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Triola M, Cobo J, González-Rodríguez A, Nieto L, Ochoa S, Usall J, García-Ribera C, Baños I, González B, Solanilla A, Massons C, Ruiz I, Ruiz AI, Oliva JC, Pousa E. Impact of Delusions and Hallucinations on Clinical Insight Dimensions in Schizophrenia Spectrum Disorders. Psychopathology 2024:1-10. [PMID: 38442692 DOI: 10.1159/000536360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/07/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Insight in psychosis has been conceptualized as a continuous, dynamic, and multidimensional phenomenon. This study aims to determine the impact of delusions and hallucinations in different dimensions of clinical insight in schizophrenia spectrum disorders. METHODS Cross-sectional multicenter study including 516 patients (336 men) diagnosed with schizophrenia spectrum disorders. Based on dichotomized scores of Positive and Negative Syndrome Scale (PANSS) items P1 (delusions) and P3 (hallucinations), patients were assigned to four groups according to current clear presence of delusions (scores 4 or above 4 in PANSS item P1) and/or hallucinations (scores 4 or above 4 in PANNS item P3). Insight was assessed using the three main dimensions of the Scale of Unawareness of Mental Disorder (SUMD). RESULTS Around 40% of patients showed unawareness of illness; 30% unawareness of the need for treatment; and 45% unawareness of the social consequences of the disorder. Patients with current clear presence of delusions had higher overall lack of awareness, regardless of current clear presence of hallucinations. Similarly, the clear presence of delusions showed a greater predictive value on insight than the presence of hallucinations, although the implication of both in the prediction was modest. CONCLUSIONS Our results confirm that lack of insight is highly prevalent in schizophrenia spectrum disorders, particularly when patients experience delusions. This study adds insight-related data to the growing symptom-based research, where specific types of psychotic experiences such as hallucinations and delusions could form different psychopathological patterns, linking the phenomenology of delusions to a lack of clinical insight.
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Affiliation(s)
- Maria Triola
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
| | - Jesus Cobo
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospìtal, Terrassa, Spain
- University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Lourdes Nieto
- Department of Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico D.F., Mexico
| | - Susana Ochoa
- Research and Development Unit, Parc Sanitari San Joan de Dèu, MERITT Group, Institut de Recerca Sant Joan de Déu - CIBERSAM - ISCIII, Sant Boi de Llobregat, Barcelona, Spain
| | - Judith Usall
- Research and Development Unit, Parc Sanitari San Joan de Dèu, MERITT Group, Institut de Recerca Sant Joan de Déu - CIBERSAM - ISCIII, Sant Boi de Llobregat, Barcelona, Spain
| | - Carles García-Ribera
- Department of Psychiatry, Hospital de La Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau, IIB-Sant Pau, CIBERSAM, Barcelona, Spain
| | - Iris Baños
- Research and Development Unit, Parc Sanitari San Joan de Dèu, MERITT Group, Institut de Recerca Sant Joan de Déu - CIBERSAM - ISCIII, Sant Boi de Llobregat, Barcelona, Spain
| | - Beatriz González
- Mental Health Department, Hospital Benito Menni, Sant Boi de Llobregat, Barcelona, Spain
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Ariadna Solanilla
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
| | - Carmina Massons
- Mental Health Department, Corporació Sanitària Parc Taulí - CIBERSAM - ISCIII - I3PT - CREA, Sabadell, Spain
| | - Isabel Ruiz
- Department of Health and Clinical Psychology, Research Unit, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ada I Ruiz
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | | | - Esther Pousa
- Department of Psychiatry, Hospital de La Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau, IIB-Sant Pau, CIBERSAM, Barcelona, Spain
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Vlachos II, Selakovic M, Ralli I, Hatzimanolis A, Xenaki LA, Dimitrakopoulos S, Soldatos RF, Foteli S, Nianiakas N, Kosteletos I, Stefanatou P, Ntigrintaki AA, Triantafyllou TF, Voulgaraki M, Ermiliou V, Mantonakis L, Kollias K, Stefanis NC. Role of Clinical Insight at First Month in Predicting Relapse at the Year in First Episode of Psychosis (FEP) Patients. J Clin Med 2023; 12:4261. [PMID: 37445295 DOI: 10.3390/jcm12134261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Clinical insight constitutes a useful marker of the progress and outcome of the First Episode of Psychosis (FEP), and lack of insight has been associated with more severe psychopathology, treatment non-adherence, and rehospitalization/relapse. In this study, we aimed to further investigate the possible role of insight as a predictor of relapse, its relation to diagnosis, and other parameters of positive psychotic symptomatology (delusions, hallucinations, and suspiciousness). METHODS The Athens FEP study employed a prospective, longitudinal cohort design in which consecutive newly diagnosed patients with psychosis were interviewed and asked to voluntarily participate after completing informed consent. A total of 88/225 patients were examined at three different time points (baseline, month, and year). Their scores in the relevant items of the Positive and Negative Syndrome Scale (PANSS) were compared (G12 for insight, P1 for delusions, P3 for hallucinations, and P6 for suspiciousness), and they were further associated to diagnosis and the outcome at the end of the year (remission/relapse). RESULTS In total, 22/88 patients with relapse at the year had greater scores in G12 for both the month and the year, and this finding was corroborated after adjusting the statistical analysis for demographics, diagnosis, social environment, and depression via multiple logistic regression analysis. Moreover, delusions and suspiciousness were significantly higher in patients diagnosed with non-affective psychosis compared to those diagnosed with affective psychosis (p < 0.001) at the first month. CONCLUSIONS Lack of insight at the first month may serve as a predictor of relapse at the year.
