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Park SW, Lee NY, Jeong HY, Chung IW, Kim YS, Jeong SH. The Mediating Role of Anxiety/Depression Between Auditory Verbal Hallucinations and the Level of Insight in Schizophrenia. Psychiatry Investig 2024; 21:403-414. [PMID: 38695048 PMCID: PMC11065532 DOI: 10.30773/pi.2023.0396] [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: 11/16/2023] [Revised: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE Auditory verbal hallucination (AVH) is a prominent symptom of schizophrenia causing profound distress. The influence of AVHs on insight appears to be intricate and contingent on other accompanying symptoms. This study investigated the relationship and possible mediators between AVHs and the degree of insight. METHODS One hundred patients with schizophrenia participated in the study. Scales were used to evaluate the hallucinatory experience, the level of insight and other psychopathology. Complex relationships between variables were envisaged as a path model, whose initial structure was constructed via Gaussian Graphical Model. The validity of the final model was verified by Structural Equation Modeling. Separate analyses were performed for self-reported and clinician-rated data to enhance the model's robustness. RESULTS The greater the severity of the physical aspects of AVHs, the lower the level of insight observed. Conversely, higher emotional distress was associated with increased insight. These relationships were only evident in the self-reported results and were not reflected in the clinician-rated results. The path model suggested that the Positive and Negative Syndrome Scale (PANSS) anxiety/depression factor was an important mediator that linked the found association. Notably, the PANSS negative symptom had the opposite effect on the PANSS anxiety/depression factor and insight, making it difficult to define its overall effect. CONCLUSION The findings of this study provided one possible route for the positive influence of AVH experience in gaining insight. The mediating role of anxiety/depression modified by negative symptoms emerged as a valuable concept for clarifying this intricate relationship.
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Affiliation(s)
- Sang Won Park
- Inarae Psychiatry Clinic, Cheongju, Republic of Korea
| | - Nam Young Lee
- Department of Psychiatry, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, Republic of Korea
| | - Hee Yeon Jeong
- Department of Psychiatry, SNU SMG Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In Won Chung
- Department of Psychiatry and Yong-In Psychiatric Institute Yong-In Mental Hospital, Yongin, Republic of Korea
| | - Yong Sik Kim
- Department of Psychiatry, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Seong Hoon Jeong
- Department of Psychiatry, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
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Wright AC, Palmer-Cooper E, Cella M, McGuire N, Montagnese M, Dlugunovych V, Liu CWJ, Wykes T, Cather C. Experiencing hallucinations in daily life: The role of metacognition. Schizophr Res 2024; 265:74-82. [PMID: 36623979 DOI: 10.1016/j.schres.2022.12.023] [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: 08/28/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hallucinations have been linked to failures in metacognitive reflection suggesting an association between hallucinations and overestimation of performance, although the cross-sectional findings are inconsistent. This inconsistency may relate to the fluctuating hallucinatory experiences that are not captured in cross-sectional studies. Ecological Momentary Assessment (EMA) captures in-the-moment experiences over time so can identify causal relationships between variables such as the associations between metacognition and hallucinatory experience in daily life and overcome problems in cross-sectional designs. METHODS Participants (N = 41) experiencing daily hallucinations completed baseline questionnaires and smartphone surveys 7 times per day for 14 days. They were prompted to identify a task they would complete in the next 4 h and to make metacognitive predictions around the likelihood of completing the task, the difficulty of the task, and how well they would complete it (standard of completion). RESULTS 76 % finished the 14-days of assessment with an average of 42.2 % survey completion. Less accurate metacognition was associated with more hallucinations, but less accurate likelihood and standard of completion was associated with fewer hallucinations. Using a cross-lagged analysis, metacognitive predictions around the likelihood of completion (p < .001) and standard of completion (p = .01) predicted hallucination intensity at the following timepoint, and metacognitive predictions regarding likelihood of completion (p = .02) predicted hallucination control at the following timepoint. DISCUSSION Interventions that aim to improve metacognitive ability in-the-moment may serve to reduce the intensity and increase the control of hallucinations.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emma Palmer-Cooper
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Nicola McGuire
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marcella Montagnese
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Chih-Wei Joshua Liu
- Physics of Living Systems Group, Department of Physics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Martin S. Why using “consciousness” in psychotherapy? Insight, metacognition and self-consciousness. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2023.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Köktaş NÇ, Yiğitoğlu GT, Kenar ANİ. The effect of interpersonal relations theory-based motivational interviews on functional remission and insight levels of patients with schizophrenia: A randomized controlled trial. Arch Psychiatr Nurs 2023; 45:72-79. [PMID: 37544705 DOI: 10.1016/j.apnu.2023.04.018] [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: 03/19/2022] [Revised: 12/31/2022] [Accepted: 04/30/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Using therapeutic techniques and conducting motivational interviews in communication with patients with schizophrenia increases individuals' functional remission, insight, and motivation levels. AIM This single-blind, randomized controlled study examines the effect of Interpersonal Relations Theory-Based motivational interviews on functional remission and insight levels in patients with schizophrenia. METHODS The participants of this study were 40 patients with schizophrenia randomly assigned to either the experimental or control groups (20 in each group). The researchers carried out a 6-session Interpersonal Relations Theory-based motivational interview with the participants in the experimental group. Study data were collected using a demographic questionnaire, the Functional Remission of General Schizophrenia Scale (FROGS), and the Scale for Assessing the Three Components of Insight (SAI). RESULTS Social Functioning, Health and Treatment, Daily Living Skills, and SAI scores of the individuals in the intervention group were statistically higher than those in the control group (p < 0.05) in the post-intervention and follow-up measures. There was a positive and significant correlation between the post-intervention Social Functioning, Health and Treatment, Daily Life Skills, and total FROGS scores and the SAI score of the individuals in the intervention group (p < 0.05). CONCLUSIONS It was concluded that motivational interviews based on Interpersonal Relations Theory were effective in increasing the insights and functionality of patients with schizophrenia. Psychiatric nurses' practice of motivational interviews based on the therapeutic relationship is considered to increase the quality of care and satisfaction of patients with schizophrenia. It is recommended that this practice be used extensively in clinical practice.
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Affiliation(s)
- Nesrin Çunkuş Köktaş
- Department of Psychiatric Nursing, Faculty of Health Science, Pamukkale University, Denizli, Turkey.
| | - Gülay Taşdemir Yiğitoğlu
- Department of Psychiatric Nursing, Faculty of Health Science, Pamukkale University, Denizli, Turkey
| | - Ayşe Nur İnci Kenar
- Department of Psychiatric, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Gundogmus AG, Gerretsen P, Song J, Erdi Akdag F, Demirel C, Kokurcan A, Orsel S, Karadag H, Ozdel K. Insight in schizophrenia is associated with psychoeducation and social support: Testing a new more comprehensive insight tool in Turkish schizophrenia patients. PLoS One 2023; 18:e0288177. [PMID: 37418428 DOI: 10.1371/journal.pone.0288177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/20/2023] [Indexed: 07/09/2023] Open
Abstract
Insight is a continuous and multidimensional phenomenon, including awareness of having an illness, the presence of symptoms and accurate symptom attribution, the need for treatment, and the consequences of treatment. Good insight into illness is associated with better adherence to treatment, better cognitive, psychosocial, and vocational functioning along with less symptom severity, decreased relapses, and hospitalizations. Several tools are used for insight evaluation. We recruited 90 patients diagnosed with schizophrenia and analyzed the forms of 58 patients. The patients completed the VAGUS-SR (self-rated), Beck Cognitive Insight Scale, Knowledge About Schizophrenia Questionnaire, and Multidimensional Scale of Perceived Social Support (MSPSS). Clinicians performed a mental status examination and completed the Positive and Negative Syndrome Scale, Schedule for the Assessment of Insight, VAGUS-CR (clinician-rated), Calgary Depression Scale for Schizophrenia, and Clinical Global Impressions. We found that the level of insight evaluated using the VAGUS forms increased with knowledge regarding schizophrenia. Upon investigating the relationship between perceived social support and insight, we identified a relationship between VAGUS-CR and only significant other subscales of MSPSS, and between one of the VAGUS-SR scale sub-dimensions and significant other and total scores of MSPSS. Our findings also suggest that the VAGUS-SR and VAGUS-CR scales can be used to evaluate insight in Turkish populations. The positive relationship between perceived social support and insight emphasizes the importance of increasing social support through interventions aimed at improving insight. Our data also highlighted the value of psychoeducational studies in this patient group. Considering the multidimensional effects of insight on patients with schizophrenia, it would be beneficial to use scales such as VAGUS, which allow the insights of individuals to be evaluated in detail by both the clinician and the patient.
