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Scholte-Stalenhoef AN, Pijnenborg GHM, Hasson-Ohayon I, Boyette LL. Personality traits in psychotic illness and their clinical correlates: A systematic review. Schizophr Res 2023; 252:348-406. [PMID: 36804473 DOI: 10.1016/j.schres.2023.01.001] [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: 01/17/2022] [Revised: 12/18/2022] [Accepted: 01/02/2023] [Indexed: 02/17/2023]
Abstract
This systematic review focuses on personality traits according to both the Five Factor Model and Cloninger Psychobiological Model in relation to treatment related outcome variables across all stages of clinical psychotic illness. Search of Pubmed and Psychinfo databases led to final inclusion of 65 studies, which were ranked on quality and analyzed according to the associations between personality and outcome. Main findings are that higher levels of Harm Avoidance and Neuroticism are associated with higher symptom levels, tendency towards passive coping, greater self-stigma, lower quality of life, and Harm Avoidance to higher suicidality. Higher levels of Extraversion and higher levels of Self-Directedness are associated with more preference for active coping, more intrinsic motivation and higher self-esteem. Higher Novelty Seeking is related to more substance use and aggression, in men specifically. On outcome of trauma, care consumption and duration of untreated illness no consistent associations with personality traits were found. Combined evidence from both personality models however reveals a consistent pattern of personality traits related to clinical outcome in psychotic disorder, which is discussed in a dimensional manner.
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Affiliation(s)
- Anne Neeltje Scholte-Stalenhoef
- Ziekenhuis Groep Twente, Department of Psychiatry, Almelo, the Netherlands; University of Groningen, Department of Psychology, Groningen, the Netherlands.
| | | | | | - Lindy-Lou Boyette
- University of Amsterdam, Department of Clinical Psychology, Amsterdam, the Netherlands
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Fischer-Vieler T, Ringen PA, Kvig E, Bell C, Hjell G, Tesli N, Rokicki J, Melle I, Andreassen OA, Friestad C, Haukvik UK. Associations Between Clinical Insight and History of Severe Violence in Patients With Psychosis. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad011. [PMID: 39145347 PMCID: PMC11207844 DOI: 10.1093/schizbullopen/sgad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background and Hypothesis Violence is more prevalent in patients with psychotic disorders compared to the general population. Hence, adequate violence risk assessment is of high clinical importance. Impaired insight is suggested as a risk factor for violence in psychosis, but studies have yielded conflicting results. We hypothesized that impaired insight was associated with a history of severe violence in patients with psychotic disorders. Study Design Clinical insight was assessed both using the Birchwood Insight Scale (BIS) and the Positive and Negative Symptom Scale (PANSS) item G12 (lack of judgment and insight). The degree of impaired clinical insight was compared between psychosis patients with (N = 51) and without (N = 178) a history of severe violence. Multiple linear regression analyses were performed to investigate the effects of putative confounders. Study Results We found that a history of severe violence was significantly associated with lower insight in one of the three BIS components (the relabeling of symptoms) (P = .03, R2 = 0.02) and the PANSS item G12 (P = .03, R2 = 0.02) also after controlling for putative confounders. Conclusions The results suggest there is an association between impaired insight and severe violence in psychosis patients. We propose that examination of insight by validated instruments comprising different components may add useful information to clinical violence risk assessment in psychosis patients.
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Affiliation(s)
- Thomas Fischer-Vieler
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Petter Andreas Ringen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erling Kvig
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Mental Health and Addiction, Nordlandssykehuset, Bodø, Norway
| | - Christina Bell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Gabriela Hjell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Østfold Hospital Trust, Graalum, Norway
| | - Natalia Tesli
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jaroslav Rokicki
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole Andreas Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Christine Friestad
- Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
- University College of Norwegian Correctional Service, Oslo, Norway
| | - Unn Kristin Haukvik
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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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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Ogawa Y, Fukuhara K, Tanaka H, Nagata Y, Ishimaru D, Urakawa M, Nishikawa T. Insight Into Illness and Psychological Defense Attitudes in People With Chronic Schizophrenia Using Markova's Insight Scale. J Nerv Ment Dis 2021; 209:879-883. [PMID: 34264901 DOI: 10.1097/nmd.0000000000001392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Insight into illness is a multidimensional phenomenon, and various assessments are available. We focused on Markova's Insight Scale (IS) and investigated the relationship between insight, psychological defenses, and neurocognition in 38 patients with schizophrenia. Results showed that insight was significantly correlated with an immature defense style. Moreover, IS was significantly predicted by immature defense style after adjusting for clinical variables. Although insight is often assumed to be multidetermined with potential contributions from factors such as cognitive function and psychological defensive mechanisms, our results indicated that better insight assessed with the IS is more likely to reflect immature defenses. This may also be reflected in our result that a higher insight score correlated with earlier onset of illness. The insight score may reflect the immature psychological defensive attitudes of schizophrenia and may lead such patients to wish to comply with the views of clinicians.
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Affiliation(s)
| | | | - Hiroyuki Tanaka
- Department of Clinical Rehabilitation, Osaka Prefecture University Graduate School of Comprehensive Rehabilitation
| | - Yuma Nagata
- Department of Psychiatry, Course of Integrated Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Daiki Ishimaru
- Department of Psychiatry, Course of Integrated Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Mizuki Urakawa
- Department of Rehabilitation, Hokutokai Sawa Hospital, Osaka
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