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Affiliation(s)
- Ilias I Vlachos
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Mirjana Selakovic
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
- Department of Psychiatry, Sismanoglion General Hospital, 15126 Attica, Greece
| | - Irene Ralli
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Alexandros Hatzimanolis
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Lida-Alkisti Xenaki
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Stefanos Dimitrakopoulos
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
- Psychiatric Clinic, 414 Military Hospital of Athens, 15236 Palea Penteli, Greece
| | - Rigas-Filippos Soldatos
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Stefania Foteli
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Nikos Nianiakas
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Ioannis Kosteletos
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Pentagiotissa Stefanatou
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | | | | | - Marina Voulgaraki
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Vassiliki Ermiliou
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Leonidas Mantonakis
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Konstantinos Kollias
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
| | - Nikos C Stefanis
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece
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Pratt DN, Bridgwater M, Schiffman J, Ellman LM, Mittal VA. Do the Components of Attenuated Positive Symptoms Truly Represent One Construct? Schizophr Bull 2023; 49:788-798. [PMID: 36454660 PMCID: PMC10154719 DOI: 10.1093/schbul/sbac182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND HYPOTHESES Psychosis-risk inventories, like the Structured Interview for Psychosis-Risk Syndromes (SIPS), utilize symptom components and coalesce the information into a single-severity rating. These components include frequency, duration, in-the-moment conviction, retrospective insight, distress, and effect on social/role functioning. While combining components distills a great deal of important information into one practical symptom rating, this approach may mask important details of the greater clinical picture. STUDY DESIGN Individuals at clinical high risk for psychosis (n = 115) were assessed with the SIPS Score Separable Components (SSSC) scale, created to accompany the SIPS positive items by dividing each item into the 7 components identified above. The latent structure of the SSSC was identified with an exploratory factor analysis (EFA). The factors were followed up with validation analyses including hypothesized cognitive, functioning, and symptom measures. Finally, clinical utility analyses were conducted to understand relationships between psychosis risk and common comorbidities. STUDY RESULTS EFA revealed that the SSSC had 3 interpretable factors with the appropriate fit (rmsr = 0.018, TLI = 0.921): Conviction (in-the-moment conviction, retrospective insight), Distress-Impairment (distress, social/role functioning), and Frequency/Duration (frequency, duration). Conviction was minimally valid, Distress-Impairment had excellent validity, and Frequency/Duration was not related to any of the candidate validators. Conviction significantly predicted elevated psychosis risk. Distress-Impairment was related to common comorbid symptoms. Notably, the factors associated more strongly with clinical features than the traditional SIPS scores. CONCLUSIONS The SSSC offers a supplemental approach to single-severity ratings, providing useful clinical insight, mechanistic understanding, and the potential for better capturing heterogeneity in this population.
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Affiliation(s)
- Danielle N Pratt
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Miranda Bridgwater
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
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DeTore NR, Bain K, Wright A, Meyer-Kalos P, Gingerich S, Mueser KT. A Randomized Controlled Trial of the Effects of Early Intervention Services On Insight in First Episode Psychosis. Schizophr Bull 2022; 48:1295-1305. [PMID: 35997816 PMCID: PMC9673270 DOI: 10.1093/schbul/sbac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Impaired insight into one's illness is common in first episode psychosis (FEP), is associated with worse symptoms and functioning, and predicts a worse course of illness. Despite its importance, little research has examined the effects of early intervention services (EIS) on insight. DESIGNS This paper evaluated the impact of EIS (NAVIGATE) on insight compared to usual community care (CC) in a large cluster randomized controlled trial. Assessments were conducted at baseline and every 6 months for 2 years. RESULTS A multilevel regression model including all time points showed a significant time by treatment group interaction (P < .001), reflecting greater improvement in insight for NAVIGATE than CC participants. Impaired insight was related to less severe depression but worse other symptoms and functioning at baseline for the total sample. At 6 months, the same pattern was found within each group except insight was no longer associated with depression among NAVIGATE participants. Impaired insight was more strongly associated with worse interpersonal relationships at 6 months in NAVIGATE than in CC, and changes in insight from baseline to 6 months were more strongly correlated with changes in relationships in NAVIGATE than CC. CONCLUSIONS The NAVIGATE program improved insight significantly more than CC. Although greater awareness of illness has frequently been found to be associated with higher depression in schizophrenia, these findings suggest EIS programs can improve insight without worsening depression in FEP. The increased association between insight and social relationships in NAVIGATE suggests these 2 outcomes may synergistically interact to improve each other in treatment.