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Affiliation(s)
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jianmeng Song
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Funda Erdi Akdag
- Department of Psychiatry, Bergama Necla-Mithat Ozture State Hospital, Izmir, Turkey
| | - Cagri Demirel
- Department of Psychiatry, Ankara Etlik City Hospital, Ankara, Turkey
| | - Ahmet Kokurcan
- Department of Psychiatry, University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Sibel Orsel
- Department of Psychiatry, Ankara Etlik City Hospital, Ankara, Turkey
| | - Hasan Karadag
- Department of Psychiatry, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Kadir Ozdel
- Department of Psychiatry, Ankara Etlik City Hospital, Ankara, Turkey
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Beainy C, Haddad C, Fekih-Romdhane F, Hallit S, Haddad G. Decreased insight, but not self-stigma or belief about medicine, is associated with greater severity of delusions in a sample of long-stay patients with schizophrenia: a cross-sectional study. BMC Psychiatry 2023; 23:222. [PMID: 37013492 PMCID: PMC10069113 DOI: 10.1186/s12888-023-04711-1] [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: 08/26/2022] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND There are, to date, limited and inconsistent findings concerning the relationship between insight and psychotic symptoms, despite some evidence in favor of the clinical and therapeutic relevance of the insight construct. We aimed to add to the pool of the available data in this area, by examining the correlations between the severity of insight and positive psychotic symptoms (delusions and auditory hallucinations), while accounting for self-stigma and attitudes towards medication, in a sample of long-stay inpatients with schizophrenia. METHODS A cross-sectional study was conducted at the Psychiatric Hospital of the Cross, between July and October 2021. A total of 82 patients diagnosed with schizophrenia (aged 55.55 ± 10.21 years, 54.9% males) were enrolled. The semi-structured psychotic symptom rating scales, the Birchwood Insight Scale, the Belief About Medicine Questionnaire, and the Internalized Stigma of Mental Illness were used. RESULTS The mean duration of illness in years was 30.15 ± 11.73, and the mean duration of hospitalization in years was 17.56 ± 9.24. Sixteen out of the 82 patients (19.5%) were considered as having poor insight. Bivariate analyses showed that higher chlorpromazine equivalent dose was significantly associated with more delusions, whereas higher insight was significantly associated with lower delusions. Multivariable analyses revealed that Higher chlorpromazine equivalent dose (Beta = 0.004) was significantly associated with more delusions, whereas higher insight (Beta = - 0.89) was significantly associated with less delusions. No significant associations were found between insight, self-stigma and hallucinations. CONCLUSION Our results imply that more impaired insight is associated with greater severity of delusions, above and beyond the effects of self-stigma and medication doses. These findings are valuable to aid clinicians and researchers improve their understanding of the relationship insight-psychotic symptoms, and could help personalize prevention and early intervention strategies in schizophrenia.
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Affiliation(s)
| | - Chadia Haddad
- Research and Psychiatry Departments, Psychiatric Hospital of the Cross, P.O. Box 60096, Jall-Eddib, Lebanon.
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie- Liban), Beirut, Lebanon.
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon.
- School of Medicine, Lebanese American University, Byblos, Lebanon.
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, 2010, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Souheil Hallit
- Research and Psychiatry Departments, Psychiatric Hospital of the Cross, P.O. Box 60096, Jall-Eddib, Lebanon
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Georges Haddad
- Research and Psychiatry Departments, Psychiatric Hospital of the Cross, P.O. Box 60096, Jall-Eddib, Lebanon
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
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P50 sensory gating, cognitive deficits and depressive symptoms in first-episode antipsychotics-naïve schizophrenia. J Affect Disord 2023; 324:153-161. [PMID: 36587903 DOI: 10.1016/j.jad.2022.12.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Sensory gating P50 (SG-P50) may be involved in the pathophysiological mechanisms of impaired cognition in schizophrenia (SCZ). Comorbid depressive symptoms are common in SCZ patients and are also found to be associated with their cognitive impairment. However, it is unclear whether SG-P50 is abnormal in first episode antipsychotics naïve (FEAN) SCZ patients with depressive symptoms. Our aimed to investigate the relationships between SG-P50, depressive symptoms and neurocognition in FEAN-SCZ patients. METHODS We recruited 103 FEAN-SCZ patients (depression: n = 63; non-depression: n = 40) and 55 healthy controls. SG-P50 was measured using the standard auditory dual-click (S1&S2) paradigm. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Hamilton Depression Rating Scale-17 (HDRS-17). Cognitive performance was evaluated using the MATRICS Consensus Cognitive Battery (MCCB). RESULTS Compared with non-depressive patients, depressive patients had a significantly larger S2 amplitude (p = 0.005) and a higher S2/S1 ratio at trend level (p = 0.075) after corrected. There were significant differences in the scores of CPT-IP and Mazes (NAB) between depressive and non-depressive FEAN-SCZ patients (both p values < 0.05). For all patients, the SG-P50 S2/S1 ratio was significantly correlated with HDRS-17 score (r = 0.23, p = 0.020) and MCCB-Symbol coding (r = -0.16, p = 0.043). For depressive FEAN-SCZ patients, S2 amplitude was an independent predictor of the MCCB-Mazes (NAB) (β = -0.31, t = -2.52, p = 0.015). CONCLUSIONS SG-P50 deficit may be an informational biomarker for depressive symptoms and neurocognitive impairments in FEAN-SCZ patients.
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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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Bushuven S, Trifunovic-Koenig M, Bentele M, Bentele S, Strametz R, Klemm V, Raspe M. Self-Assessment and Learning Motivation in the Second Victim Phenomenon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16016. [PMID: 36498086 PMCID: PMC9736892 DOI: 10.3390/ijerph192316016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The experience of a second victim phenomenon after an event plays a significant role in health care providers' well-being. Untreated; it may lead to severe harm to victims and their families; other patients; hospitals; and society due to impairment or even loss of highly specialised employees. In order to manage the phenomenon, lifelong learning is inevitable but depends on learning motivation to attend training. This motivation may be impaired by overconfidence effects (e.g., over-placement and overestimation) that may suggest no demand for education. The aim of this study was to examine the interdependency of learning motivation and overconfidence concerning second victim effects. METHODS We assessed 176 physicians about overconfidence and learning motivation combined with a knowledge test. The nationwide online study took place in early 2022 and addressed about 3000 German physicians of internal medicine. Statistics included analytical and qualitative methods. RESULTS Of 176 participants, 83 completed the assessment. Analysis showed the presence of two overconfidence effects and in-group biases (clinical tribalism). None of the effects correlated directly with learning motivation, but cluster analysis revealed three different learning types: highly motivated, competent, and confident "experts", motivated and overconfident "recruitables", and unmotivated and overconfident "unawares". Qualitative analysis revealed four main themes: "environmental factors", "emotionality", "violence and death", and "missing qualifications" contributing to the phenomenon. DISCUSSION We confirmed the presence of overconfidence in second victim management competencies in about 3% of all persons addressed. Further, we could detect the same three learning motivation patterns compared to preceding studies on learning motivation in other medical competencies like life support and infection control. These findings considering overconfidence effects may be helpful for safety managers, medical teachers, curriculum developers and supervisors to create preventive educational curricula on second victim recognition and management.
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Affiliation(s)
- Stefan Bushuven
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, 78262 Gailingen, Germany
- Institute for Medical Education, University Hospital, LMU Munich, 80336 Munich, Germany
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Milena Trifunovic-Koenig
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, 78262 Gailingen, Germany
- Training Center for Emergency Medicine (NOTIS e.V.), 78234 Engen, Germany
| | - Michael Bentele
- Training Center for Emergency Medicine (NOTIS e.V.), 78234 Engen, Germany
- Institute for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau-Bodensee Hospital Singen, 78224 Singen, Germany
| | - Stefanie Bentele
- Training Center for Emergency Medicine (NOTIS e.V.), 78234 Engen, Germany
- Department of Emergency Medicine, University-Hospital Augsburg, University of Augsburg, 86156 Augsburg, Germany
| | - Reinhard Strametz
- Wiesbaden Business School, Rhein Main University of Applied Sciences, 65183 Wiesbaden, Germany
| | - Victoria Klemm
- Wiesbaden Business School, Rhein Main University of Applied Sciences, 65183 Wiesbaden, Germany
| | - Matthias Raspe
- Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Webster L, Norman C, Jones G, Marriott M. Mediating role for metacognitive processes in the relationship between schizotypy and anxiety and depression symptoms. Cogn Neuropsychiatry 2022; 27:393-410. [PMID: 35975632 DOI: 10.1080/13546805.2022.2108388] [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] [Indexed: 01/31/2023]
Abstract
Introduction: Depression and anxiety symptoms are highly prevalent in schizophrenia-spectrum disorders and are commonly associated with schizotypy in non-clinical samples. However, it remains unclear what factors could be contributing to the relationships between schizotypy and anxiety and depression symptoms. Using path analysis, we explored the complex interplay between schizotypy, metacognitive beliefs, cognitive insight, and symptoms of emotional distress.Methods: Self-report data of schizotypy, metacognitive beliefs, cognitive insight, depression, and anxiety symptoms were collected from 344 participants from a predominantly student sample.Results: Path analysis confirmed unique associations between schizotypy dimensions, metacognitive beliefs, and cognitive insight. Furthermore, negative beliefs about worry mediated the link between the schizotypy dimensions, unusual experiences, cognitive disorganisation, and introvertive anhedonia and both depression and anxiety symptoms. Lack of cognitive confidence also mediated the relationship between cognitive disorganisation and depression symptoms. Finally, the cognitive insight subcomponent self-reflectiveness mediated the relationship between unusual experiences and cognitive disorganisation and anxiety.Conclusions: This study significantly furthers our understanding of the complex relationship between schizotypy, metacognitive processes, and emotional distress. Our findings also provide support for interventions which modify metacognitive beliefs and self-reflectiveness, which may prove beneficial for treatment in clinical settings.
