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Lopez-Morinigo JD, Martínez ASE, Barrigón ML, Escobedo-Aedo PJ, Ruiz-Ruano VG, Sánchez-Alonso S, Mata-Iturralde L, Muñoz-Lorenzo L, Cuadras D, Ochoa S, Baca-García E, David AS. A pilot 1-year follow-up randomised controlled trial comparing metacognitive training to psychoeducation in schizophrenia: effects on insight. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:7. [PMID: 36717598 PMCID: PMC9886217 DOI: 10.1038/s41537-022-00316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/14/2022] [Indexed: 06/18/2023]
Abstract
Poor insight in schizophrenia spectrum disorders (SSD) is linked with negative outcomes. This single-centre, assessor-blind, parallel-group 1-year follow-up randomised controlled trial (RCT) tested whether metacognitive training (MCT) (compared to psychoeducation) may improve insight and outcomes in outpatients with SSD assessed: at baseline (T0); after treatment (T1) and at 1-year follow-up (T2). Insight (primary outcome) was measured with (i) the Schedule for Assessment of Insight-Expanded version- (SAI-E), including illness recognition (IR), symptom relabelling (SR), treatment compliance (TC) and total insight scores (TIS); and (ii) the Beck Cognitive Insight Scale (BCIS). Between-group comparisons were nonsignificant, while within the MCT group (but not within controls) there was a significant medium effect size for improved TIS at T2 (d = 0.67, P = 0.02). Secondary outcomes included cognitive measures: Jumping to Conclusions (JTC), Theory of Mind (ToM), plus symptom severity and functioning. Compared to psychoeducation, MCT improved the PANSS excitement (d = 1.21, P = 0.01) and depressed (d = 0.76, P = 0.05) factors at T2; and a JTC task both at T1 (P = 0.016) and at T2 (P = 0.031). Participants in this RCT receiving MCT showed improved insight at 1-year follow-up, which was associated with better mood and reduced JTC cognitive bias. In this pilot study, no significant benefits on insight of MCT over psychoeducation were detected, which may have been due to insufficient power.
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Affiliation(s)
- Javier-David Lopez-Morinigo
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain.
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain.
| | | | - María Luisa Barrigón
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, University Hospital Virgen del Rocio, Seville, Spain
| | | | - Verónica González Ruiz-Ruano
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | | | | | - Daniel Cuadras
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Etiopatogenia y tratamiento de los trastornos mentales graves (MERITT), Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Susana Ochoa
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Etiopatogenia y tratamiento de los trastornos mentales graves (MERITT), Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Enrique Baca-García
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Universidad Católica del Maule, Talca, Chile
- Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, Nîmes, Francia
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Gan J, Fu H, Zhu X. Relationships Between Multiple Dimensions of Insight and Neurocognition, Metacognition, and Social Cognition: A Meta-Analysis. J Nerv Ment Dis 2022; 210:577-584. [PMID: 35900777 DOI: 10.1097/nmd.0000000000001495] [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] [Indexed: 11/25/2022]
Abstract
ABSTRACT Insight is a complex and multidimensional concept, and has a complex relationship with cognition. A meta-analysis of 102 studies of 9396 patients was conducted to determine the magnitude of the relationship between insight and neurocognition, higher-order cognition in multiple mental disorders. Insight has been found moderately related to higher-order cognition, but only weakly related to neurocognition. The different relationship has been found between the dimensions of insight and higher-order cognition. Almost none of the correlational coefficients of insight and cognitive domains were found to differ significantly among the different diagnostic groups. In conclusion, insight may be essentially related to higher-order cognition, but not to neurocognition. The orientation and expression of different dimensions of insight might be different, and the relationship of insight and cognition might not be explained by specific diagnosis.