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Affiliation(s)
- N R DeTore
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - K Bain
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - A Wright
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - P Meyer-Kalos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Boston, MA, USA
| | | | - K T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
- Department of Occupational Therapy, Boston University, Boston, MA, USA
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Cognitive insight in individuals at ultra-high risk for psychosis compared to patients with first-episode psychosis and non-psychotic help-seeking youths. Asian J Psychiatr 2022; 73:103107. [PMID: 35461034 DOI: 10.1016/j.ajp.2022.103107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Defective insight is a hallmark of schizophrenia. Less is known about insight in emerging psychosis. In this study a widely used measure of cognitive insight, the Beck Cognitive Insight Scale (BCIS), has been applied to a sample including patients with first-episode psychosis (FEP), at ultra-high risk (UHR) for psychosis, and help-seeking youths without psychotic symptoms. METHODS The Comprehensive Assessment of At-Risk Mental State (CAARMS) interview was used to classify patients. Enrolled patients were assessed with the General Health Questionnaire-12 (GHQ-12), the Prodromal Questionnaire-16 (PQ-16), the Social and Occupational Functioning Assessment Scale (SOFAS), and the BCIS. RESULTS The sample included 212 participants (58%) with non-psychotic mental distress, 131 participants (36%) were UHR, and 22 (6%) were with FEP. Males and females were in equal proportion, mean age was 19.2 ± 2.6 years old (range: 15-25 years). Reliability (Cronbach's alpha) was good for clinical scales (>0.7) and acceptable (around 0.6) for the two BCIS subscales. The self-certainty subscale of the BCIS was more reproducible in factor analysis than the self-reflectiveness scale. Youths devoid of psychotic symptoms scored lower than UHR and FEP participants on the GHQ-12 and the PQ-16 and had better psychosocial functioning as measured by the SOFAS. Levels of cognitive insight did not differ between groups. CONCLUSION People in the early stages of psychosis may be still accessible to self-reflectiveness and more hesitant about the certainty of their beliefs than patients at more advanced stages of the illness, as those with fully displayed schizophrenia.
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Anxiety symptoms, rule learning, and cognitive flexibility in non-clinical psychosis. Sci Rep 2022; 12:5649. [PMID: 35383232 PMCID: PMC8983653 DOI: 10.1038/s41598-022-09620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Abstract
Individuals with psychotic-like experiences (PLEs) represent a critical group for improving the understanding of vulnerability factors across the psychosis continuum. A growing body of literature has identified functional deficits associated with PLEs. However, it is unclear if such deficits purely reveal the underlying psychosis vulnerability or if they are also linked with comorbid anxiety symptoms. Although anxiety disorders are often associated with impairments in psychosis-risk, symptoms of anxiety may facilitate executive functioning in certain psychosis groups. The Community Assessment of Psychic Experiences was completed to assess psychosis-like symptoms in a total of 57 individuals, and its median score was used to categorize PLE groups (high-PLE = 24, low-PLE = 33). Anxiety symptoms were measured via the Beck Anxiety Inventory, and cognitive flexibility was measured by the Penn Conditional Exclusion Test. The high-PLE group endorsed more anxiety symptoms, demonstrated poorer accuracy and efficiency on the cognitive task, and made more perseverative errors compared to the low-PLE group. Within the high-PLE group, higher levels of anxiety symptoms were associated with better performance and less perseverative errors compared to individuals with lower levels of anxiety symptoms. Conversely, greater anxiety symptoms were associated with poorer performance in the low-PLE group. Taken together, these findings provide a preliminary support for a potential psychosis vulnerability × anxiety symptom interaction. Given the interest in the psychosis continuum and potential treatment implications, the present findings warrant replication efforts.
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Adaptation following errors: Error awareness predicts future performance. Mem Cognit 2021; 50:672-680. [PMID: 34648122 DOI: 10.3758/s13421-021-01246-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/08/2022]
Abstract
The ability to detect an error in performance is critical to ongoing and future goal-directed behaviour. Diminished awareness of errors has been associated with a loss of insight and poor functional recovery in several clinical disorders (e.g., attention-deficit/hyperactivity disorder, addiction, schizophrenia). Despite the clear imperative to understand and remediate such deficits, error awareness and its instantiation in corrective behaviour remains to be fully elucidated. The present study investigated the relationship between error awareness and future performance in order to determine whether conscious recognition of errors facilitates adaptive behaviour. Fifty-one healthy participants completed a motor Go/No-Go error awareness task that afforded the opportunity to learn from errors. A mixed-effects model was specified wherein awareness of an error was used to predict inhibitory performance on the following No-Go trial. The model revealed a significant predictive effect of error awareness on future performance, such that aware errors were more frequently followed by correct inhibitory performance. Notably, improvement in performance accuracy was not due to a temporary increase in conservatism of responding, but appeared to be a context-specific adaptation. These results highlight the adaptive role of error awareness and the relationship between error awareness and learning from errors that has the potential to contribute to clinical symptomatology.