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Affiliation(s)
- Lucy Webster
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Christine Norman
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Gary Jones
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Mike Marriott
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
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Lysaker PH, Weiden PJ, Sun X, O’Sullivan AK, McEvoy JP. Impaired insight in schizophrenia: impact on patient-reported and physician-reported outcome measures in a randomized controlled trial. BMC Psychiatry 2022; 22:574. [PMID: 36031632 PMCID: PMC9420291 DOI: 10.1186/s12888-022-04190-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/21/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Impaired insight poses a challenge in the treatment of patients with schizophrenia because of its potential to jeopardize therapeutic engagement and medication adherence. This study explored how insight impairment, graded from none to extreme, is related to patient-reported mental health status, depression, and neurocognition in schizophrenia. METHODS In a post hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study (NCT00014001), insight was measured using the Positive and Negative Syndrome Scale (PANSS) Item G12 (lack of insight). Additional assessments for this analysis included the 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS), physician- and patient-reported Clinical Global Impression-Severity (CGI-S), MATRICS Consensus Cognitive Battery, and Calgary Depression Scale for Schizophrenia. Relationships between patient-reported outcomes and PANSS total and Item G12 ratings were evaluated. RESULTS Among 1431 CATIE study participants in this analysis, increasingly impaired insight at baseline was significantly associated with better patient-reported quality of life (QoL), lower baseline depression, and greater divergence between physician- and patient-reported illness severity. Patients with more severely impaired insight reported milder illness compared with physician reports, particularly those with moderate-severe to extreme impairment (PANSS Item G12 rating ≥ 5), approximately 10% (138/1431) of CATIE participants. For the 90% of patients with PANSS Item G12 ratings < 5, patient-reported QoL decreased with increasing symptoms. SF-12 MCS scores were linearly related to baseline PANSS total score only in patients with PANSS total score < 90 (moderately ill or better), and better symptom scores were associated with higher QoL. No significant relationship between insight and neurocognition was observed. CONCLUSIONS In the small subgroup (10%) of CATIE study patients with schizophrenia and PANSS Item G12 ratings ≥5, moderate-severe-severe/extreme insight impairment was associated with significantly more positive perception of QoL and illness severity by the patient versus the treating physician. This was not observed in the remaining 90% of patients with normal to moderately impaired insight, suggesting that poor insight as a threat to the validity of self-report is uncommon.
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Affiliation(s)
- Paul H. Lysaker
- grid.280828.80000 0000 9681 3540Richard L. Roudebush VA Medical Center and Indiana University School of Medicine, 1481 West 10th Street, Indianapolis, IN 46202 USA
| | - Peter J. Weiden
- grid.422303.40000 0004 0384 9317Alkermes, Inc., Waltham, MA USA
| | - Xiaowu Sun
- grid.422303.40000 0004 0384 9317Alkermes, Inc., Waltham, MA USA
| | | | - Joseph P. McEvoy
- grid.410427.40000 0001 2284 9329Psychiatry and Health Behavior at Augusta University, Augusta, GA USA
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12
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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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13
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Xu L, Cui H, Wei Y, Qian Z, Tang X, Hu Y, Wang Y, Hu H, Guo Q, Tang Y, Zhang T, Wang J. Relationships between self-reflectiveness and clinical symptoms in individuals during pre-morbid and early clinical stages of psychosis. Gen Psychiatr 2022; 35:e100696. [PMID: 35721834 PMCID: PMC9161056 DOI: 10.1136/gpsych-2021-100696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Self-reflectiveness, one dimension of cognitive insight, plays a protective role in an individual's mental state. Both high and low levels of self-reflectiveness have been reported in patients with schizophrenia and individuals at clinical high risk for the illness. Aims This study aimed to explore the relationship patterns between self-reflectiveness and clinical symptoms in individuals during the pre-morbid and early clinical stages of psychosis. Methods A total of 181 subjects, including individuals with attenuated positive symptoms (APS, n=122) and patients with first-episode psychosis (FEP, n=59), completed the Beck Cognitive Insight Scale and were evaluated using the Schedule of Assessment of Insight and Positive and Negative Syndrome Scale. All subjects were classified into three groups according to their level of self-reflectiveness: low level (LSR, n=59), medium level (MSR, n=67) and high level (HSR, n=55). Both linear and non-linear relationships between self-reflectiveness and clinical symptoms were explored. Results More individuals with APS were classified into the MSR group, while more patients with FEP were classified into the LSR group. The LSR group demonstrated less awareness of illness than the MSR and HSR groups, more stereotyped thinking and poorer impulse control but less anxiety than the MSR group, and lower levels of blunted affect and guilt feelings than the HSR group. The MSR group demonstrated lower stereotyped thinking than the HSR group. Compared to the LSR group, the MSR group had increased self-reflectiveness, improved awareness of illness, decreased stereotyped thinking, and better impulse control, but increased feelings of guilt. The HSR group showed increased stereotyped thinking when compared to the MSR group, but the other variables did not change significantly between these two groups. Overall, self-reflectiveness demonstrated an approximately inverse S-shaped relationship with the awareness of illness, a U-shaped relationship with stereotyped thinking and poor impulse control, and an almost linear relationship with anxiety and guilt feelings. Conclusions Self-reflectiveness demonstrates complex relationships with clinical symptoms and fails to exert significant positive effects when reaching a certain high level.
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Affiliation(s)
- Lihua Xu
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiru Cui
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanyan Wei
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenying Qian
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochen Tang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yegang Hu
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingchan Wang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Hu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Guo
- Department of Early Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Tang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianhong Zhang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jijun Wang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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14
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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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15
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Oliveira ICD, Rocha Neto HG, Nascimento I, Pinto VAM, Appolinario JC, Cavalcanti MT. Patients and physician’s self-assessment regarding clinical stability in severe mental disorders: a cross-sectional study. JORNAL BRASILEIRO DE PSIQUIATRIA 2022. [DOI: 10.1590/0047-2085000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective This study explores the relationship between patients’ self-assessment and physicians’ evaluation regarding clinical stability. Methods This cross-sectional study was carried out at the general outpatient clinic of the Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) in a large sample (1,447) of outpatients, of which 67.9% were patients with severe mental disorders (SMD). We collected information using a structured questionnaire developed for this purpose, filled in by the patient’s physician. Clinical stability was assessed by means of five psychiatric instability criteria and by the physician’s global clinical impression over the six previous months. The patients’ self-assessment was based on a question about how they evaluated their health status: stable/better, worse, does not know. For the analyses, patients’ self-evaluation was considered as our standard. Results The sample was composed of 824 (57%) women with an average age of 49 years. The most prevalent diagnoses within the SMD category corresponded to 937 patients, of whom 846 (90.3%) assessed themselves as stable/better. The physicians’ evaluations agreed more with patients with bipolar disorders and less with schizophrenics regarding stability. As for patients with depressive disorder, physicians agreed more with them regarding instability. Conclusion The data analysis confirms our hypothesis that the self-assessment made by patients with SMD was accurate regarding their health condition, and that the self-assessment made by patients who considered themselves stable agree with the physicians’ evaluation.
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Affiliation(s)
| | - Helio G. Rocha Neto
- Federal University of Rio de Janeiro, Brazil; University of Lisbon, Portugal
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16
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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. Corrigendum: Relationship Between Cognitive and Clinical Insight at Different Durations of Untreated Attenuated Psychotic Symptoms in High-Risk Individuals. Front Psychiatry 2022; 13:839315. [PMID: 35211047 PMCID: PMC8861634 DOI: 10.3389/fpsyt.2022.839315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyt.2021.753130.].
