questionnaires, including Adult Attachment Scale-Revised. The schizophrenia group was also given the Positive and Negative Syndrome Scale and the Markova and Berrios Insight Scale. Insecure attachment was overrepresented in the schizophrenic group, and this difference was mainly accounted for lower levels of dependence, representing a moderate effect size (Cohen's d = 0.32). In the schizophrenia group, the closeness and the dependence subscale were negatively correlated with psychopathology severity. Using a multiple regression analysis, the insight was predicted by attachment anxiety, accounting for 20% of the total variance (R2 = 0.199, p <0.05). Our data confirm previous evidence that insecure attachment is associated with schizophrenia and suggest that the less comfortable the patient is with closeness and intimacy the greater the severity of symptoms. Furthermore, our findings indicate that higher separation anxiety might predict a better insight.
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Affiliation(s)
- Gustavo França
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal.
| | - Erika Laranjeira
- Center for Economics and Finance, Oporto University, Porto, Portugal
| | - Fabio Silva
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Lília Monteiro
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Ana Maria Moreira
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Serafim Carvalho
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
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14
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Wright A, Fowler D, Greenwood K. Influences on functional outcome and subjective recovery in individuals with and without First Episode Psychosis: A metacognitive model. Psychiatry Res 2020; 284:112643. [PMID: 31718807 DOI: 10.1016/j.psychres.2019.112643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 11/28/2022]
Abstract
Models of functional and subjective recovery in psychosis suggest that the path between neurocognition and functioning is mediated by cognitive processes, which may include metacognition, considered 'thinking about thinking'. Metacognition has several components: metacognitive ability, experience and efficiency, connected by metacognitive monitoring and metacognitive control processes; akin to executive control processes. This study aimed to explore whether metacognitive components are fragmented, how individuals with FEP perform on the metacognitive scores compared to healthy control participants, and whether metacognitive components are associated with functioning and, for FEP only, subjective recovery. 62 individuals with FEP and 73 matched healthy controls completed measures of metacognition, functional capacity, functional outcome, and subjective recovery; covariates: IQ and symptoms. Factor analysis, to assess loading of metacognitive items onto separate factors, demonstrated that metacognitive ability, experience, efficiency and monitoring were separate components, with limited association. Metacognitive ability and metacognitive control process were reduced in FEP sample, but metacognitive experience and monitoring process were higher in FEP. Metacognitive ability predicted functional capacity, functional outcome and subjective recovery. Metacognitive experience predicted functional capacity. This is the first study to assess key metacognitive components within a large model and consider the distinct contributions to both functional and subjective recovery.
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Affiliation(s)
- Abigail Wright
- Center of Excellence for Psychosocial & Systemic Research, Massachusetts General Hospital; University of Sussex, School of Psychology.
| | - David Fowler
- University of Sussex, School of Psychology; Sussex Partnership NHS Foundation Trust
| | - Kathryn Greenwood
- University of Sussex, School of Psychology; Sussex Partnership NHS Foundation Trust
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15
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The association of clinical insight and depression with quality of life in schizophrenia. Psychiatry Res 2019; 279:350-352. [PMID: 30902352 DOI: 10.1016/j.psychres.2019.02.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/21/2022]
Abstract
This study assesses how insight influences depression and Quality of Life (QOL) in schizophrenia-spectrum outpatients and whether depression modifies the relationship between insight and QOL. 141 patients with schizophrenia or schizoaffective disorders with stable disease completed the EUROQOL-5D-5L and SQLS-R4, SAI-E and Calgary scales. Univariate and multivariate linear regression models were fitted to assess whether insight was related to QOL and/or depression. Higher levels of insight were (inversely) only related to EuroQOL-health but showed no relationship with depression. Depression showed an inversely strong relationship with EuroQOL-health. The relationship between clinical insight and QOL does not seem to be associated with depression.