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Raucher-Chéné D, Bodnar M, Lavigne KM, Malla A, Joober R, Lepage M. Dynamic Interplay Between Insight and Persistent Negative Symptoms in First Episode of Psychosis: A Longitudinal Study. Schizophr Bull 2021; 48:211-219. [PMID: 34230974 PMCID: PMC8781342 DOI: 10.1093/schbul/sbab079] [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] [Indexed: 01/18/2023]
Abstract
Persistent negative symptoms (PNS) are an important factor of first episode of psychosis (FEP) that present early on in the course of illness and have a major impact on long-term functional outcome. Lack of clinical insight is consistently associated with negative symptoms during the course of schizophrenia, yet only a few studies have explored its evolution in FEP. We sought to explore clinical insight change over a 24-month time period in relation to PNS in a large sample of FEP patients. Clinical insight was assessed in 515 FEP patients using the Scale to assess Unawareness of Mental Disorder. Data on awareness of illness, belief in response to medication, and belief in need for medication were analyzed. Patients were divided into 3 groups based on the presence of negative symptoms: idiopathic (PNS; n = 135), secondary (sPNS; n = 98), or absence (non-PNS; n = 282). Secondary PNS were those with PNS but also had clinically relevant levels of positive, depressive, or extrapyramidal symptoms. Our results revealed that insight improved during the first 2 months for all groups. Patients with PNS and sPNS displayed poorer insight across the 24-month period compared to the non-PNS group, but these 2 groups did not significantly differ. This large longitudinal study supported the strong relationship known to exist between poor insight and negative symptoms early in the course of the disorder and probes into potential factors that transcend the distinction between idiopathic and secondary negative symptoms.
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Affiliation(s)
- Delphine Raucher-Chéné
- Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada,Cognition, Health, and Society Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France,Academic Department of Psychiatry, University Hospital of Reims, EPSM Marne, Reims, France
| | - Michael Bodnar
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Katie M Lavigne
- Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada,McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Québec, Canada
| | - Ashok Malla
- Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Ridha Joober
- Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada,To whom correspondence should be addressed; Douglas Mental Health University Institute, Frank B Common Pavilion, F1143, 6875 LaSalle Blvd., Verdun, Quebec H4H 1R3, Canada; tel: (514) 761-6131 ext. 4393, fax: (514) 888-4064, e-mail:
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Response and remission of subjective well-being in patients suffering from schizophrenia spectrum disorders. Eur Psychiatry 2020; 26:284-92. [DOI: 10.1016/j.eurpsy.2009.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 09/14/2009] [Accepted: 11/17/2009] [Indexed: 11/19/2022] Open
Abstract
AbstractBackgroundPurpose of this study was to assess subjective well-being in schizophrenia inpatients and to find variables predictive for response and remission of subjective well-being.MethodThe subjective well-being under neuroleptic treatment scale (SWN-K) was used in 232 schizophrenia patients within a naturalistic multicenter trial. Early response was defined as a SWN-K total score improvement of 20% and by at least 10 points within the first 2 treatment weeks, response as an improvement in SWN-K total score of at least 20% and by at least 10 points from admission to discharge and remission in subjective well-being as a total score of more or equal to 80 points at discharge. Logistic regression and CART analyses were used to determine valid predictors of subjective well-being outcome.ResultsTwenty-nine percent of the patients were detected to be SWN-K early responders, 40% fulfilled criteria for response in subjective well-being and 66% fulfilled criteria for remission concerning subjective well-being. Among the investigated predictors, SWN-K early improvement and the educational status were significantly associated with SWN-K response. The SWN-K total score at baseline showed a significant negative predictive value for response. Baseline SWN-K total score, PANSS global subscore, and side effects as well as the educational status were found to be significantly predictive for remission.ConclusionsDepressive symptoms should be radically treated and side effects closely monitored to improve the patient's subjective well-being. The important influence of subjective well-being on overall treatment outcome could be underlined.