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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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17
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Capdevielle D, Norton J, Aouizerate B, Berna F, Chereau I, D'Amato T, Dubertret C, Dubreucq J, Fond G, C L, Mallet J, Misdrahi D, Passerieux C, Rey R, Schurhoff F, Urbach M, Llorca PM, Raffard S. Comparison of three scales (BIS, SUMD and BCIS) for measuring insight dimensions and their evolution after one-year of follow-up: Findings from the FACE-SZ Cohort. Psychiatry Res 2021; 303:114044. [PMID: 34161854 DOI: 10.1016/j.psychres.2021.114044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/30/2021] [Indexed: 11/18/2022]
Abstract
The aim of our study was to compare the performance of three different instruments measuring clinical and cognitive dimensions of insight. Data on 182 outpatients with schizophrenia and one-year follow-up assessments was drawn from the FACE-SZ cohort. Awareness of clinical state (« clinical insight ») was measured using both a clinician-rated measure (the Scale to assess Unawareness of Mental Disorder (SUMD)), and a self-report measure (the Birchwood Insight Scale (BIS). Cognitive insight was measured using a self-report measure (the Beck Cognitive Insight Scale (BCIS)). For each scale, change in insight was examined at the follow-up. Correlations between SUMD and BIS subscales measuring same dimensions were significant. BIS-BCIS correlations were weak for all combinations except between BIS illness dimension and BCIS composite score. At the follow-up, BIS and SUMD awareness of treatment need improved whereas illness and symptom awareness increased only on the SUMD. Conversely, cognitive insight composite scores decreased. Despite relatively good overall agreement between the two clinical insight instruments, considerable variability for similar insight dimensions measured by different instruments was found. Agreement between cognitive and clinical insight is moderate. Our study strengthens the argument that insight is harder to operationalize than other symptoms and may explain why it is so seldom explicitly targeted in schizophrenia treatment.
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Affiliation(s)
- Delphine Capdevielle
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHU Montpellier, Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.
| | - Joanna Norton
- University of Montpellier, Institute for Neurosciences of Montpellier (INM), INSERM, Montpellier, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; Bordeaux Sleep Clinique, Pellegrin University Hospital, Bordeaux University, USR CNRS 3413 SANPSY, Research Unit, 33000 Bordeaux, France; Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, F-33000 Bordeaux, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France; Clermont-Ferrand University Hospital, EA 7280 Auvergne University, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - Thierry D'Amato
- Fondation FondaMental, Créteil, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894, Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - Julien Dubreucq
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Guillaume Fond
- Fondation FondaMental, Créteil, France; AP-HM, la Conception Hospital, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Lançon C
- Fondation FondaMental, Créteil, France; Pôle psychiatrie universitaire, CHU Sainte-Marguerite, F-13274 Marseille cedex 09, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894, Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Charles Perrens Hospital, F-33076 Bordeaux; University of Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France
| | - Catherine Passerieux
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - Romain Rey
- Fondation FondaMental, Créteil, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - Franck Schurhoff
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94000 Créteil, France
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France; Clermont-Ferrand University Hospital, EA 7280 Auvergne University, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - Stéphane Raffard
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHU Montpellier, Montpellier, France; Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA, Montpellier, France
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18
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Measuring the effectiveness of psychoeducation on adherence, depression, anxiety and stress among patients with diagnosis of schizophrenia. a control trial. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00255-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AbstractDespite evidence of the impact of depression and stress on attitudes towards medication in general medical pathology regimens, little is known of the effects of depression and stress on attitudes towards medication in schizophrenia. This study explores the effects of a hope-based psychoeducation on attitudes towards medication, depression, anxiety and stress, and predictors of attitudes towards medication. The participants in the study (n = 29) were randomly allocated to either the psychoeducation group or the control group. Results from the psychoeducation group revealed that attitudes towards medication were significantly improved and anxiety was significantly reduced. Given the small sample, which was recruited from among patients of a day mental health centre, findings should be interpreted tentatively. Being longer in pharmacotherapy, having experienced fewer occurrences of hospitalisation, and being less depressed predicted positivity towards medication. Patients in the control group did not exhibit significant change in any of the studied variables. Findings were interpreted in the light of research on stigma and insight into illness, and add modestly to literature arguing for the importance of patients’ retention of hope, empowerment and sense of control over illness. This study proposed that psychoeducation is an appropriate intervention to address a wide range of factors that compound adherence to medication and patients’ symptoms, such as patients’ interpretations of causal models, their sense of hope and control over the illness, and their insight into illness and self-stigma.
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Raftery D, Kelly PJ, Deane FP, Carter G, Dean OM, Lubman DI, Turner A, McKetin R. Cognitive insight, medication adherence and methamphetamine cessation in people enrolled in a pharmacotherapy trial for methamphetamine use. J Subst Abuse Treat 2021; 130:108473. [PMID: 34118709 DOI: 10.1016/j.jsat.2021.108473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The current study examined correlates of cognitive insight in people enrolled in a methamphetamine pharmacotherapy trial; whether cognitive insight at the start of the trial predicted medication adherence and reductions in methamphetamine use during the trial; and, whether insight would remain stable over the trial or improve with reductions in methamphetamine use. METHODS A subset of people enrolled in a 12-week randomised placebo-controlled pharmacotherapy trial for methamphetamine dependence completed the Beck Cognitive Insight Scale, comprising subscales for Self-Reflection and Self-Certainty, at baseline (n = 152) and at week 12 (n = 79). Medication adherence was expressed as the percentage of non-missed doses measured using eCAP™ technology. Methamphetamine use days were assessed using the Timeline Followback. RESULTS At baseline, greater Self-Reflection was correlated with more severe methamphetamine withdrawal, and hostility, whereas Self-Certainty was correlated with less education and longer duration of methamphetamine use. No relationship was found between BCIS subscales at baseline and medication adherence (Self-Reflection b[SE] = -0.73 [0.43] p = .09; Self-Certainty b[SE] = -0.31 [0.48] p = .52,). Neither BCIS subscale was predictive of reduced methamphetamine use at 12 weeks (Self-Reflection b[SE] = 0.001 [0.01] p = .95 Self-Certainty b[SE] = -0.003 [0.01], p = .74). Self-Reflection decreased over the trial (t = 3.42, p = .001) but this was unrelated to change in methamphetamine use (Self-Reflection, b[SE] = -1.68 [1.16] p = .15) Change in methamphetamine use was found to be a significant predictor of Self-Certainty at 12 weeks (b [SE] = -2.71 [1.16] p = .02). CONCLUSIONS We found no evidence that cognitive insight predicted medication adherence or methamphetamine reduction in people engaged in this trial. Ongoing or increased methamphetamine use predicted increased Self-Certainty at 12 weeks.
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Affiliation(s)
- Dayle Raftery
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia.
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia
| | - Gregory Carter
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, Australia
| | - Olivia M Dean
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Richmond, Australia
| | - Alyna Turner
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, Australia; Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Geelong, Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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20
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Ma S, Yang J, Yang B, Kang L, Wang P, Zhang N, Wang W, Zong X, Wang Y, Bai H, Guo Q, Yao L, Fang L, Liu Z. The Patient Health Questionnaire-9 vs. the Hamilton Rating Scale for Depression in Assessing Major Depressive Disorder. Front Psychiatry 2021; 12:747139. [PMID: 34803766 PMCID: PMC8599822 DOI: 10.3389/fpsyt.2021.747139] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The Hamilton Rating Scale for Depression (HAMD-17) has been used for several decades to assess the severity of depression. Multiple studies have documented defects in this scale and deemed it unsuitable for clinical evaluation. The HAMD-6, which is the abbreviated version of HAMD-17, has been shown to be effective in assessing the core symptoms of depression with greater sensitivity than HAMD-17. And the Patient Health Questionnaire-9 (PHQ-9) is suggested as an effective alternative to the HAMD-17 because of its simplicity and ease-of-use. Methods: Research was completed involving 1,741 participants having major depressive disorder. Cronbach's alpha, intraclass correlation coefficient (ICC) and weighted Kappa analysis was used to determine the reliability of the scales. Pearson correlation analysis and factor analysis were used to analyze validity. Item response theory (IRT) was used to analyze psychological characteristics of items in both the HAMD-17 and PHQ-9. Results: Reliability analysis showed that the Cronbach's alpha of the HAMD-17, HAMD-6 and PHQ-9 were 0.829, 0.764, and 0.893 respectively, and the ICC of the three scales ranged from 0.606 to 0.744. The Kappa score of the consistency of depression severity assessment was 0.248. Validity analysis showed that the PHQ-9 was a single factor structure, and the total score of the scale was strongly correlated with the HAMD-17 (r = 0.724, P < 0.001). The IRT analysis showed that the discrimination parameters of the PHQ-9 were higher than that of the HAMD-17 in all dimensions. The HAMD-6 had the lowest measurement accuracy in distinguishing the severity of depression, while the PHQ-9 had the highest measurement accuracy. Conclusion: Results showed that the PHQ-9 was satisfactory in terms of reliability, validity and distinguishing the severity of depression. It is a simple, rapid, effective and reliable tool which can be used as an alternative to the HAMD-17 to assess the severity of depression.