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Affiliation(s)
- Jun Gan
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu
| | - Hong Fu
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu
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Kam TK, Lui TT, Lau FC, Chan KW, Lee HM, Hui LM, Suen YN, Lui SY, Chen E, Chang WC. Clinical and psychological correlates of insight dimensions in patients with early psychosis. Early Interv Psychiatry 2022; 16:527-532. [PMID: 34309188 DOI: 10.1111/eip.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/23/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate correlates of insight dimensions in Chinese adult patients with early psychosis. METHODS Insight dimensions including awareness of mental disorder (AMD), illness consequences (AIC) and medication effect (AME) were measured. A wide array of variables encompassing demographics, premorbid adjustment, onset profiles, symptomatology, treatment characteristics and psychological factors were comprehensively assessed. RESULTS Of 130 participants, 53.1%, 47.7% and 56.2% were categorized with good AMD, AIC and AME, respectively. Good AMD was associated with female gender, fewer positive and disorganization symptoms, more severe depression and greater self-stigma. Good AIC was related to female gender, more severe depression and greater self-stigma. Younger age of onset, fewer positive symptoms and greater service satisfaction associated with good AME. CONCLUSIONS Poor insight is prevalent in early psychosis. Differential relationships of insight dimensions with other illness variables underscore the importance of multidimensional approach in insight evaluation, and suggest potential treatment target for insight enhancement.
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Affiliation(s)
- Tze Kwan Kam
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Pokfulam, Hong Kong
| | - Tsz Ting Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Fu Chun Lau
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kit Wa Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ho Ming Lee
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lai Ming Hui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sai Yu Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Eric Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
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Escobedo-Aedo PJ, Forjan-González A, Sánchez-Escribano Martínez A, Ruiz-Ruano VG, Sánchez-Alonso S, Mata-Iturralde L, Muñoz-Lorenzo L, Baca-García E, David AS, Lopez-Morinigo JD. Investigating the Role of Insight, Decision-Making and Mentalizing in Functional Outcome in Schizophrenia: A Cross-Sectional Study. Behav Sci (Basel) 2022; 12:bs12020028. [PMID: 35200280 PMCID: PMC8868582 DOI: 10.3390/bs12020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Recovery has become a priority in schizophrenia spectrum disorders (SSDs). This study aimed to investigate predictors of objective—general functioning and disability—and subjective—quality of life (QoL)—measures of functional outcomes in SSD. Methods: Sample: n = 77 SSD outpatients (age 18–64, IQ > 70) participating in a randomised controlled trial. Baseline data were used to build three multivariable linear regression models on: (i) general functioning—General Assessment of Functioning (GAF); (ii) disability—the World Health Organization Disability Assessment Schedule (WHODAS-2.0); and (iii) QoL—Satisfaction Life Domains Scale (SLDS). Results: Young age and being employed (R2 change = 0.211; p = 0.001), late adolescence premorbid adjustment (R2 change = 0.049; p = 0.0050), negative symptoms and disorganization (R2 change = 0.087; p = 0.025) and Theory of Mind (R2 change = 0.066, p = 0.053) predicted general functioning. Previous suicidal behaviour (R2 change = 0.068; p = 0.023) and negative and depressive symptoms (R2 change = 0.167; p = 0.001) were linked with disability. Previous suicidal behaviour (R2 change = 0.070, p = 0.026), depressive symptoms (R2 change = 0.157; p < 0.001) and illness recognition (R2 change = 0.046, p = 0.044) predicted QoL. Conclusions: Negative, disorganization and depressive symptoms, older age, unemployment, poor premorbid adjustment, previous suicide attempts and illness awareness appear to underlie a poor global functional outcome in SSD. Achieving recovery in SSD appears to require both symptomatic remission (e.g., through antipsychotics) and measures to improve mastery and relieve low mood.
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Affiliation(s)
- Paula Jhoana Escobedo-Aedo
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (P.J.E.-A.); (A.F.-G.); (A.S.-E.M.); (V.G.R.-R.); (S.S.-A.); (L.M.-I.); (L.M.-L.); (E.B.-G.)
| | - Ana Forjan-González
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (P.J.E.-A.); (A.F.-G.); (A.S.-E.M.); (V.G.R.-R.); (S.S.-A.); (L.M.-I.); (L.M.-L.); (E.B.-G.)
| | - Adela Sánchez-Escribano Martínez
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (P.J.E.-A.); (A.F.-G.); (A.S.-E.M.); (V.G.R.-R.); (S.S.-A.); (L.M.-I.); (L.M.-L.); (E.B.-G.)
| | - Verónica González Ruiz-Ruano
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (P.J.E.-A.); (A.F.-G.); (A.S.-E.M.); (V.G.R.-R.); (S.S.-A.); (L.M.-I.); (L.M.-L.); (E.B.-G.)
