Impact of interpersonal factors on insight in schizophrenia

The effects of life review-based collage book making on psychosocial functioning and discrepancy between patients' and hospital staff's perception of daily functioning in long-term hospitalized patients with schizophrenia: A randomized controlled trial

The purpose of this study was to investigate the psychosocial effects of life review-based collage book making on long-term inpatients with schizophrenia, and to verify the effectiveness of this program in reducing the discrepancy between self-perception and others' evaluation of patients' day-to-day functioning. Participants were randomly assigned to intervention or control group. The intervention group participated in an individual program of life review-based collage book making. At three evaluation points (pre-and post-intervention and at 3-month follow-up) the patients rated their subjective difficulties, and the staff rated the objective severity of the patient's day-to-day functioning, using the Schizophrenia Cognition Rating Scale Japanese version (SCoRS-J). The Profile of Mood Status-Brief Form (POMS), Recovery Assessment Scale, and Life Skills Profile were used to assess psychosocial functioning, and the changes in scores on the scales were compared between the two groups. In addition, for those with large discrepancy between patient and staff rating scores on the SCoRS-J at baseline, the change in the discrepancy scores were compared between the two groups. As a result, there was a significant group main effect and interaction between the two groups in the changes in the Confusion subscale scores of the POMS, indicating an alleviation of confusion in this program. In addition, for those with large discrepancy scores on the SCoRS-J, there was a significant group main effect and interaction between the two groups in discrepancy scores, indicating that this program can contribute to the reduction of discrepancies in the perceptions, and to the collaborative approach to treatment.

Functioning, clinical severity, education and sex moderate the inverse relationship between insight and quality of life in patients with schizophrenia

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.

Experiences of interpersonal interaction among patients with chronic schizophrenia: A phenomenological study

PURPOSE

To explore the subjective interpersonal interaction experiences of patients with chronic schizophrenia.

DESIGN AND METHODS

Descriptive phenomenological, purposive sampling, in-depth one-to-one, and unstructured interviews were used. Colaizzi's method was used to analyze narratives.

FINDINGS

Three themes and six subthemes were emerged: Feelings associated with interpersonal interactions (pleasant and unpleasant feelings experienced during interpersonal interactions); interpersonal interaction is a dynamic process (Positive and negative dynamic processes); selection of interaction targets (limitations in the selection of interaction targets and selection criteria for interaction targets).

PRACTICE IMPLICATIONS

Professionals should understand the interpersonal interactions experiences of patients with schizophrenia to help them have a better interpersonal relationship.

Discrepancies between Self- and Clinical Staff Members' Perception of Cognitive Functioning among Patients with Schizophrenia Undergoing Long-Term Hospitalization

In Japan, long-term hospitalization of patients with schizophrenia is still prevalent, even though the focus of psychiatric care is shifting from hospitals to the community. Difficulties in discharge planning often arise because clinical staff members' functional assessment differs from that of patients' self-assessment. Therefore, we attempted to identify characteristics related to these perceptual differences to promote the development of more effective approaches toward the discharge and societal reintegration of patients with schizophrenia undergoing prolonged hospitalization. Forty-eight long-term inpatients (23 men and 25 women with a mean age of 60.72 years) with schizophrenia were examined using the Schizophrenia Cognition Rating Scale Japanese version (SCoRS-J), Life Skills Profile (LSP), and Profile of Mood States- (POMS-) Brief Form. Differences between patients' self-ratings and clinical staff members' ratings on the SCoRS-J were used to divide patients into overestimators, underestimators, and accurate raters. These groups were then comparatively analyzed. Accordingly, overestimators displayed significantly severe cognitive dysfunction on the SCoRS-J objective ratings (p = .001) and significantly less difficulty on the SCoRS-J subjective ratings (p = .002) as compared to underestimators. Overestimators also scored significantly lower on the communication (p = .012) and responsibility (p = .021) LSP subscales compared to underestimators, and the total LSP score for overestimators was significantly lower compared to accurate raters (p = .036) and underestimators (p = .009). However, underestimators displayed significantly higher confusion on the titular POMS subscale than did overestimators (p = .021). These findings indicate that, among the three groups, overestimators scored lowest for objectively rated functioning. In contrast, underestimators attained the highest functioning; however, they were also confused. Clinical staff should examine how patients' self-perceptions deviate from the perceptions of staff and implement an appropriate approach considering the patient characteristics revealed from the results of this study.