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Affiliation(s)
- Simeng Ma
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Yang
- School of Information Engineering, Wuhan University of Technology, Wuhan, China
| | - Bingxiang Yang
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Lijun Kang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Peilin Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Nan Zhang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaofen Zong
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ying Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hanping Bai
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qingshan Guo
- Department of Psychiatry, Jingmen No. 2 People's Hospital, Jingmen, China
| | - Lihua Yao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Fang
- Department of Psychiatry, Jingmen No. 2 People's Hospital, Jingmen, China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
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21
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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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22
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Kim JH, Son YD, Kim HK, Kim JH. Association Between Lack of Insight and Prefrontal Serotonin Transporter Availability in Antipsychotic-Free Patients with Schizophrenia: A High-Resolution PET Study with [ 11C]DASB. Neuropsychiatr Dis Treat 2021; 17:3195-3203. [PMID: 34707358 PMCID: PMC8544267 DOI: 10.2147/ndt.s336126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/08/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Previous studies suggested a link between serotonergic neurotransmission and impaired insight in schizophrenia. In this study, we examined the relationship between serotonin transporter (SERT) availability in regions of the prefrontal cortex (dorsolateral, ventrolateral, ventromedial, and orbitofrontal cortices) and insight deficits in antipsychotic-free patients with schizophrenia using high-resolution positron emission tomography (PET) with [11C]DASB. METHODS Nineteen patients underwent [11C]DASB PET and 7-Tesla magnetic resonance imaging scans. To assess SERT availability, the binding potential with respect to non-displaceable compartment (BPND) was derived using the simplified reference tissue model. Patients' level of insight was assessed using the Insight and Treatment Attitude Questionnaire (ITAQ). The relationship between ITAQ scores and [11C]DASB BPND values was examined using the region-of-interest (ROI)- and voxel-based analyses with relevant variables as covariates. The prefrontal cortex and its four subregions were selected as a priori ROIs since the prefrontal cortex has been implicated as the critical neuroanatomical substrate of impaired insight in schizophrenia. RESULTS The ROI-based analysis revealed that the ITAQ illness insight dimension had significant negative correlations with the [11C]DASB BPND in the left dorsolateral, left orbitofrontal, and bilateral ventrolateral prefrontal cortices. The ITAQ treatment insight dimension had significant negative correlations with the [11C]DASB BPND in the bilateral dorsolateral, left orbitofrontal, and bilateral ventrolateral prefrontal cortices. The ITAQ total score showed significant negative correlations with the [11C]DASB BPND in the bilateral prefrontal cortex and three subregions (dorsolateral, ventrolateral, and orbitofrontal cortices). A supplementary voxel-based analysis corroborated a significant negative association between the ITAQ score and the [11C]DASB BPND in the prefrontal cortices. CONCLUSION Our study provides in vivo evidence of significant negative correlations between insight deficits and prefrontal SERT availability in patients with schizophrenia, suggesting significant involvement of prefrontal serotonergic signaling in impaired insight, one of the core symptoms of schizophrenia.
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Affiliation(s)
- Jeong-Hee Kim
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea.,Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, Republic of Korea
| | - Young-Don Son
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea.,Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, Republic of Korea.,Gachon Advanced Institute for Health Sciences & Technology, Gachon University, Incheon, Republic of Korea
| | - Hang-Keun Kim
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea.,Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, Republic of Korea.,Gachon Advanced Institute for Health Sciences & Technology, Gachon University, Incheon, Republic of Korea
| | - Jong-Hoon Kim
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea.,Gachon Advanced Institute for Health Sciences & Technology, Gachon University, Incheon, Republic of Korea.,Department of Psychiatry, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
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23
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Rhee TG, Mohamed S, Rosenheck RA. Stages of major depressive disorder and behavioral multi-morbidities: Findings from nationally representative epidemiologic study. J Affect Disord 2021; 278:443-452. [PMID: 33010569 DOI: 10.1016/j.jad.2020.09.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To present a three stage-model of major depressive disorder (MDD) and evaluate differences in behavioral histories/experiences and multi-morbidities between stages. METHODS We used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative cross-sectional survey of US adults (n = 36,309). Based on DSM-5 diagnostic criteria, we identified and compared three groups of adults with MDD histories: 1) new onset MDD (n = 509; 5.6%); 2) chronic MDD (n = 3,871; 46.1%); and 3) recovered from MDD (n = 3,673; 48.3%). Multivariable analyses tested independent group differences in behavioral histories/experiences and diagnostic multi-morbidities between 1) recovered MDD vs. new onset MDD; 2) chronic MDD vs. new onset MDD; and 3) recovered MDD vs. chronic MDD. RESULTS Adults who have recovered from MDD as compared to those with chronic MDD were 2.5 times more likely to have recovered from two or more psychiatric disorders in addition to MDD (95% confidence intervals [CI]=1.76-3.61) and from alcohol use disorder (adjusted odds ratio [AOR]=1.28; 95% CI=1.08-1.52). They were also less likely than those with chronic MDD to have borderline personality disorder (p<0.001), pain (p<0.001), or medical co-morbidity (p = 0.003). Adults with new onset MDD were younger than other groups, and more likely than those who have recovered to have borderline personality disorder and concurrent psychiatric or substance use disorders (p<0.05 for all). CONCLUSION Behavioral histories/experiences and multi-morbidities differ significantly across stages of MDD. These concurrent problems may impede recovery and foster chronicity and should therefore be an integral focus of treatment.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, United States of America; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States of America; Mental Illness Research, Education and Clinical Center of New England, US Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America.
| | - Somaia Mohamed
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States of America; Mental Illness Research, Education and Clinical Center of New England, US Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
| | - Robert A Rosenheck
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States of America; Mental Illness Research, Education and Clinical Center of New England, US Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
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24
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Martin S, Graziani P, Del-Monte J. Insight's level in borderline personality disorder, questioning consciousness. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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25
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Exploring the relationship of insight with psychopathology and gender in individuals with schizophrenia spectrum disorders with structural equation modelling. Arch Womens Ment Health 2020; 23:643-655. [PMID: 32385644 DOI: 10.1007/s00737-020-01031-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 04/07/2020] [Indexed: 12/18/2022]
Abstract
To model the influence of psychopathology on insight deficits in schizophrenia spectrum patients with a gender-stratified analysis. Five hundred sixteen patients (65.1% men) with schizophrenia spectrum disorders were evaluated in four centres of the metropolitan area of Barcelona (Catalonia). Psychopathological assessment was performed using different PANSS factors. Insight and its three main dimensions were assessed by means of the Scale of Unawareness of Mental Disorder: awareness of the disease (SUMD-1), of the effect of medication (SUMD-2) and of the social consequences of the disease (SUMD-3). Structural equation models (SEMs) were used to fix the model in the total sample and by gender. Additional analyses included age, duration of illness (DOI) and education status (ES). There were no significant differences between men and women in the three main dimensions of insight. The SEMs in the total sample showed a modest fitting capacity. Fitting improved after a gender-stratified analysis (particularly in women). In men, positive and excited symptoms were associated with poorer insight in all SUMD dimensions, whereas depressive symptoms were associated with better insight. ES in men was also associated with better SUMD-2 or SUMD-3. In contrast, in women, symptoms did not have a negative effect on SUMD-1 or SUMD-2. However, positive symptoms were associated with a poorer SUMD-3, whereas depressive symptoms were associated with better SUMD-3. Moreover, education level was also associated with a better SUMD-3. A gender approach improved the comprehension of the model, supporting the relevance of gender analysis in the study of insight.