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - Sergio Sánchez-Alonso
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (P.J.E.-A.); (A.F.-G.); (A.S.-E.M.); (V.G.R.-R.); (S.S.-A.); (L.M.-I.); (L.M.-L.); (E.B.-G.)
| | - Laura Mata-Iturralde
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (P.J.E.-A.); (A.F.-G.); (A.S.-E.M.); (V.G.R.-R.); (S.S.-A.); (L.M.-I.); (L.M.-L.); (E.B.-G.)
| | - Laura Muñoz-Lorenzo
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (P.J.E.-A.); (A.F.-G.); (A.S.-E.M.); (V.G.R.-R.); (S.S.-A.); (L.M.-I.); (L.M.-L.); (E.B.-G.)
| | - Enrique Baca-García
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (P.J.E.-A.); (A.F.-G.); (A.S.-E.M.); (V.G.R.-R.); (S.S.-A.); (L.M.-I.); (L.M.-L.); (E.B.-G.)
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28007 Madrid, Spain
- Psychology Department, Universidad Católica del Maule, Talca 3460000, Chile
| | - Anthony S. David
- Division of Psychiatry, Faculty of Brain Sciences, Institute of Mental Health, University College London, London WC1E 6BT, UK;
| | - Javier-David Lopez-Morinigo
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain; (P.J.E.-A.); (A.F.-G.); (A.S.-E.M.); (V.G.R.-R.); (S.S.-A.); (L.M.-I.); (L.M.-L.); (E.B.-G.)
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Investigación Biomédica en Red de Salud Mental, CIBERSAM, 28007 Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, 28009 Madrid, Spain
- Correspondence:
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Karpenko O. Compliance and insight as factors of recovery in patients with schizophrenia spectrum disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:41-48. [DOI: 10.17116/jnevro202212201241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Giordano GM, Bucci P, Mucci A, Pezzella P, Galderisi S. Gender Differences in Clinical and Psychosocial Features Among Persons With Schizophrenia: A Mini Review. Front Psychiatry 2021; 12:789179. [PMID: 35002807 PMCID: PMC8727372 DOI: 10.3389/fpsyt.2021.789179] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023] Open
Abstract
An extensive literature regarding gender differences relevant to several aspects of schizophrenia is nowadays available. It includes some robust findings as well as some inconsistencies. In the present review, we summarize the literature on gender differences in schizophrenia relevant to clinical and social outcome as well as their determinants, focusing on clinical variables, while gender differences on biological factors which may have an impact on the outcome of the disorder were not included herewith. Consistent findings include, in male with respect to female patients, an earlier age of illness onset limited to early- and middle-onset schizophrenia, a worse premorbid functioning, a greater severity of negative symptoms, a lower severity of affective symptoms and a higher rate of comorbid alcohol/substance abuse. Discrepant findings have been reported on gender differences in positive symptoms and in social and non-social cognition, as well as in functional outcome and rates of recovery. In fact, despite the overall finding of a more severe clinical picture in males, this does not seem to translate into a worse outcome. From the recent literature emerges that, although some findings on gender differences in schizophrenia are consistent, there are still aspects of clinical and functional outcome which need clarification by means of further studies taking into account several methodological issues.
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Affiliation(s)
| | - Paola Bucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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Kilciksiz CM, Keefe R, Benoit J, Öngür D, Torous J. Verbal memory measurement towards digital perspectives in first-episode psychosis: A review. Schizophr Res Cogn 2020; 21:100177. [PMID: 32322540 PMCID: PMC7163058 DOI: 10.1016/j.scog.2020.100177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Even in the early phases of psychotic spectrum illnesses such as schizophrenia, patients can experience cognitive decline or deficits prior to the onset of psychotic symptoms such as delusions and hallucinations. In this systematic review, we assessed which verbal memory assessments are most widely used in first-episode psychosis and may be applied via digital technologies (smartphone applications, etc.) for use in early detection. METHODS In November 2019, we searched for studies measuring verbal memory in first episode psychosis or schizophrenia over the past 10 years on PubMed and PsycINFO. We screened abstracts of these studies and excluded review studies. Full-texts of included studies were used to identify the verbal memory measurement tests, follow-up frequencies, and sample sizes. RESULTS We screened 233 reports and found that 120 original research studies measured verbal memory in first episode psychosis over the past 10 years. Four of these studies specified using a computer, 24 (20%) used a paper-pen format, 1(1%) used both, and 91 (76%) studies did not specify their administration tools or suggest there were offered in digital formats. Thirty-five (30%) studies had follow-up measurements of verbal memory, while 85 (70%) had only a single verbal memory measurement. DISCUSSION While many scales are commonly used to measure verbal memory in first episode psychosis, they are not often administered via digital technology. There is an emerging opportunity to administer these and other tests via digital technologies for expanding access to early detection of cognitive decline in clinical high risk and first-episode psychosis.
