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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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Okobi OE, Agazie O, Ayisire OE, Babalola F, Dick AI, Akinsola Z, Adeosun AA, Owolabi OJ, Ajayi TO, Odueke AY. Approaches to Medication Administration in Patients With Lack of Insight. Cureus 2022; 14:e27143. [PMID: 36017276 PMCID: PMC9393026 DOI: 10.7759/cureus.27143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Lack of insight typically complicates psychiatric presentations, necessitating careful thought and planning to choose the best course of treatment. Exploring methods of medication administration techniques in the context of a lack of insight is crucial to achieving the ultimate goal of overcoming the insight barrier as rapidly as possible, which will result in therapeutic benefit. This study's objective was to systematically review the evidence on medication administration techniques in a backdrop of lack of insight and how that evidence was curated in the scientific literature. This study used the literature search strategy, which entails retrieving and analyzing the existing scientific literature pertinent to medication administration techniques for individuals with no insight between 2010 and 2022. Accessing online databases, such as PubMed, Google Scholar, and Medline was utilized in this study's literature search strategy. In our findings, in the primary evidence search, no randomized control trial (RCT) comparing the various models of medication administration with a lack of insight was found. No study provided data on the superiority of utility, quality of life, or efficacy outcome. Some 17 scientific papers were identified that cited various trials about lack of insight and medication use and met the inclusion criteria. We concluded that it could be challenging to administer medication to patients who lack insight. Nonetheless, progress has been made to mitigate this obstacle. Common moral values, common sense, medicolegal support, person-centered integrated care, and cutting-edge medication techniques may play a role. However, these models of medication administration are still evolving, along with the ethical concerns accompanying them. Hopefully, the available models discussed in this analysis will serve as a foundation for future developments. Nonetheless, much remains to be done. We encourage contemporary research to investigate safer and more dynamic methods that can alleviate this condition.
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Mervis JE, Vohs JL, Lysaker PH. An Update on Clinical Insight, Cognitive Insight, and Introspective Accuracy in Schizophrenia-Spectrum Disorders: Symptoms, Cognition, and Treatment. Expert Rev Neurother 2022; 22:245-255. [PMID: 35244496 DOI: 10.1080/14737175.2022.2049757] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Poor insight, or unawareness of morbid changes in cognition, emotional states, or behavior, is commonly observed among people with schizophrenia. Poor insight represents a persistent barrier to wellness because it interferes with treatment and self-direction. Paradoxically, good insight may also be a barrier to health when awareness of these changes leads to depression or self-stigma. AREAS COVERED This paper builds upon this previous work by exploring these issues in schizophrenia separately as they have appeared in published research over the last three years in three different kinds of insight: clinical, cognition, and introspective accuracy. Specifically, studies are reviewed that address: the adverse effects of poor insight, the paradoxical effects of good insight, correlates with other forms of cognition, and emerging treatments. EXPERT OPINION The evidence continues to offer a nuanced picture of the complex effects of good insight in schizophrenia. Incremental improvements were also found in the development of novel integrative treatment approaches. This work also highlights the intricacy of the concept of insight, the need for further exploration of the effects of culture, and conceptual work that distinguishes the points of convergence and divergence of these forms of insight.
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Affiliation(s)
- Joshua E Mervis
- University of Minnesota, Department of Psychology, Minneapolis, Minnesota, USA.,Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Jenifer L Vohs
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana, USA.,Eskenzai Health, Sandra Eskenazi Mental Health Center, Prevention and Recovery Center for Early PsychosisE, Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Department of Psychiatry, Indianapolis, Indiana, USA
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Mervis JE, Bonfils KA, Cooper SE, Wiesepape C, Lysaker PH. Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia-Spectrum Disorders: Relationship to Metacognitive Deficits. SCHIZOPHRENIA BULLETIN OPEN 2021; 2:sgab034. [PMID: 34901868 PMCID: PMC8650079 DOI: 10.1093/schizbullopen/sgab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
People diagnosed with schizophrenia have been broadly observed to experience deficits in clinical and cognitive insight; however, less is understood about how these deficits are related. One possibility is that these deficits co-occur among people when other deficits in cognition are present, such as in executive function, social cognition, and metacognition, which may either promote the development of both forms of poor insight or allow one to negatively influence the other. To explore this possibility, we conducted a cluster analysis using assessments of clinical and cognitive insight among 95 adults with a schizophrenia spectrum disorder. As predicted, this analysis yielded a group with concurrently poor clinical and cognitive insight (n = 36). Additional groups were found with concurrently good clinical and cognitive insight (n = 28) and poor clinical insight and good cognitive insight (n = 31). Groups were then compared on assessments of executive function, social cognition, and metacognition. The group with concurrently lower levels of cognitive and clinical insight had significantly poorer metacognition relative to the other groups. In particular, they tended to form more fragmented and less integrated ideas about themselves and others. No differences were found for executive function or social cognition. The result may suggest that while clinical and cognitive insight is partially orthogonal phenomena, relatively lower levels of metacognition, or difficulties forming integrated ideas about oneself and others, maybe a condition leading to the confluence of lower clinical and cognitive insight. Interventions targeting metacognition may be of particular use for this group.
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Affiliation(s)
- Joshua E Mervis
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Samuel E Cooper
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, USA
| | - Courtney Wiesepape
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- To whom correspondence should be addressed; 1481 W 10th St, Indianapolis, IN 46202, USA; tel: (317) 988-2546, e-mail:
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