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26
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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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27
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García-Mieres H, De Jesús-Romero R, Ochoa S, Feixas G. Beyond the cognitive insight paradox: Self-reflectivity moderates the relationship between depressive symptoms and general psychological distress in psychosis. Schizophr Res 2020; 222:297-303. [PMID: 32518005 DOI: 10.1016/j.schres.2020.05.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND People with psychosis experience significant emotional burden and distress associated with the symptomatic consequences of their mental disorder, thus difficulting their recovery. Several studies have found self-reflectivity, a dimension of cognitive insight, to be associated with effects which taken together may seem paradoxical, by predicting less psychotic symptom severity but more depression. To elucidate this issue, we examined the influence of psychotic symptoms, depressive symptoms, and self-reflectivity, on psychological distress. Further, we tested whether self-reflectivity moderated the relationship between depressive symptoms and psychological distress. METHODS Seventy-six outpatients with psychotic-spectrum disorders were assessed using measures of psychotic symptoms, depressive symptoms, cognitive insight (i.e., self-reflectivity, self-certainty) and psychological distress. RESULTS A regression model revealed that depressive, positive symptoms and the interaction between depressive symptoms and self-reflectivity had a significant effect on psychological distress. The moderation analysis showed that higher levels of self-reflectivity were related to less psychological distress associated with depressive mood. CONCLUSIONS The role of self-reflectivity on depression and distress may be more complex than a direct effect. Interventions targeted to improve metacognition by enhancing self-reflectivity might be important for lowering the psychological distress associated with depressive symptoms in people with psychosis.
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Affiliation(s)
- Helena García-Mieres
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035, Barcelona, Spain; The Institute of Neurosciences, University of Barcelona, 08035, Barcelona, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
| | - Robinson De Jesús-Romero
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 47405, IN, United States
| | | | - Susana Ochoa
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Mental Health Networking Biomedical Research Centre, CIBERSAM, Madrid, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035, Barcelona, Spain; The Institute of Neurosciences, University of Barcelona, 08035, Barcelona, Spain
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Mindfulness-Based Interventions for People with Schizophrenia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134690. [PMID: 32629764 PMCID: PMC7369977 DOI: 10.3390/ijerph17134690] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/19/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022]
Abstract
(1) Background: There is increasing interest in the practice of mindfulness-based interventions (MBIs) to treat people with schizophrenia, as evidenced by the publication of different randomized controlled trials (RCTs). However, no meta-analysis of RCTs has been carried out to date with the exclusive inclusion of this type of interventions. (2) Objective: To analyze empirical evidence regarding the effectiveness of MBIs for the improvement of clinical parameters associated with schizophrenia. Method: A systematic review and meta-analysis was conducted of RCTs published in the databases PsycINFO, PubMed, WOS, and Cochrane Library. (3) Results: A total of 10 articles (n = 1094) fulfilled the criteria for inclusion in the review. The analysis of these studies suggests that MBIs combined with standard interventions are able to generate significant improvements in a variety of clinical schizophrenia-related parameters, such as the intensity of overall symptomatology (g = 0.72), positive symptoms (g = 0.32), negative symptoms (g = 0.40), functioning level (g = 1.28), and awareness of illness (g = 0.65). (4) Conclusions: There is evidence that supports the effectiveness and safety of MBIs for the treatment of people with schizophrenia. The results obtained by MBIs are comparable to those obtained by cognitive-behavioral therapy for psychosis. However, given the heterogeneity of the applied interventions and the methodological limitations found in the reviewed trials, the results should be interpreted with caution.
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Elowe J, Golay P, Baumann PS, Solida-Tozzi A, Conus P. Moderating role of cannabis use between insight and depression in early psychosis. Schizophr Res 2020; 215:61-65. [PMID: 31780343 DOI: 10.1016/j.schres.2019.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/02/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND A high level of insight in first episode psychosis (FEP) is positively correlated to important prognostic factors such as medication adherence and functional outcome but is associated with increased depression level and suicidal behavior. AIMS This is the first study questioning the potential moderating role of cannabis use in the relationship between insight and depression one year after a FEP. METHOD In this prospective observational study, we enrolled 214 FEP patients who had provided informed consent and been referred to a specialized early psychosis program and followed for 36 months. A series of multivariate regression models were used. Baseline insight, medication adherence and cannabis use (level of use on a continuum) were entered as independent variables, while the PANSS (positive and negative), the MADRS and the SOFAS scores after one year were alternately selected as the dependent variable. RESULTS We found a three-way interaction term between cannabis use, insight and medication adherence on depression level one year after the entry into the program. A high level of insight was significantly associated with higher MADRS scores in patients with high cannabis use, while depression decreased in high-insight patients with low cannabis use. CONCLUSIONS Cannabis use continuation during the year following a first episode psychosis may play a significant role in the development or the maintenance of post-psychotic depression in patients who present with high level of insight and adherence to medication, stressing the need for specific therapeutic strategies in this subgroup of patients.
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Affiliation(s)
- Julien Elowe
- Department of Psychiatry, Lausanne University Hospital, Prangins Psychiatric Hospital (CHUV), Chemin Oscar Forel 3, 1196 Prangins, Switzerland.
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Philipp S Baumann
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Hôpital de Cery, 1008 Prilly, Switzerland
| | - Alessandra Solida-Tozzi
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Hôpital de Cery, 1008 Prilly, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Hôpital de Cery, 1008 Prilly, Switzerland
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Discrepancies between Self- and Clinical Staff Members' Perception of Cognitive Functioning among Patients with Schizophrenia Undergoing Long-Term Hospitalization. Occup Ther Int 2019; 2019:6547096. [PMID: 31777475 PMCID: PMC6875358 DOI: 10.1155/2019/6547096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 08/13/2019] [Accepted: 08/29/2019] [Indexed: 11/17/2022] Open
Abstract
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.
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Martin S, Del-Monte J, Graziani P. Impulsivity issues in borderline personality disorder and it's links with insight: the role of urgency. Heliyon 2019; 5:e02564. [PMID: 31667405 PMCID: PMC6812187 DOI: 10.1016/j.heliyon.2019.e02564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/27/2019] [Accepted: 09/30/2019] [Indexed: 12/03/2022] Open
Abstract
Objective Impulsivity plays a major role in a wide range of disorders including Borderline Personality Disorder. Another crucial clinical dimension is insight. This clinical dimension is linked with symptomatology and treatment issue. The present study aims to investigate the impact of positive and negative urgency on insight in Borderline Personality Disorder. Methods We recruited eighty-one women with Borderline Personality Disorder and assessed insight level and impulsivity scores using the Beck Cognitive insight scale and the UPPS-short form scale. Results Our results showed interesting links between positive urgency and insight quality. Conclusion Negative emotions play a fundamental role for the insight quality, but positive emotions are surprisingly related to clinical insight. We discuss the possible therapeutical impact of this results on treatment adaptation.
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Affiliation(s)
- Sylvia Martin
- Laboratory of Social Psychology (LPS), University of Aix-Marseille & Nîmes, France
| | - Jonathan Del-Monte
- Laboratory of Social Psychology (LPS), University of Aix-Marseille & Nîmes, France
| | - Pierluigi Graziani
- Laboratory of Social Psychology (LPS), University of Aix-Marseille & Nîmes, France
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Chen B, Klarmann R, Israel M, Ning Y, Colle R, Hummel T. Difference of olfactory deficit in patients with acute episode of schizophrenia and major depressive episode. Schizophr Res 2019; 212:99-106. [PMID: 31416747 DOI: 10.1016/j.schres.2019.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/03/2019] [Accepted: 08/03/2019] [Indexed: 12/16/2022]
Abstract
UNLABELLED Aim Olfactory deficits are potential markers of early diagnosis, monitoring progress and predicting outcome in patients with schizophrenia and depression. We aimed to investigate differences in patterns and influencing factors of olfactory deficits between patients with acute episode of schizophrenia and major depressive episode (MDE). METHODS Fifty-two patients with acute episode of schizophrenia, 75 patients with unipolar MDE and 199 healthy controls were included in this retrospective study. Following a structured interview, participants underwent olfactory tests (Sniffin' Sticks), assessment of psychiatric symptoms (Positive and Negative Syndrome Scale), depressive symptoms (Hamilton Depression Rating Scale), and cognitive function (color-word test and word generation test). RESULTS Both patients with schizophrenia and MDE exhibited significant olfactory deficits, and MDE patients have poorer olfactory sensitivity than schizophrenia. Patients with MDE had a higher proportion of olfactory deficits (45.3% and 28%, respectively) but a better self-awareness (21.3% and 9.6%, respectively) than patients with schizophrenia. In patients with schizophrenia, PANSS scores was positively associated with olfactory sensitivity but negatively associated with olfactory identification, and olfactory discrimination was associated with word generation. In patients with MDE, olfactory discrimination was associated with word generation and age, but not disease severity. First-episode schizophrenia group showed significantly lower threshold scores than recurrent schizophrenia group, and first-episode MDE group had significantly lower threshold scores and higher discrimination scores than the recurrent MDE group. CONCLUSIONS Patterns and modulating factors of olfactory deficits in acute episode of schizophrenia and MDE are different, their differences should be considered when using olfactory deficits as marker in clinical practice.