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16
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Sagayadevan V, Jeyagurunathan A, Lau YW, Shafie S, Chang S, Ong HL, Samari E, Verma SK, Chong SA, Subramaniam M. Cognitive insight and quality of life among psychiatric outpatients. BMC Psychiatry 2019; 19:201. [PMID: 31253121 PMCID: PMC6599343 DOI: 10.1186/s12888-019-2163-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past studies have focused primarily on clinical insight and less on cognitive insight among individuals with mental illness. METHODS This study examined the level of cognitive insight (CI) and its association with quality of life (QoL) among psychiatric outpatients (N = 400) in Singapore. The Beck Cognitive Insight Scale (BCIS) consisting of two subscales (self-reflectiveness (SR) and self-certainty (SC)) was used to measure CI while the brief version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was used to assess the subjective well-being of the individual. RESULTS Socio-demographic correlates of CI, differences in SR, SC, and CI scores across diagnostic groups, and the association between insight and QoL were examined. Significant differences across diagnostic groups were found only for SR scores. Higher SR and overall CI scores were significantly associated with higher QoL in the environmental domain whereas higher SC scores were associated with lower QoL in the social relationships domain. CONCLUSIONS An understanding of cognitive insight is necessary to produce a significant change in the underlying belief system of an individual. Together with clinical insight, these two forms of insight can be used to inform therapeutic approaches to increase awareness and improve the QoL of those with mental illnesses.
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Affiliation(s)
- Vathsala Sagayadevan
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747, Singapore.
| | - Ying Wen Lau
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Saleha Shafie
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Sherilyn Chang
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Hui Lin Ong
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Ellaisha Samari
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Swapna Kamal Verma
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore ,0000 0004 0469 9592grid.414752.1Early Psychosis Intervention Programme (EPIP) & General Psychiatry (GP1), Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Siow Ann Chong
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
| | - Mythily Subramaniam
- 0000 0004 0469 9592grid.414752.1Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10, Buangkok View, Singapore, 539747 Singapore
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17
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Sevilla-Llewellyn-Jones J, Cano-Domínguez P, de-Luis-Matilla A, Espina-Eizaguirre A, Moreno-Kustner B, Ochoa S. Subjective quality of life in recent onset of psychosis patients and its association with sociodemographic variables, psychotic symptoms and clinical personality traits. Early Interv Psychiatry 2019; 13:525-531. [PMID: 29278295 DOI: 10.1111/eip.12515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/26/2017] [Accepted: 09/30/2017] [Indexed: 01/16/2023]
Abstract
AIM There is lack of research on the study of clinical personality traits in recent onset of psychosis (ROP) patients. The aims of this research were to study the relations among psychosocial, personality and clinical characteristics in ROP patients and also the effect that significant variables had on the different domains of Quality of Life (QoL). METHODS Data for these analyses were obtained from 81 ROP patients. The Millon Clinical Multiaxial Inventory, the Positive and Negative Syndrome Scale and the World Health Organization Quality of Life Brief Scale were used to assess personality, symptoms and QoL. RESULTS Correlations between the negative symptoms and the physical, psychological and social domains of QoL, and the disorganized symptoms and physical domain, were found. Furthermore, the physical, psychological and social relationship domains of QoL were lower in patients with schizoid traits and the psychological domain was lower in patients with depressive traits. In contrast, the psychological and social domains were higher in patients with histrionic traits, while the physical domain was higher for patients with narcissistic traits. Multiple linear regressions demonstrated that negative symptoms and narcissistic and depressive traits explained 16.9% of the physical domain. Narcissistic and depressive traits explained 15% of the psychological domain. Finally, the negative symptoms and histrionic traits explained 13.7% of the social domain. CONCLUSIONS QoL seems to be better explained by negative psychotic symptoms and some clinical personality traits. Our results support the importance of integrated intervention approaches that consider personality.