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Elowe J, Conus P. Much ado about everything: A literature review of insight in first episode psychosis and schizophrenia. Eur Psychiatry 2020; 39:73-79. [DOI: 10.1016/j.eurpsy.2016.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022] Open
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Raveendranathan D, Joseph J, Machado T, Mysore A. Neurocognitive and clinical correlates of insight in schizophrenia. Indian J Psychiatry 2020; 62:131-136. [PMID: 32382171 PMCID: PMC7197834 DOI: 10.4103/psychiatry.indianjpsychiatry_238_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/20/2019] [Accepted: 02/09/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Schizophrenia is a heterogeneous disorder characterized by various symptom dimensions and neurocognitive deficits. Impairment of insight is a core clinical symptom of the disorder. There has been an increasing focus on neurocognition and insight in schizophrenia; although, many studies fail to control for premorbid cognitive status. MATERIALS AND METHODS Schizophrenia patients (n = 60) selected for adequate background education were recruited from outpatient services of a tertiary care hospital and community care homes in Southern India. These patients were comprehensively assessed using a neurocognitive battery. Clinical assessments were done using the Positive and Negative Syndrome Scale (PANSS) and Schedule for the Assessment of Insight-expanded version (SAI-E). Partial correlation was performed to examine the relationship of insight with clinical and neurocognitive measures. Statistical significance was set at P = 0.004 (Bonferroni correction for 12 tests of association). Linear regression analysis was performed to examine the predictors of insight. RESULTS The mean PANSS positive, negative, general psychopathology, and total scores were 14.2 ± 4.9, 17.4 ± 5.0, 34.3 ± 6.8, and 65.8 ± 13.9, respectively. Mean insight score (SAI-E) was 8.5 ± 2.9. In partial correlation done after controlling for IQ, significant negative correlations were observed between insight score and the Wisconsin Card Sorting Test (WCST) total errors (P = 0.001), WCST perseverative errors (P < 0.001). Insight scores had negative correlations with PANSS negative (P < 0.002) and total scores (P < 0.002). WCST perseverative errors were the primary predictor of insight in the regression analysis. CONCLUSION Insight has a strong relationship with executive functioning in schizophrenia. This could indicate shared neurobiological substrates for insight and executive functioning.
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Affiliation(s)
| | - Jessie Joseph
- Consultant Psychiatrist, St. Isabel's Hospital, Chennai, Tamil Nadu, India
| | - Tanya Machado
- Department of Psychiatry, St. John's Medical College, Bengaluru, Karnataka, India
| | - Ashok Mysore
- Department of Psychiatry, St. John's Medical College, Bengaluru, Karnataka, India
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Kim J, Ozzoude M, Nakajima S, Shah P, Caravaggio F, Iwata Y, De Luca V, Graff-Guerrero A, Gerretsen P. Insight and medication adherence in schizophrenia: An analysis of the CATIE trial. Neuropharmacology 2019; 168:107634. [PMID: 31077729 DOI: 10.1016/j.neuropharm.2019.05.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/30/2019] [Accepted: 05/07/2019] [Indexed: 01/11/2023]
Abstract
Adherence to antipsychotic medication is critical for the treatment of patients with schizophrenia. Impaired insight into illness is one of the principal drivers of medication nonadherence, which contributes to negative clinical outcomes. The aims of this study were to examine the relationships between impaired insight and (1) rates of antipsychotic medication nonadherence, and (2) time to medication nonadherence using data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Insight was assessed using the Positive and Negative Syndrome Scale (PANSS) item G12 (lack of judgment and insight). Patients were divided into 3 groups based on their degree of insight impairment, i.e. no impairment (PANSS G12 = 1), minimal impairment (PANSS G12 = 2-3), and moderate-to-severe insight impairment (PANSS G12 ≥ 4). Medication nonadherence was defined as taking less than 80% of monthly pill counts. Kaplan-Meier survival and Cox regression analyses were performed to examine differences in time to medication nonadherence between insight groups. There were significant differences between insight groups in the percentage of nonadherent patients at 6 months (χ2(2) = 8.80, p = 0.012) and 18 months (χ2(2) = 10.04, p = 0.007) after study initiation. Moderate-to-severe insight impairment was associated with earlier nonadherence compared to minimal (χ2 = 4.70, p = 0.030) or no impairment (χ2 = 11.92, p = 0.001). The association remained significant after adjustment for illness severity, substance use, attitudes toward medication, cognition, level of hostility, and depression. The results of this study indicate a strong link between impaired insight and antipsychotic medication nonadherence. Interventions to enhance insight early during treatment may help improve medication adherence, and in turn, long-term clinical and functional outcomes in patients with schizophrenia. This article is part of the issue entitled 'Special Issue on Antipsychotics'.
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Affiliation(s)
- Julia Kim
- 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
| | - Miracle Ozzoude
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Neuropsychiatry, Keio University, Tokyo, Japan
| | - Parita Shah
- 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
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vincenzo De Luca
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, CAMH, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- 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, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
| | - 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, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.