The relationship between the therapeutic alliance and client variables in individual treatment for schizophrenia spectrum disorders and early psychosis: Narrative review

Given the high rates of treatment disengagement and medication nonadherence in individuals with schizophrenia spectrum disorders and early psychosis, fostering a strong alliance in treatment is critical. Moreover, the role of the therapeutic alliance extends beyond that in traditional psychotherapy because of the multifaceted nature of treatment. Thus, this review provides a comprehensive discussion of the relationship between the alliance and client variables across various provider types and individual treatments. This review summarizes existing research on (a) client correlates/predictors of the therapeutic alliance and on (b) the relationship between the alliance and client treatment outcomes in individual treatment for schizophrenia spectrum disorders and early psychosis. Parallel literature searches were conducted using PubMed and PsycINFO databases, which yielded 1202 potential studies with 84 studies meeting inclusion criteria. With regard to correlates/predictors, the existing evidence suggests that better insight, medication adherence, social support, and recovery variables were related to better client-rated alliance. Better medication adherence and recovery variables as well as less severe symptoms were related to better provider-rated alliance. In terms of alliance-outcome relationships, evidence suggests that a strong provider-rated alliance was predictive of improved functioning and medication and treatment adherence. There was some limited evidence that better client-rated alliance was related to improved recovery outcomes. Despite mixed results and heterogeneity among studies, this review suggests that a strong alliance can be beneficial in individual schizophrenia treatment. Thus, training and supervision of providers should emphasize developing a positive alliance, particularly with clients for whom developing an alliance may be difficult.

Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles: A Latent Class Analysis

The integrated model of insight in schizophrenia suggests that poor insight is the result of multiple factors which compromise persons' abilities to integrate streams of information into a personal awareness of psychiatric challenges, and make adaptive responses. This model hypothesizes that metacognitive deficits, or difficulties forming a complex and integrated understanding of the self and others, influence insight, regardless of other proximal causes including clinical profile. To explore this possibility, we performed a latent class analysis on 324 adults with schizophrenia or schizoaffective disorder. This analysis produced 4 groups on the basis of assessment of insight and Positive and Negative Syndrome Scale (PANSS) positive, negative, cognitive, and hostility symptoms. The resultant groups were characterized as: Good Insight/Low Symptoms (n = 71), Impaired Insight/High Negative Symptoms, (n = 43), Impaired Insight/High Positive Symptoms (n = 50) and Impaired Insight/Diffuse Symptoms (n = 160). When we compared metacognitive function as assessed with the Metacognition Assessment Scale - Abbreviated (MAS-A) across groups, we found that the good insight group had better overall metacognition as well as higher levels of self-reflectivity, awareness of the other and mastery as compared to all 3 groups with impaired insight. When controlling for total symptoms, all differences in metacognitive function between the good insight and the impaired insight groups remained significant. These results are consistent with the view that, independent of symptoms, impaired metacognition contributes to difficulties integrating information and hence impedes insight, or awareness of psychiatric challenges. Consistent with extant literature, results suggest that interventions focusing on metacognition as the target may lead to improved insight.

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

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.

Social Cognition in Schizophrenia: Cognitive and Neurobiological Aspects

Social cognition in schizophrenia is currently one of the major fields of interest in studies of this disorder. It is commonly conceptualised as a set of mental operations underlying social interactions, and therefore related to the ability to interpret and predict the behaviour of others in different social contexts. The research community has defined the functional areas that constitute the domain of social cognition, including, at least, the theory of mind, sensory perception, social perception, and attributional bias. Different bodies of evidence have shown that alterations in these functions in patients with schizophrenia are linked to some of their main psychopathological dysfunctions, such as defects in sensory perception, insight and attributional origin, and authorship of human acts. These behavioural alterations have been linked to structural and functional disturbances in the constituents of the so-called social brain. This includes a set of medial parietal, temporal, and pre-frontal areas that have been associated with some anomalies in the theory of mind, the perception of emotions, and the ability to consider the perspective of others, phenomena commonly found in schizophrenia. Future research in the domain of social cognition should be aimed at clarifying its relationship with the social brain and neurocognition.