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Affiliation(s)
- Can Mişel Kilciksiz
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Richard Keefe
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - James Benoit
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States of America
| | - John Torous
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Elowe J, Conus P. Much ado about everything: A literature review of insight in first episode psychosis and schizophrenia. Eur Psychiatry 2020; 39:73-79. [DOI: 10.1016/j.eurpsy.2016.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022] Open
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Raftery D, Kelly PJ, Deane FP, Mcketin R, Baker AL, Turner A, Dean OM. Measuring cognitive insight in people with problematic substance use: An exploration of the factor validity of the Beck Cognitive Insight Scale. Drug Alcohol Rev 2019; 38:622-629. [DOI: 10.1111/dar.12966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 04/25/2019] [Accepted: 06/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Dayle Raftery
- School of PsychologyUniversity of Wollongong Wollongong Australia
| | - Peter J. Kelly
- School of PsychologyUniversity of Wollongong Wollongong Australia
| | - Frank P. Deane
- School of PsychologyUniversity of Wollongong Wollongong Australia
| | - Rebecca Mcketin
- National Drug and Alcohol Research CentreUniversity of New South Wales Sydney Australia
| | - Amanda L. Baker
- School of Medicine and Public HealthUniversity of Newcastle Callaghan Australia
| | - Alyna Turner
- School of Medicine and Public HealthUniversity of Newcastle Callaghan Australia
- IMPACT Strategic Research Centre, School of Medicine, Barwon HealthDeakin University Melbourne Australia
- Department of PsychiatryUniversity of Melbourne Melbourne Australia
| | - Olivia M. Dean
- IMPACT Strategic Research Centre, School of Medicine, Barwon HealthDeakin University Melbourne Australia
- Department of PsychiatryUniversity of Melbourne Melbourne Australia
- Florey Institute for Neuroscience and Mental HealthUniversity of Melbourne Melbourne Australia
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Sauvé G, Kline RB, Shah JL, Joober R, Malla A, Brodeur MB, Lepage M. Cognitive capacity similarly predicts insight into symptoms in first- and multiple-episode psychosis. Schizophr Res 2019; 206:236-243. [PMID: 30514643 DOI: 10.1016/j.schres.2018.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/03/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Lack of insight is a frequent characteristic of psychotic disorders, both in patients who recently experienced a first episode of psychosis (FEP) and those who experience recurrent multiple episodes (MEP). Insight is a multifaceted construct: its clinical form notably includes the unawareness of being ill, of symptoms, and of the need for treatment. Cognitive capacity is among the key determinants of insight into symptoms, but less is known about whether stage of illness (FEP vs. MEP) moderates this association. METHODS Our aim is to evaluate the association between cognitive capacity and symptom unawareness using structural equation modeling and moderated multiple regression. A total of 193 FEP and MEP patients were assessed using the CogState battery and the Scale to Assess Unawareness of Mental Disorder. RESULTS Analyses suggest that cognitive capacity accounts for a relatively small proportion of the total variation in symptom unawareness (6.4%). There was no evidence to suggest a moderating effect of stage of illness on this association. CONCLUSIONS The effect of general cognitive capacity on symptom unawareness is relatively small, and this basic relation was unrelated to stage of illness. It is possible that stage of illness could moderate this association only for certain facets of insight not assessed in this study (e.g., unawareness of the need for treatment).
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Affiliation(s)
- Geneviève Sauvé
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
| | - Rex B Kline
- Department of Psychology, Concordia University, 7141 Sherbrooke West, Montreal, Quebec H4B 1R6, Canada.