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13
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Phahladira L, Asmal L, Kilian S, Chiliza B, Scheffler F, Luckhoff HK, du Plessis S, Emsley R. Changes in insight over the first 24 months of treatment in schizophrenia spectrum disorders. Schizophr Res 2019; 206:394-399. [PMID: 30385130 DOI: 10.1016/j.schres.2018.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/17/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND While insight in schizophrenia improves with treatment, significant impairments often persist. The degree of persistence is not well characterised. AIMS We assessed patient and clinician-rated changes in insight in acutely ill, minimally treated first-episode schizophrenia spectrum disorder patients over 24 months of standardised treatment with a depot antipsychotic. METHOD This single arm open label longitudinal cohort study included 105 participants with first-episode schizophrenia, schizophreniform or schizoaffective disorder. Insight was assessed at months 0, 6, 12 and 24 using the patient-rated Birchwood Insight Scale (BIS) and clinician-rated global insight item of the Positive and Negative Syndrome Scale (PANSS). Changes in insight over time were assessed using linear mixed-effect models for continuous repeated measures. Relationships between insight and psychopathology, functionality, cognition and quality of life were assessed with regression models. RESULTS There was significant improvement over time for the PANSS insight item (p < 0.0001). However, the only significant improvement for the BIS was with the Need for Treatment subscale (p = 0.01). There were no significant improvements noted for the Symptom Attribution (p = 0.7) and Illness Awareness (p = 0.2) subscales, as well as the BIS Total score (p = 0.6). Apart from depressive symptoms at baseline, there were no significant predictors of patient-rated insight. CONCLUSIONS Clinicians should note that, even when treatment is assured and response is favourable, fundamental impairments in patient-rated insight persist.
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Affiliation(s)
| | - Laila Asmal
- Department of Psychiatry, Stellenbosch University, South Africa
| | - Sanja Kilian
- Department of Psychiatry, Stellenbosch University, South Africa
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, South Africa
| | | | | | | | - Robin Emsley
- Department of Psychiatry, Stellenbosch University, South Africa
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Büchmann CB, Pedersen G, Aminoff SR, Laskemoen JF, Barrett EA, Melle I, Lagerberg TV. Validity of the Birchwood insight scale in patients with schizophrenia spectrum- and bipolar disorders. Psychiatry Res 2019; 272:715-722. [PMID: 30832191 DOI: 10.1016/j.psychres.2018.12.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022]
Abstract
The aim of this study is to investigate the validity of the Norwegian version of the Insight Scale (IS) in large and representative samples of patients with schizophrenia spectrum disorders, bipolar I disorder and bipolar II disorder. A total of 997 participants were included (schizophrenia spectrum disorders: 557; bipolar I disorder: 282; bipolar II disorder: 138). Confirmatory factor analysis was conducted to investigate the construct validity and bivariate correlational analysis was applied to investigate convergent validity. Confirmatory factor analyses indicated a reasonable model fit to the original three-factor subscale structure of the IS in all three diagnostic groups. The IS total score and its subscales correlated significantly with both the insight items in the Young Mania Rating Scale and the Positive and Negative Syndrome Scale in both schizophrenia spectrum disorders and bipolar I disorder. In the bipolar II disorder group, however, the IS subscales correlated poorly with both the observer-rated measures. Our study supports the construct validity of the IS in both schizophrenia spectrum disorder- and bipolar disorder populations. The study also demonstrates that patients' self-reports of insight correspond to observer-based single item ratings of insight in bipolar I disorder and schizophrenia spectrum disorders.
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Affiliation(s)
- Camilla Bakkalia Büchmann
- NORMENT and K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Geir Pedersen
- NORMENT and K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway; Oslo University Hospital, Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo, Norway
| | - Sofie Ragnhild Aminoff
- NORMENT and K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway; Oslo University Hospital, Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo, Norway
| | - Jannicke Fjæra Laskemoen
- NORMENT and K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - Elizabeth Ann Barrett
- Oslo University Hospital, Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo, Norway
| | - Ingrid Melle
- NORMENT and K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway; NORMENT and K.G. Jebsen Center for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Trine Vik Lagerberg
- NORMENT and K.G. Jebsen Center for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Gardsjord ES, Romm KL, Røssberg JI, Friis S, Barder HE, Evensen J, Haahr U, Ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld J, Larsen TK, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, Melle I. Depression and functioning are important to subjective quality of life after a first episode psychosis. Compr Psychiatry 2018; 86:107-114. [PMID: 30114656 DOI: 10.1016/j.comppsych.2018.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/05/2018] [Accepted: 07/26/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Subjective quality of life (S-QoL) is an important outcome measure in first-episode psychosis, but its associations with clinical predictors may vary across the illness course. In this study we examine the association pattern, including both direct and indirect effects, between specific predefined clinical predictors (insight, depression, positive psychotic symptoms and global functioning) and S-QoL the first ten years after a first-episode psychosis. METHODS Three hundred and one patients with a first-episode psychosis were included at first treatment, and reassessed at 3 months, 1 year, 2 years, 5 years and 10 years after inclusion. At 10-year follow-up 186 participated. S-QoL was assessed with Lehman's Quality of Life Interview. Applying a structural equation model, we investigated cross-sectional association patterns at all assessments between the predefined clinical predictors and S-QoL. RESULTS At baseline, only depression was significantly associated with S-QoL. At all follow-up assessments, depression and functioning showed significant associations with S-QoL. Insight was not associated with S-QoL at any of the assessments. Better insight, less depressive symptoms and less positive psychotic symptoms were all associated with higher functioning at all assessments. Functioning seems to mediate a smaller indirect inverse association between positive psychotic symptoms and S-QoL. The association pattern was stable across all follow-up assessments. CONCLUSIONS Together with depression, functioning seems to be important for S-QoL. Functioning seems to be a mediating factor between positive symptoms and S-QoL. A focus on functional outcome continues to be important.