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Affiliation(s)
- Julia Sevilla-Llewellyn-Jones
- Department of Mental Health, Clínico Universitario Virgen de la Victoria Hospital, Málaga, Spain.,Faculty of Psychology, Malaga University, Málaga, Spain.,Institute of Psychiatry and Mental Health, Clínico San Carlos Hospital, Madrid
| | - Pablo Cano-Domínguez
- Department of Mental Health, Clínico Universitario Virgen de la Victoria Hospital, Málaga, Spain
| | - Antonia de-Luis-Matilla
- Department of Mental Health, Clínico Universitario Virgen de la Victoria Hospital, Málaga, Spain
| | | | | | - Susana Ochoa
- Research Unit of Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, CIBERSAM
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18
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Wright AC, Fowler D, Greenwood KE. Developing a dynamic model of anomalous experiences and function in young people with or without psychosis: a cross-sectional and longitudinal study protocol. BMJ Open 2018; 8:e022546. [PMID: 30391913 PMCID: PMC6231554 DOI: 10.1136/bmjopen-2018-022546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/06/2018] [Accepted: 09/21/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Anomalous experiences are common within the general population, but the frequency and intensity is increased in young people with psychosis. Studies have demonstrated that perceptual biases towards noticing these phenomena plays a role, but the way one thinks about one's experience (metacognition) may also be relevant. While poor metacognitive function has been theoretically associated with anomalous experiences, this relationship is currently unclear. However, metacognition may work along a continuum with various metacognitive levels, many of which have been demonstrated as impaired in psychosis. These metacognitive components may interact via processes that maintain poor metacognition across levels, and that potentially impact both what people do in their everyday lives (functional outcome) and how people feel about their everyday lives (subjective recovery outcome) in young people with psychosis compared with healthy control participants. METHODS AND ANALYSIS This study will investigate the association and contribution of metacognition to anomalous experiences and outcome measures cross-sectionally and longitudinally in a 36-month follow-up. First, young people with psychosis will be compared with healthy control participants on selected measures of anomalous experience, metacognition, and function, using analysis of covariance to identify group differences. Next, the relationship between metacognitive components and processes will be explored, including processes connecting the different components, using regression analyses. Finally, mediation analyses will be used to assess the predictive value of metacognitive measures on outcome measures, both cross-sectionally and longitudinally at 36 months, while controlling for symptoms and cognition. ETHICS AND DISSEMINATION Ethical and Health Research Authority approval has been obtained through Camberwell St. Giles Research Ethics Committee (reference number: 17/LO/0055). This research project will be reported within a PhD thesis and submitted for journal publication. Once key predictive components of poor outcome in psychosis are identified, this study will develop a series of dynamic models to understand influences on outcome for young people with psychosis.
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Affiliation(s)
- Abigail C Wright
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
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19
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Establishing Clinical Cutoff Values for the Beck Cognitive Insight Scale. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9963-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Rotstein A, Roe D, Gelkopf M, Levine SZ. Age of onset and quality of life among males and females with schizophrenia: A national study. Eur Psychiatry 2018; 53:100-106. [DOI: 10.1016/j.eurpsy.2018.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 01/26/2023] Open
Abstract
AbstractBackground:Age of onset is considered central to understanding the course of schizophrenia, yet little is known regarding its association with quality of life in general, and specifically among males and females.Aims:To examine the association between the age of schizophrenia onset and quality of life, in general, and among males and females, using data from a national sample and competing statistical models.Methods:Participants with a diagnosis of schizophrenia (N = 1624) completed the Manchester Short Assessment of Quality of Life (MSA-QoL) and were rated on a parallel measure by their professional caregivers (N = 578). Multiple regression analysis models were computed for self-appraised quality of life, and mixed models with random intercepts were used for caregivers. Six competing models were tested for parsimony for each rating source. Three models without adjustment and three models adjusted for confounding variables. Sensitivity analyses were conducted for males and females separately.Results:Age of onset was statistically significantly (P <.05) negatively associated with self-appraised and caregiver-appraised quality of life on aggregate and among females. Among males, a significant (P <.01) quadratic effect of onset age on self-appraised quality of life demonstrated a negative association up to onset age of 36.67 years, after which the association was positive.ConclusionsAn earlier age of onset is associated with a better quality of life in schizophrenia which is tentatively explained by social decline. Specific trends in psychiatric symptom severity may account for this association among females while social advantages may account for the particular results found among males.