| | - Jai L Shah
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
| | - Ridha Joober
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
| | - Ashok Malla
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
| | - Mathieu B Brodeur
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
| | - Martin Lepage
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
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Wang MY, Ho NF, Sum MY, Collinson SL, Sim K. Impact of duration of untreated psychosis and premorbid intelligence on cognitive functioning in patients with first-episode schizophrenia. Schizophr Res 2016; 175:97-102. [PMID: 27146474 DOI: 10.1016/j.schres.2016.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/29/2016] [Accepted: 04/03/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The neurotoxic hypothesis suggests that psychosis is toxic to the brain leading to clinical consequences. In this study, we hypothesized that a longer duration of untreated psychosis (DUP) in first episode schizophrenia (FES) patients is associated with poorer cognitive functioning, and that higher premorbid intelligence buffers against DUP-related cognitive impairment. METHOD Eighty-one FES patients completed a neuropsychological battery, the Brief Assessment of Cognition in Schizophrenia (BACS). Composite scores of the BACS, which were normalized to a matched healthy control of seventy-three subjects, were used as an index of general cognition. A median split using the Wide Range Achievement Test-Reading Test scores was used to divide the patients into low versus high premorbid IQ groups. Hierarchical linear regression was performed to examine predictors of general cognition, including DUP. RESULTS Longer DUP was found to be a significant predictor of poorer general cognition. In addition, DUP predicted general cognition in the low premorbid IQ group but not in the high premorbid IQ group. CONCLUSIONS Our findings demonstrate that longer DUP in FES patients is associated with worse cognitive scores, and that this association is more pronounced in a subgroup of patients who have lower premorbid intelligence. Our results suggest the importance of earlier identification and management of patients with low premorbid IQ, given that their cognition may be more vulnerable to the toxicity of psychosis.
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Affiliation(s)
- M Y Wang
- Research Division, Institute of Mental Health, Singapore
| | - N F Ho
- Research Division, Institute of Mental Health, Singapore
| | - M Y Sum
- Research Division, Institute of Mental Health, Singapore
| | - S L Collinson
- Department of Psychology, National University of Singapore, Singapore
| | - K Sim
- Research Division, Institute of Mental Health, Singapore; General Psychiatry, Institute of Mental Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Vohs JL, George S, Leonhardt BL, Lysaker PH. An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments. Expert Rev Neurother 2016; 16:1193-204. [PMID: 27278672 DOI: 10.1080/14737175.2016.1199275] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Poor insight, or unawareness of some major aspect of mental illness, is a major barrier to wellness when it interferes with persons seeking out treatment or forming their own understanding of the challenges they face. One barrier to addressing impaired insight is the absence of a comprehensive model of how poor insight develops. AREAS COVERED To explore this issue we review how poor insight is the result of multiple phenomena which interfere with the construction of narrative accounts of psychiatric challenges, rather than a single social or biological cause. Expert commentary: We propose an integrative model of poor insight in schizophrenia which involves the interaction of symptoms, deficits in neurocognition, social cognition, metacognition, and stigma. Emerging treatments for poor insight including therapies which focus on the development of metacognition are discussed.
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Affiliation(s)
- Jenifer L Vohs
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Sunita George
- b School of Psychological Sciences , University of Indianapolis , Indianapolis , IN , USA
| | - Bethany L Leonhardt
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Paul H Lysaker
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,c Roudebush VA Medical Hospital , Indianapolis , IN , USA
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Abstract
The concept of insight in psychosis has been an interesting area in clinical psychiatry for well over a century with a surge in research interest over the past 25 years. Moreover, the past 5 years have been particularly fruitful in deciphering its neurobiological underpinnings. This article presents the development of the concept of insight in psychosis and reviews the current neurobiological research findings in this area.
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Affiliation(s)
- Starlin Vijay Mythri
- Asha Bipolar Clinic, Asha Hospital, Road no.14, Banjara Hills, Hyderabad, Telangana, India
| | - Y Sanjay
- Professor, Department of Psychiatry, Katuri Medical College and Hospital, Eudulapalem, Guntur - 522019, Andhra Pradesh, India
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Sánchez-Torres AM, Zarzuela A, Peralta V, Cuesta MJ. The association of lifetime insight and cognition in psychosis. Schizophr Res 2015; 162:183-8. [PMID: 25583245 DOI: 10.1016/j.schres.2014.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 12/01/2022]
Abstract
Poor insight has been related to poor course in psychosis. However, the role of cognition in insight remains unclear. The aim of this study was to examine the influence of cognition and lifetime psychopathological dimensions on insight in psychosis. We followed up 42 patients with psychotic disorders over 10years. Lifetime psychopathological dimensions and cognitive performance were assessed. Patients were divided into two groups by lifetime patterns of insight and compared with 42 healthy volunteers. Lower IQ and poorer social cognition were associated with higher risks of poorer lifetime insight of feeling ill and global insight respectively. Lifetime negative symptoms were associated with a higher risk of poorer lifetime insight into symptoms. Lifetime lack of insight is independent of cognitive impairment in specific domains, except for social cognition. Higher IQ may contribute to better lifetime awareness of illness, while better ability to manage emotions is involved in lifetime global insight.