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Affiliation(s)
- Ben Chen
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU, Dresden, Germany; Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
| | | | | | - Yuping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Romain Colle
- INSERM UMR-1178, CESP, Université Paris-Sud, Faculté de Médecine Paris-Sud, Service Hospitalo-Universitaire de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre F-94275, France
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU, Dresden, Germany
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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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Konsztowicz S, Lepage M. The role of illness engulfment in the association between insight and depressive symptomatology in schizophrenia. J Psychiatr Res 2019; 111:1-7. [PMID: 30658135 DOI: 10.1016/j.jpsychires.2018.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/15/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
Good clinical insight in schizophrenia tends to be associated with better outcomes, but also with increased depression. We hypothesized that illness engulfment, a process whereby an individual's self-concept becomes defined solely by illness and the 'patient identity' becomes primary, is a mediating and/or moderating factor in the association between insight and depressive symptomatology in schizophrenia. Mediation and moderation analyses were conducted using the PROCESS macro on data from 140 individuals with enduring schizophrenia who completed measures of the insight dimension of 'Awareness of Illness and Need for Treatment' (AINT), the Calgary Depression Scale, and the Modified Engulfment Scale. There was a significant indirect effect of AINT, mediated through engulfment, on depressive symptomatology (95% CI = 0.017 to 0.143), independent of duration of illness and current severity of positive symptoms. Moderation analysis revealed a significant interaction effect between level of engulfment and AINT, on depressive symptomatology, b = 0.005, t (134) = 2.814, p < .01, 95% CI = 0.002 to 0.009, controlling for the duration of illness and current severity of positive symptoms. At low levels of engulfment, higher AINT was associated with lower depression scores; while at high levels of engulfment, higher AINT was associated with higher depression scores. Illness engulfment may be an important process by which insight influences mood in schizophrenia. Insight interventions that also target engulfment may reduce the risk of increased depressive symptomatology.
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Affiliation(s)
- Susanna Konsztowicz
- Department of Psychology, McGill University, 2001 McGill College Ave, Montréal, QC, H3A 1G1, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Montreal, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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Van Camp L, van den Ameele S, Sabbe BGC, Oldenburg JFE. The longitudinal course of cognitive insight and mood in bipolar disorder. Psychiatry Res 2018; 269:9-12. [PMID: 30144670 DOI: 10.1016/j.psychres.2018.08.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/06/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
Cognitive insight or the ability to be self-reflective and to retain from being over-confident in own beliefs is an upcoming topic in research regarding psychiatric disorders. In bipolar disorder investigations are scarce and an important lacuna is the unexamined longitudinal relationship between cognitive insight and mood. Therefore, in this study the level of cognitive insight, mania and depression were assessed in a total of 56 patients with bipolar disorder at baseline, four months and eight months follow-up. In addition, the cognitive insight of 35 healthy controls was assessed at baseline and at four months follow-up. The current research shows that self-reflectiveness and self-certainty remained stable over time in bipolar disorder. The improvement of mood did not affect the course of cognitive insight. However, at baseline higher levels of depression were correlated with more self-reflectiveness. In addition, self-reflectiveness was higher for bipolar disorder patients in comparison with the healthy controls. Our results could imply that higher levels of self-reflectiveness are a specific characteristic in bipolar disorder that is independent from an improvement in mood.
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Affiliation(s)
- L Van Camp
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine, University of Antwerp, Universiteitsplein 1, Antwerp 2610, Belgium.; Psychiatric Hospital Duffel, University Department, Stationsstraat 22c, Duffel 2570, Belgium.
| | - S van den Ameele
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine, University of Antwerp, Universiteitsplein 1, Antwerp 2610, Belgium.; Psychiatric Hospital Duffel, University Department, Stationsstraat 22c, Duffel 2570, Belgium
| | - B G C Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine, University of Antwerp, Universiteitsplein 1, Antwerp 2610, Belgium.; Psychiatric Hospital Duffel, University Department, Stationsstraat 22c, Duffel 2570, Belgium
| | - J F E Oldenburg
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine, University of Antwerp, Universiteitsplein 1, Antwerp 2610, Belgium.; Psychiatric Hospital Duffel, University Department, Stationsstraat 22c, Duffel 2570, Belgium
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36
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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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Konsztowicz S, Schmitz N, Lepage M. Dimensions of insight in schizophrenia: Exploratory factor analysis of items from multiple self- and interviewer-rated measures of insight. Schizophr Res 2018. [PMID: 29530378 DOI: 10.1016/j.schres.2018.02.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Insight in schizophrenia is regarded as a multidimensional construct that comprises aspects such as awareness of the disorder and recognition of the need for treatment. The proposed number of underlying dimensions of insight is variable in the literature. In an effort to identify a range of existing dimensions of insight, we conducted a factor analysis on combined items from multiple measures of insight. METHOD We recruited 165 participants with enduring schizophrenia (treated for >3years). Exploratory factor analysis was conducted on itemized scores from two interviewer-rated measures of insight: the Schedule for the Assessment of Insight-Expanded and the abbreviated Scale to assess Unawareness of Mental Disorder; and two self-report measures: the Birchwood Insight Scale and the Beck Cognitive Insight Scale. RESULTS A five-factor solution was selected as the best-fitting model, with the following dimensions of insight: 1) awareness of illness and the need for treatment; 2) awareness and attribution of symptoms and consequences; 3) self-certainty; 4) self-reflectiveness for objectivity and fallibility; and 5) self-reflectiveness for errors in reasoning and openness to feedback. CONCLUSIONS Insight in schizophrenia is a multidimensional construct comprised of distinct clinical and cognitive domains of awareness. Multiple measures of insight, both clinician- and self-rated, are needed to capture all of the existing dimensions of insight. Future exploration of associations between the various dimensions and their potential determinants will facilitate the development of clinically useful models of insight and effective interventions to improve outcome.
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Affiliation(s)
- Susanna Konsztowicz
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec H3A 1B1, Canada.
| | - Norbert Schmitz
- Douglas Mental Health University Institute, 6875 LaSalle Boulevard, 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 Boulevard, Verdun, Quebec H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada.
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Gender differences in schizophrenia: A multicentric study from three Latin-America countries. Psychiatry Res 2018; 266:65-71. [PMID: 29843000 DOI: 10.1016/j.psychres.2018.05.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/21/2018] [Accepted: 05/11/2018] [Indexed: 11/22/2022]
Abstract
This study was aimed to explore clinical differences between women and men with schizophrenia (SZ) in Latin-America. It was conducted in public mental health centers in Bolivia, Peru and Chile. Two hundred forty-seven SZ patients participated in the study, 83 (33.6%) were women and 115 (46.6%) were Aymara. Compared to men, SZ women had slightly lower negative symptoms, reported slightly less social cognitive impairments, lower Family Relationships scores and higher Sentimental Life scores, independently of marital status, illness duration, age at illness onset and type of mental health treatment. All these differences have been replicated in the Aymara subgroup except for Sentimental Life scores. Aymara SZ women reported to be significantly less adherent into treatment compared to Aymara men. SZ women were found to have a better clinical profile and higher sentimental life scores than men. However, while SZ women reported more impaired Family Relationships compared to men, they were found to receive less psychotherapy in addition to pharmacological treatment. SZ Aymara women were also identified as a specific subgroup that may be targeted for increased observance strategies.
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39
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Affiliation(s)
- Anthony S David
- PO Box 68, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF, UK.
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40
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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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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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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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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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Relationship between insight and theory of mind in schizophrenia: A meta-analysis. Schizophr Res 2017; 190:11-17. [PMID: 28302393 DOI: 10.1016/j.schres.2017.03.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 11/21/2022]
Abstract
Poor insight in schizophrenia has been associated with executive dysfunction and deficits in general cognitive ability. The overall outcome of available neurocognitive studies suggests that there is a significant but modest relationship between cognitive deficits and poor insight in schizophrenia. However, social cognitive abilities, particularly, theory of mind (ToM), might also play a role in poor insight in schizophrenia. A novel meta-analysis of the relationship between ToM and insight in schizophrenia was conducted. Current meta-analysis included 16 studies including 1085 patients with schizophrenia-spectrum disorders. There was a significant association between ToM and clinical insight (r=0.28, CI=0.20-0.36). By contrast, there was no significant relationship between ToM and cognitive insight. Current findings suggest that there is a small but significant relationship between ToM and clinical insight in schizophrenia. ToM impairment is one of the factors contributing to poor insight in schizophrenia.