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21
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A longitudinal study of cognitive insight and cortical thickness in first-episode psychosis. Schizophr Res 2018; 193:251-260. [PMID: 28669589 DOI: 10.1016/j.schres.2017.06.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/23/2017] [Accepted: 06/23/2017] [Indexed: 11/23/2022]
Abstract
Among individuals with psychosis, those with poor cognitive insight (lower Self-Reflectiveness, higher Self-Certainty) show volumetric reductions in cortical structure. We evaluated whether changes in cognitive insight are associated with progressive changes in cortical structure in first-episode psychosis (FEP) and control subjects. Beck Cognitive Insight Scale ratings and magnetic resonance imaging scans were acquired at baseline for 130 FEP and 52 controls, 59 FEP and 28 controls at 1-year, and 53 FEP and 20 controls at 2-years. Cortical thickness was computed across scans and analyzed with linear mixed models. At baseline, groups did not differ on Self-Reflectiveness or Self-Certainty. At baseline, higher Self-Reflectiveness significantly correlated with thinner right occipital cortex in FEP, and higher Self-Certainty was significantly negatively correlated with cortical thickness in left posterior cingulate in controls. Longitudinal analysis showed that Self-Reflectiveness and Self-Certainty did not change over time in either group. Interestingly, the lack of change in cognitive insight aligned with longitudinal cortical thickness results, where no interaction effects were seen with cortical thickness between time and either Self-Reflectiveness or Self-Certainty. Exploratory analyses with a reduced threshold found that in FEP, across all time-points, higher Self-Certainty associated with thinner cortex in left posterior cingulate/precuneus. Results suggest that the posterior cingulate may be a common neural correlate for Self-Certainty in FEP and non-clinical subjects.
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22
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Lien YJ, Chang HA, Kao YC, Tzeng NS, Lu CW, Loh CH. The impact of cognitive insight, self-stigma, and medication compliance on the quality of life in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2018; 268:27-38. [PMID: 28756468 DOI: 10.1007/s00406-017-0829-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 07/24/2017] [Indexed: 12/20/2022]
Abstract
Impaired quality of life (QoL) is a common and clinically relevant feature of schizophrenia. In the present study, we attempted to formulate a model of QoL in the chronic stage of schizophrenia by including key variables-namely cognitive insight, self-stigma, insight into treatment, and medication compliance-that were proposed as its significant predictors in previous studies. We employed structural equation modeling (SEM) to simultaneously test the associations between these variables. A total of 170 community-dwelling patients with schizophrenia participated in this study. Cognitive insight, self-stigma, insight into treatment, medication compliance, and QoL were assessed through self-reporting. Symptoms were rated by interviewers. The influences of cognitive insight, stigma, insight into treatment, and medication compliance on QoL were supported using SEM. Our findings indicated that cognitive insight had a significant, positive, and direct effect on both self-stigma and insight into treatment; in contrast, it had a negative and direct effect on medication compliance. Notably, no evidence indicated a direct effect of cognitive insight on QoL. Thus, individuals with high cognitive insight reported low QoL because of stigma, low medication compliance, and their increased insight into treatment. In contrast, cognitive insight might indirectly ameliorate QoL mediated by the effect of insight into treatment on medication compliance. The findings provide additional support of the links between cognitive and clinical insight, self-stigma, medication compliance, and QoL in those with schizophrenia and suggest the need for screening and intervention services appropriate for this high-risk population.