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Affiliation(s)
- Ana M Sánchez-Torres
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona Spain; Department of Basic Psychology I, Faculty of Psychology, National Distance Education University (UNED), Madrid Spain
| | - Amalia Zarzuela
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona Spain
| | - Victor Peralta
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona Spain
| | - Manuel J Cuesta
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona Spain.
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Bianchini O, Porcelli S, Nespeca C, Cannavò D, Trappoli A, Aguglia E, De Ronchi D, Serretti A. Effects of antipsychotic drugs on insight in schizophrenia. Psychiatry Res 2014; 218:20-4. [PMID: 24768251 DOI: 10.1016/j.psychres.2014.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 03/16/2014] [Accepted: 03/20/2014] [Indexed: 01/03/2023]
Abstract
Lack of insight is predominant in schizophrenia though the causes are still unclear. The present study was carried on to investigate the effect of three Second Generation Antipsychotics (SGAs) and Haloperidol on insight and the associations among different clusters of symptoms and insight. Fifty-five patients have been recruited at the moment of pharmacological switch needed for psychotic exacerbation, from other antipsychotic drugs to Olanzapine, Aripiprazole, Ziprasidone and Haloperidol. Patients have been followed for 6 months and evaluated at baseline, after 3 months and after 6 months. Regarding the insight improvement, all SGAs resulted more effective than Haloperidol, while no difference was detected among different SGAs. Concerning psychopathology, all SGAs showed a better efficacy than Haloperidol, positive symptoms apart. All SGAs showed a similar efficacy on all domains, except for negative symptoms which resulted less responsive to ziprasidone and haloperidol. An association between improvement of insight and psychopathology was detected. Furthermore, insight appears to be related to psychopathology severity, particularly to negative symptoms. However, the observed different effectiveness of Ziprasidone on negative symptoms and insight suggests that these psychopathological features may be not strictly related and, thus, they may be sustained by different psychopathological processes.
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Affiliation(s)
- Oriana Bianchini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy; Institute of Psychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy.
| | - Stefano Porcelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy
| | - Claudia Nespeca
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy
| | - Dario Cannavò
- Institute of Psychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Angela Trappoli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy
| | - Eugenio Aguglia
- Institute of Psychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Diana De Ronchi
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy
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Ayesa-Arriola R, Moríñigo JDL, David AS, Pérez-Iglesias R, Rodríguez-Sánchez JM, Crespo-Facorro B. Lack of insight 3 years after first-episode psychosis: an unchangeable illness trait determined from first presentation? Schizophr Res 2014; 157:271-7. [PMID: 24934905 DOI: 10.1016/j.schres.2014.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 03/24/2014] [Accepted: 05/09/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lack of insight is recognized as a symptom that predisposes the individuals with psychosis to noncompliance with the treatment, leading to poorer course of illness. This study aimed to explore baseline predictors of disturbances on insight at follow-up. METHODS Three insight dimensions (insight of: 'mental illness', 'need for treatment' and 'the social consequences of the disorder') were measured with the Scale to Assess Unawareness of Mental Disorder (SUMD) in a cohort of 224 first-episode psychosis (FEP) patients at 3-year follow-up. Subgroups, good vs. poor insight, were compared on baseline clinical, neuropsychological, premorbid and sociodemographic characteristics. Regression models tested baseline predictors for each insight dimension. RESULTS At 3-year follow-up a high percentage of patients, 45%, 36% and 33% for each dimension, were found to remain lacking insight. Poor insight into having an illness was predicted by a diagnosis of schizophrenia and poor baseline insight of the social consequences; insight into the need for treatment was predicted by adolescent adjustment and depression at baseline; and insight into the social consequences of the disorder was determined by late adolescent adjustment and baseline insight of mental illness. CONCLUSIONS Our findings support the hypothesis that long-term insight in psychosis seems to be, to some extent, determined from first presentation, showing trait-like properties. A subgroup of 'lacking insight' patients, which is characterized by a diagnosis of schizophrenia, lower levels of premorbid adjustment and less severe depressive symptoms at baseline might benefit from special interventions targeted at enhancing insight from their first contact with psychiatric services.