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Affiliation(s)
- Erlend Strand Gardsjord
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
| | - Kristin Lie Romm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | | | - Julie Evensen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Adult Psychiatric Department Vinderen, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Ulrik Haahr
- Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark
| | - Wenche Ten Velden Hegelstad
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Inge Joa
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Johannes Langeveld
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Tor Ketil Larsen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Department of Clinical Medicine, Section Psychiatry, University of Bergen, 5021 Bergen, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, 0318 Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
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16
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Atoui M, El Jamil F, El Khoury J, Doumit M, Syriani N, Khani M, Nahas Z. The relationship between clinical insight and cognitive and affective empathy in schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2018; 12:56-65. [PMID: 29928598 DOI: 10.1016/j.scog.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 01/10/2023]
Abstract
Background Schizophrenia is often associated with poor clinical insight (unawareness of mental illness and its symptoms) and deficits in empathy, which are important for social functioning. Cognitive empathy has been linked to clinical insight while affective empathy and its role in insight and pathology have received mixed evidence. Methods Instruments assessing symptomatology (Positive and Negative Syndrome Scale; PANSS), clinical insight (Scales to assess awareness of mental disorders; SUMD), and cognitive and affective empathy were administered to 22 participants with first episode and chronic schizophrenia and 21 healthy controls. Self-report, parent-report, and performance based measures were used to assess cognitive and affective empathy (The interpersonal reactivity index; IRI/Reading the Mind in the Eyes Test/Faux Pas) to reduce bias and parse shared variance. Results Age of onset, gender, and symptomatology emerged as significant predictors of poor clinical insight. Additionally, the fantasy subscale of the IRI as reported by parents emerged as a positive predictor while the personal distress (parent report) subscale emerged as a negative predictor of awareness into mental illness. There were significant differences on performance-based measures of empathy between the control and schizophrenia groups. Conclusion Findings suggest that affective empathy is relatively intact across phases of illness whereas cognitive empathy abilities are compromised and could be targets for psychotherapy intervention.
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Affiliation(s)
- Mia Atoui
- American University of Beirut, Department of Psychology, Beirut, Lebanon
| | - Fatima El Jamil
- American University of Beirut, Department of Psychology, Beirut, Lebanon
| | - Joseph El Khoury
- American University of Beirut Medical Center, Department of Psychiatry, Beirut, Lebanon
| | - Mark Doumit
- American University of Beirut, Department of Medicine, Beirut, Lebanon
| | - Nathalie Syriani
- American University of Beirut, Department of Psychology, Beirut, Lebanon
- American University of Beirut Medical Center, Department of Psychiatry, Beirut, Lebanon
- American University of Beirut, Department of Medicine, Beirut, Lebanon
- University of Minnesota, Department of Psychiatry, MN, USA
| | - Munir Khani
- American University of Beirut Medical Center, Department of Psychiatry, Beirut, Lebanon
| | - Ziad Nahas
- University of Minnesota, Department of Psychiatry, MN, USA
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Herniman SE, Cotton SM, Killackey E, Hester R, Allott KA. Co-morbid depressive disorder is associated with better neurocognitive performance in first episode schizophrenia spectrum. J Affect Disord 2018; 229:498-505. [PMID: 29334645 DOI: 10.1016/j.jad.2017.12.088] [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: 05/22/2017] [Revised: 11/11/2017] [Accepted: 12/31/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Both major depressive disorder (MDD) and first episode schizophrenia spectrum (FES) are associated with significant neurocognitive deficits. However, it remains unclear whether the neurocognitive deficits in individuals with FES are more severe if there is comorbid depressive disorder. The aim of this study was to compare the neurocognitive profiles between those with and without full-threshold depressive disorder in FES. METHOD This study involved secondary analysis of baseline data from a randomized controlled trial of vocational intervention for young people with first-episode psychosis (N = 82; age range: 15-25 years). RESULTS Those with full-threshold depressive disorder (n = 24) had significantly better information processing speed than those without full-threshold depressive disorder. Severity of depressive symptoms was also associated with better information processing speed. LIMITATIONS In additional to the cross-sectional design, limitations of this study include the absence of assessing insight as a potential mediator. CONCLUSIONS After the first psychotic episode, it could be speculated that those with better information processing speed may be more likely to develop full-threshold depressive disorder, as their ability to efficiently process information may allow them to be more aware of their situations and environments, and consequently to have greater insight into the devastating consequences of FES. Such novel findings support the examination of full-threshold depressive disorder in relation to neurocognitive performance across illness phases in future work.