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Affiliation(s)
- Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan. .,Department of Psychiatry, Tri-Service General Hospital Songshan Branch, 131 Jiankang Road, Songshan District, Taipei, 10581, Taiwan.
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Wen Lu
- Department of Psychiatry, Tri-Service General Hospital Songshan Branch, 131 Jiankang Road, Songshan District, Taipei, 10581, Taiwan
| | - Ching-Hui Loh
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
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23
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Lysaker PH, Pattison ML, Leonhardt BL, Phelps S, Vohs JL. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry 2018; 17:12-23. [PMID: 29352540 PMCID: PMC5775127 DOI: 10.1002/wps.20508] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle L Pattison
- College of Applied Behavioral Sciences, University of Indianapolis, Indianapolis, IN, USA
| | - Bethany L Leonhardt
- Indiana University School of Medicine, Eskenazi Health-Midtown Community Mental Health, Indianapolis, IN, USA
| | | | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, IN, USA
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24
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İpçi K, İncedere A, Kiras F, Yıldız M. Şizofreni Hastalarında Öznel İyileşme İle Bilişsel İçgörü Arasındaki İlişkinin Araştırılması. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2018. [DOI: 10.30934/kusbed.337808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Pu S, Nakagome K, Itakura M, Ohtachi H, Iwata M, Nagata I, Kaneko K. Right Frontotemporal Cortex Mediates the Relationship between Cognitive Insight and Subjective Quality of Life in Patients with Schizophrenia. Front Psychiatry 2018; 9:16. [PMID: 29456514 PMCID: PMC5801421 DOI: 10.3389/fpsyt.2018.00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/17/2018] [Indexed: 11/19/2022] Open
Abstract
Although prior studies identified a relationship between cognitive insight and subjective quality of life (QOL) in patients with schizophrenia, the brain regions mediating this relationship remain unknown. Recent studies have shown that the ventrolateral prefrontal cortex may be particularly important for cognitive insight in individuals with schizophrenia. Here, we examined whether frontotemporal function mediates the relationship between cognitive insight and QOL in 64 participants, including 32 patients with schizophrenia and 32 healthy controls. Cognitive insight was measured using the Beck Cognitive Insight Scale (BCIS), while participants' subjective QOL was assessed using the Medical Outcomes Study 36-item Short-form Health Survey. Frontotemporal function was evaluated during a verbal fluency task using multichannel near-infrared spectroscopy. Consistent with previous findings, we found that frontotemporal function was impaired in patients with schizophrenia. Interestingly, our data also revealed that the right ventrolateral PFC and the right anterior part of the temporal cortex significantly mediated the relationship between the self-reflectiveness (SR) subscale of the BCIS and subjective QOL. These findings suggest that cognitive insight, particularly SR, is associated with subjective QOL in patients with schizophrenia via right frontotemporal function. The findings of this study provide important insight into a QOL model of schizophrenia, which may guide the development of cost-effective interventions that target frontotemporal function in patients with schizophrenia.
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Affiliation(s)
- Shenghong Pu
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | | | - Masashi Itakura
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroaki Ohtachi
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masaaki Iwata
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Izumi Nagata
- National Hospital Organization, Tottori Medical Center, Tottori-shi, Japan
| | - Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Faculty of Medicine, Tottori University, Yonago, Japan
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26
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Rathee R, Luhrmann TM, Bhatia T, Deshpande SN. Cognitive insight and objective quality of life in people with schizophrenia and auditory hallucinations. Psychiatry Res 2018; 259:223-228. [PMID: 29091820 PMCID: PMC5758479 DOI: 10.1016/j.psychres.2017.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/27/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
Poor cognitive insight in schizophrenia has been linked to delusions, hallucinations, and negative symptoms as well as to depressive/anxiety symptoms. Its impact on quality of life has been less studied, especially in schizophrenia subjects with ongoing auditory hallucinations. The Beck Cognitive Insight Scale (BCIS) and the Quality of Life Scale (QLS) were administered to subjects who met DSM IV criteria for schizophrenia after due translation and validation. All subjects reported ongoing auditory hallucinations at recruitment. Mean composite cognitive insight scores from participants (N = 60) (2.97 ± 2.649) were in the lower range as compared to published literature. Cognitive insight scores as well as self-reflectiveness subscale scores, but not self-certainty scores, correlated significantly with the QLS scores p < 0.001. Results suggest that better cognitive insight, especially self-reflectiveness, may be linked to better quality of life. Self-reflectiveness could be a useful construct to address in psychotherapy to improve rehabilitation.