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Affiliation(s)
- Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IFIMAV, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
| | | | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Rocío Pérez-Iglesias
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IFIMAV, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain; Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Jose Manuel Rodríguez-Sánchez
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IFIMAV, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IFIMAV, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
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López-Moríñigo JD, Wiffen B, O'Connor J, Dutta R, Di Forti M, Murray RM, David AS. Insight and suicidality in first-episode psychosis: understanding the influence of suicidal history on insight dimensions at first presentation. Early Interv Psychiatry 2014; 8:113-21. [PMID: 23489389 DOI: 10.1111/eip.12042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 12/28/2012] [Indexed: 11/29/2022]
Abstract
AIM Lack of insight is a cardinal feature of psychosis with crucial implications for outcome. Concerns have been raised regarding a link between insight and suicidality. This study aimed to test the relationship between suicidal behaviour preceding first-episode psychosis (FEP) and insight dimensions at treatment onset. METHODS A total of 112 FEP inpatients were recruited. Suicidal events prior to admission were recorded. Insight was assessed multidimensionally with the Schedule for the Assessment of Insight - Expanded version shortly after admission. Suicidal and non-suicidal patients were compared regarding scores on 'total insight' and three insight domains: 'awareness of mental illness', 'relabeling of psychotic experiences as abnormal' and 'compliance'. This analysis was also adjusted for a set of sociodemographic, clinical, neurocognitive and psychopathological variables. RESULTS Bivariate analyses demonstrated a direct association between previous suicidality and all insight domains. However, these associations did not survive multivariable regression models, which demonstrated gender (female), shorter duration of untreated psychosis (DUP) and psychopathological symptoms - depression and disorganization - to mediate the influence of suicidal history on insight, and therefore to underlie the latter. CONCLUSIONS Insight dimensions in FEP patients are influenced by having suicidal antecedents through some mediating variables such as gender, DUP and depression. Further prospective studies are needed to clarify the potential implications of these findings on the management of insight in FEP. As suicidal history is associated with greater levels of both depression and insight at first presentation, these three variables might be useful in predicting further suicidal events.
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Nair A, Palmer EC, Aleman A, David AS. Relationship between cognition, clinical and cognitive insight in psychotic disorders: a review and meta-analysis. Schizophr Res 2014; 152:191-200. [PMID: 24355529 DOI: 10.1016/j.schres.2013.11.033] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 11/20/2013] [Indexed: 11/16/2022]
Abstract
The neurocognitive theory of insight posits that poor insight in psychotic illnesses is related to cognitive deficits in cognitive self-appraisal mechanisms. In this paper we perform a comprehensive meta-analysis examining relationships between clinical insight and neurocognition in psychotic disorders. We have also completed a meta-analysis of studies examining 'cognitive insight', as measured by the Beck Cognitive Insight Scale (BCIS), and its relationship with neurocognitive function in patients with psychosis. The clinical insight analysis included data from 72 studies and a total population of 5429 patients. We found that insight in psychosis was significantly associated with total cognition (r=0.16, p<0.001), IQ (r=0.16, p<0.001), memory (r=0.13, p<0.001) and executive function (r=0.14, p<0.001). All of these correlations were stronger when examined in patients with schizophrenia only. In the BCIS analysis we included 7 studies and 466 patients in total. We found that no significant associations were found between the self-reflectiveness sub-component and neurocognition. By contrast there were significant correlations between the self-certainty subcomponent and memory (r=-0.23, p<0.001), IQ (r=-0.19, p<0.001) and total cognition (r=-0.14, p=0.01). We did not find evidence of significant publication bias in any analyses. Overall, our results indicate that there is a small but significant relationship between clinical insight, some aspects of cognitive insight and neurocognition. These findings reflect the complexity of the insight construct and indicate that while the neurocognitive model is important it is likely to be one of many which contribute to the understanding of this phenomenon.