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45
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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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Self versus informant reports on the specific levels of functioning scale: Relationships to depression and cognition in schizophrenia and schizoaffective disorder. SCHIZOPHRENIA RESEARCH-COGNITION 2017; 9:1-7. [PMID: 28740827 PMCID: PMC5514389 DOI: 10.1016/j.scog.2017.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 04/20/2017] [Indexed: 12/02/2022]
Abstract
The goal of the current study was to examine the relationships between insight and both cognitive function and depression in schizophrenia and schizoaffective disorder, and to determine if there were similar relationships across diagnostic categories. We examined discrepancies between self and informant reports of function on the Specific levels of function scale as a metric of insight for interpersonal, social acceptance, work and activities. We examined two samples of individuals with schizophrenia and/or schizoaffective disorder (Ns of 188 and 67 respectively). In Sample 1, cognition was measured using the Dot Probe Expectancy Task. In Sample 2, cognition was measured by averaging several subtests from the MATRICS consensus cognitive battery, as well as additional measures of working memory. In both samples, depression was measured using the Brief Psychiatric Rating Scale. In both samples, we found significant relationships between worse cognition and overestimations of work function, as well as between higher depression levels and underestimation of interpersonal function. These relationships were specific to interpersonal and work function, with significantly stronger correlations with interpersonal and work function compared to the other areas of function. Similar results were found across diagnostic categories. These results have important implications for treatment planning, as they suggest the need to take into account depression and cognitive function when evaluating the patient's self-report of function, and highlight the utility of informant reports in evaluating function and treatment planning. Further, they add to the literature on the similarity across schizophrenia and schizoaffective disorder in a variety of pathological mechanisms.
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Grover S, Sahoo S, Nehra R, Chakrabarti S, Avasthi A. Relationship of depression with cognitive insight and socio-occupational outcome in patients with schizophrenia. Int J Soc Psychiatry 2017; 63:181-194. [PMID: 28162014 DOI: 10.1177/0020764017691314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To evaluate the prevalence of depression using different measures in patients with schizophrenia and to study the relationship of depression in schizophrenia with cognitive insight and clinical insight, disability and socio-occupational functioning. METHODS A total of 136 patients with schizophrenia were evaluated for depression, cognitive insight and socio-occupational functioning. RESULTS Of the 136 patients included in the study, one-fourth ( N = 34; 25%) were found to have depression as per the Mini International Neuropsychiatric Interview (MINI). The prevalence of depression as assessed by Calgary Depression Scale for Schizophrenia (CDSS), Hamilton depression rating scale (HDRS) and Depressive Subscale of Positive and Negative Syndrome Scale (PANSS-D) was 23.5%, 19.9% and 91.9%, respectively. Among the different scales, CDSS has highest concordance with clinician's diagnosis. Sensitivity, specificity, positive predictive value and negative predictive value for CDSS was also higher than that noted for HDRS and PANSS-D. When those with and without depression as per clinician's diagnosis were compared, those with depression were found to have significantly higher scores on Positive and Negative Syndrome Scale (PANSS) positive and general psychopathology subscales, PANSS total score, participation restriction as assessed by P-scale and had lower level of functioning as assessed by Global Assessment of Functioning (GAF). No significant difference was noted on negative symptom subscale of PANSS, clinical insight as assessed on G-12 item of PANSS, disability as assessed by Indian Disability Evaluation and Assessment Scale (IDEAS) and socio-occupational functioning as assessed by Social and Occupational Functioning Assessment Scale (SOFS). In terms of cognitive insight, those with depression had significantly higher score for both the subscales, that is, self-reflective and self-certainty subscales as well as the mean composite index score. CONCLUSION Our results suggest that one-fourth of patients with schizophrenia have depression, compared to HDRS and PANSS-D, CDSS has highest concordance with clinician's diagnosis of depression and presence of depression is related to cognitive insight.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Life story chapters and narrative self-continuity in patients with schizophrenia. Conscious Cogn 2016; 45:60-74. [DOI: 10.1016/j.concog.2016.08.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/09/2016] [Accepted: 08/12/2016] [Indexed: 12/23/2022]
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Cobo J, Nieto L, Ochoa S, Pousa E, Usall J, Baños I, González B, Ruiz I, Ruiz AI. Insight and gender in schizophrenia and other psychoses. Psychiatry Res 2016; 243:268-77. [PMID: 27423634 DOI: 10.1016/j.psychres.2016.04.089] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 12/30/2015] [Accepted: 04/25/2016] [Indexed: 12/24/2022]
Abstract
This study aimed to evaluate gender differences in the deficit of insight in psychosis and determine influences of clinical, functional, and sociodemographic variables. A multicenter sample of 401 adult patients with schizophrenia and other psychotic disorders who agreed to participate was evaluated in four centers of the metropolitan area of Barcelona (Catalonia). Psychopathological assessment was performed using the Positive and Negative Syndrome Scale Lindenmayers' Factors. Insight and its dimensions were assessed by means of the Scale of Unawareness of Mental Disorder. Significant differences were apparent neither between men and women in the three dimensions of insight, nor in the total awareness, nor in the total attribution subscales. However, statistically significant differences were found in awareness and attribution of particular symptoms. Women showed a worse awareness of thought disorder and alogia and a higher misattribution of apathy. Higher cognitive and positive symptoms, early stage of the illness, and having been married explained deficits of insight dimensions in women. In men, other variables such as lower functioning, higher age, other psychosis diagnosis, and, to a lower extent, higher scores in cognitive, positive, and excitative symptoms, explained deficits of insight dimensions. These data could help to design gender-specific preventive and therapeutic strategies.
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Affiliation(s)
- Jesus Cobo
- Mental Health Department, Corporació Sanitària Parc Taulí, Hospital Universitari - UAB Sabadell, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine. Universitat Autònoma de Barcelona Bellaterra, Barcelona, Catalonia, Spain; Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain.
| | - Lourdes Nieto
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Department of Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Susana Ochoa
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Esther Pousa
- Mental Health Department, Corporació Sanitària Parc Taulí, Hospital Universitari - UAB Sabadell, Barcelona, Catalonia, Spain; Institut de Neuropsiquiatria i Addiccions, Hospital del Mar Barcelona, Catalonia, Spain
| | - Judith Usall
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Iris Baños
- Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Beatriz González
- Mental Health Department, Hospital Benito Menni Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Isabel Ruiz
- Department of Health and Clinical Psychology - Research Unit. Universitat Autònoma de Barcelona Bellaterra, Barcelona, Catalonia, Spain
| | | | - Ada I Ruiz
- Research Workgroup on Womens' Mental Health, Catalan Society of Psychiatry & Mental Health Barcelona, Catalonia, Spain; Institut de Neuropsiquiatria i Addiccions, Hospital del Mar Barcelona, Catalonia, Spain; IMIM - Hospital del Mar Medical Research Institut Barcelona, Catalonia, Spain
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Wang LJ, Lin PY, Lee Y, Huang YC, Hsu ST, Hung CF, Chen CK, Chen YC, Wang YL, Tsai MC. Validation of the Chinese version of Brief Assessment of Cognition in Schizophrenia. Neuropsychiatr Dis Treat 2016; 12:2819-2826. [PMID: 27826194 PMCID: PMC5096784 DOI: 10.2147/ndt.s118110] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE A test battery that measures cognitive function impairment in patients with schizophrenia, the Brief Assessment of Cognition in Schizophrenia (BACS), has been translated into various languages and validated. This study aimed to test the reliability and validity of the Chinese version of the BACS in a Chinese-speaking population. METHODS All participants in this study (66 patients with schizophrenia [mean age: 41.2 years, 57.6% male] and 66 age- and sex-matched healthy controls) were from Taiwan and assessed using the BACS and the University of California, San Diego (UCSD) Performance-Based Skills Assessment, Brief Version (UPSA-B). Thirty-eight of the 66 patients with schizophrenia received a reassessment using the BACS. RESULTS The BACS had good test-retest reliability, and all BACS subtests had statistically insignificant practice effects. Principal components analysis demonstrated that a one-factor solution best fits our dataset (60.9% of the variance). In both patients and controls, the BACS composite scores were positively correlated with all BACS subscales (P<0.001) and UPSA-B scales (P<0.001). Furthermore, all BACS subtests (verbal memory, working memory, motor speed, verbal fluency, attention and processing speed, and executive function) significantly differentiated patients with schizophrenia from healthy controls (P<0.001), and the BACS composite score had the best discriminative validity (P<0.001). CONCLUSION The Chinese version of the BACS exhibits satisfactory psychometric properties, including high test-retest reliability, high internal consistency, acceptable concurrent validity, and good discriminant validity. We suggest that the BACS is a reliable and practical tool for assessing cognitive function in patients with schizophrenia.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Yu-Chi Huang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Su-Ting Hsu
- Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Chih-Ken Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Yi-Chih Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Ya-Ling Wang
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Ming-Che Tsai
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
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