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Affiliation(s)
- Ruchika Rathee
- Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital (PGIMER-RMLH), Park Street, New Delhi, India.
| | | | - Triptish Bhatia
- Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital (PGIMER-RMLH), Park Street, New Delhi, India.
| | - Smita N. Deshpande
- Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital (PGIMER-RMLH), Park Street, New Delhi, India,Correspondence to: Department of Psychiatry, PGIMER, Dr. R.M.L. Hospital, New Delhi 110001, India
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27
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Cognitive insight: A systematic review. Clin Psychol Rev 2017; 55:12-24. [DOI: 10.1016/j.cpr.2017.04.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 03/12/2017] [Accepted: 04/30/2017] [Indexed: 11/23/2022]
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28
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Kuang C, Buchy L, Barbato M, Makowski C, MacMaster FP, Bray S, Deighton S, Addington J. A pilot study of cognitive insight and structural covariance in first-episode psychosis. Schizophr Res 2017; 179:91-96. [PMID: 27720314 DOI: 10.1016/j.schres.2016.09.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
Cognitive insight is described as a balance between one's self-reflectiveness (recognition and correction of dysfunctional reasoning), and self-certainty (overconfidence). Neuroimaging studies have linked the ventrolateral prefrontal cortex (VLPFC) to cognitive insight in people with psychosis. However, the relationship between cognitive insight and structural connectivity between the VLPFC and other brain areas is unknown. Here, we investigated the modulation of cognitive insight on structural covariance networks involving the VLPFC in a first-episode psychosis sample. Fifteen patients with a first-episode psychosis provided magnetic resonance (MR) scans and completed the Beck Cognitive Insight Scale (BCIS). MR scans were also available for 15 historical controls. Seed-based analysis of structural covariance was conducted using the Mapping Anatomical Correlations Across the Cerebral Cortex (MACACC) methodology, whereby Pearson correlation coefficients were extracted between seed regions in left and right VLPFC and cortical thickness across the brain. Structural covariance maps between groups were compared at each vertex. In first-episode subjects, we evaluated the modulation of BCIS scores on cortical covariance between VLPFC and every other vertex. Findings showed no significant group difference between first-episode psychosis subjects and controls in thickness covariance seeded from left or right VLPFC. However, in first-episode psychosis subjects, a positive association with self-certainty was found in networks seeded from both left and right VLPFC with thickness in medial frontal cortex and right pars triangularis. No significant associations were found for self-reflectiveness. These results suggest that self-certainty, but not self-reflectiveness, positively modulated cortical covariance in a frontal network in patients with a first-episode psychosis.
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Affiliation(s)
- Corin Kuang
- Department of Neuroscience, University of Calgary, Alberta, Canada
| | - Lisa Buchy
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada.
| | - Mariapaola Barbato
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Carolina Makowski
- McGill Centre for Integrative Neuroscience, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada
| | - Frank P MacMaster
- Department of Psychiatry, University of Calgary, Alberta, Canada; Strategic Clinical Network for Addictions and Mental Health, Alberta, Canada; Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Signe Bray
- Department of Radiology and Paediatrics, University of Calgary, Alberta, Canada; Child and Adolescent Imaging Research (CAIR) Program, Alberta Children's Hospital Research Institute, Alberta, Canada
| | - Stephanie Deighton
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada
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