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Affiliation(s)
- Akshay Nair
- NIHR Academic Clinical Fellow, South London & Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry, King's College, London, UK.
| | - Emma Claire Palmer
- Department of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College, London, UK
| | - André Aleman
- Cognitive Neuropsychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anthony S David
- Cognitive Neuropsychiatry, Institute of Psychiatry, King's College, London, UK
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Lysaker PH, Vohs J, Hillis JD, Kukla M, Popolo R, Salvatore G, Dimaggio G. Poor insight into schizophrenia: contributing factors, consequences and emerging treatment approaches. Expert Rev Neurother 2013; 13:785-93. [PMID: 23898850 DOI: 10.1586/14737175.2013.811150] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Poor insight or unawareness of illness has been commonly observed in schizophrenia and has been long recognized as a potent barrier to treatment adherence and a risk factor for a range of poorer outcomes. Paradoxically, the achievement of insight often poses a different set of problems including depression and low self-esteem. One barrier to the treatment of poor insight has been a lack of understanding of the phenomenon, which causes poor insight to develop and persist over time. Without knowing what promotes poor insight, treatment to date has had little to offer beyond the supportive provision of information. To explore these issues, this article reviews emerging literature on the correlates of poor insight in schizophrenia, and newly developing ways of conceptualizing insight. It then details a number of innovative integrative group and individual treatment approaches in the early stages of development, which take into account some of the potential causal forces behind poor insight, including deficits in neurocognition, social cognition, metacognition and heightened self-stigma. A plan for further research is presented to develop a model of the factors whose interaction influences insight, and to refine and test integrative treatments.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
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Barder HE, Sundet K, Rund BR, Evensen J, Haahr U, Ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld J, Larsen TK, Melle I, Opjordsmoen S, Røssberg JI, Simonsen E, Vaglum P, McGlashan T, Friis S. Ten year neurocognitive trajectories in first-episode psychosis. Front Hum Neurosci 2013; 7:643. [PMID: 24109449 PMCID: PMC3791439 DOI: 10.3389/fnhum.2013.00643] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/16/2013] [Indexed: 11/27/2022] Open
Abstract
Objective: Neurocognitive impairment is commonly reported at onset of psychotic disorders. However, the long-term neurocognitive course remains largely uninvestigated in first episode psychosis (FEP) and the relationship to clinically significant subgroups even more so. We report 10 year longitudinal neurocognitive development in a sample of FEP patients, and explore whether the trajectories of cognitive course are related to presence of relapse to psychosis, especially within the first year, with a focus on the course of verbal memory. Method: Forty-three FEP subjects (51% male, 28 ± 9 years) were followed-up neurocognitively over five assessments spanning 10 years. The test battery was divided into four neurocognitive indices; Executive Function, Verbal Learning, Motor Speed, and Verbal Fluency. The sample was grouped into those relapsing or not within the first, second and fifth year. Results: The four neurocognitive indices showed overall stability over the 10 year period. Significant relapse by index interactions were found for all indices except Executive Function. Follow-up analyses identified a larger significant decrease over time for the encoding measure within Verbal Memory for patients with psychotic relapse in the first year [F(4, 38) = 5.8, p = 0.001, η2 = 0.40]. Conclusions: Main findings are long-term stability in neurocognitive functioning in FEP patients, with the exception of verbal memory in patients with psychotic relapse or non-remission early in the course of illness. We conclude that worsening of specific parts of cognitive function may be expected for patients with on-going psychosis, but that the majority of patients do not show significant change in cognitive performance during the first 10 years after being diagnosed.
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Affiliation(s)
- Helene E Barder
- Psychosis Research Unit/TOP, Division of Mental Health and Addiction, KG Jebsen Center for Psychosis Resarch, Oslo University Hospital Oslo, Norway ; Department of Psychology, University of Oslo Oslo, Norway
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Abstract
The origins of poor insight in schizophrenia are still unclear. We contrasted the changes in clinical insight, basic cognitive processes, autobiographical memory and metacognition in 63 outpatients with schizophrenia pseudo-randomly assigned to one of three cognitive remediation groups: one targeting basic cognitive processes (RECOS), a second autobiographical memory (REMAu), and a third metacognitive deficits (MBCT). Three dimensions of insight (awareness of: mental illness, benefit of treatment, psychosocial consequences) improved after treatment, regardless of the group. In addition, the REMAu and MBCT showed an improvement on other dimensions of insight (symptomatic awareness and symptomatic attribution, respectively). Poor insight and its improvement after treatment were best predicted by a combination of basic cognitive, autobiographical and metacognitive measures. This study supports a multidimensional conception of insight and recommends the combination of remediation therapies to improve clinical insight in schizophrenia.
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