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Affiliation(s)
- Sarah E Herniman
- Orygen, the National Centre of Excellence in Youth Mental Health, Locked Bag 10, 35 Poplar Road, Parkville, Melbourne, VIC 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Melbourne, VIC 3052, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Level 12, Redmond Barry Building 115, Parkville, Melbourne, VIC 3010, Australia.
| | - Sue M Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Locked Bag 10, 35 Poplar Road, Parkville, Melbourne, VIC 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Melbourne, VIC 3052, Australia.
| | - Eóin Killackey
- Orygen, the National Centre of Excellence in Youth Mental Health, Locked Bag 10, 35 Poplar Road, Parkville, Melbourne, VIC 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Melbourne, VIC 3052, Australia.
| | - Robert Hester
- Centre for Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Melbourne, VIC 3052, Australia.
| | - Kelly A Allott
- Orygen, the National Centre of Excellence in Youth Mental Health, Locked Bag 10, 35 Poplar Road, Parkville, Melbourne, VIC 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Melbourne, VIC 3052, Australia.
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18
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Klaas HS, Clémence A, Marion-Veyron R, Antonietti JP, Alameda L, Golay P, Conus P. Insight as a social identity process in the evolution of psychosocial functioning in the early phase of psychosis. Psychol Med 2017; 47:718-729. [PMID: 27866482 PMCID: PMC5426321 DOI: 10.1017/s0033291716002506] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Awareness of illness (insight) has been found to have contradictory effects for different functional outcomes after the early course of psychosis. Whereas it is related to psychotic symptom reduction and medication adherence, it is also associated with increased depressive symptoms. In this line, the specific effects of insight on the evolution of functioning over time have not been identified, and social indicators, such as socio-occupational functioning have barely been considered. Drawing from social identity theory we investigated the impact of insight on the development of psychosocial outcomes and the interactions of these variables over time. METHOD The participants, 240 patients in early phase of psychosis from the Treatment and Early Intervention in Psychosis Program (TIPP) of the University Hospital of Lausanne, Switzerland, were assessed at eight time points over 3 years. Cross-lagged panel analyses and multilevel analyses were conducted on socio-occupational and general functioning [Social and Occupational Functioning Assessment Scale (SOFAS) and Global Assessment of Functioning (GAF)] with insight, time and depressive symptoms as independent variables. RESULTS Results from multilevel analyses point to an overall positive impact of insight on psychosocial functioning, which increases over time. Yet the cross-lagged panel analysis did not reveal a systematic positive and causal effect of insight on SOFAS and GAF scores. Depressive symptoms seem only to be relevant in the beginning of the treatment process. CONCLUSIONS Our results point to a complex process in which the positive impact of insight on psychosocial functioning increases over time, even when considering depressive symptoms. Future studies and treatment approaches should consider the procedural aspect of insight.
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Affiliation(s)
- H. S. Klaas
- Swiss National Centre of Competence in Research LIVES, Life Course and Inequality Research Centre (LINES), Faculty of Social and Political Sciences, University of Lausanne, Switzerland
| | - A. Clémence
- Psychology Institute, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - R. Marion-Veyron
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Département de Psychiatrie Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland
| | - J.-P. Antonietti
- Psychology Institute, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - L. Alameda
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Département de Psychiatrie Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland
| | - P. Golay
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Département de Psychiatrie Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland
| | - P. Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Département de Psychiatrie Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland
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Van Camp LSC, Oldenburg JFE, Sabbe BGC. How self-reflection and self-certainty are related to neurocognitive functioning: an examination of cognitive insight in bipolar disorder. Cogn Neuropsychiatry 2016; 21:130-45. [PMID: 26878384 DOI: 10.1080/13546805.2015.1137214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The pattern of associations between clinical insight, cognitive insight, and neurocognitive functioning was assessed in bipolar disorder patients. METHODS Data from 42 bipolar disorder patients were examined. Cognitive insight was measured using the Beck Cognitive Insight Scale (BCIS). The BCIS is a 15-item self-report instrument consisting of two subscales, self-reflectiveness and self-certainty. Clinical insight was measured by the use of the item G12 of the Positive and Negative Syndrome Scale. Neurocognitive functioning was assessed using the International Society for Bipolar Disorders-Battery for Assessment of Neurocognition. RESULTS Correlation analyses revealed significant positive associations between self-reflectiveness and speed of processing, attention, working memory, visual learning, and reasoning and problem solving. The subscale self-certainty was negatively correlated to working memory, however, this correlation disappeared when we controlled for confounding variables. No correlations between clinical insight and neurocognition were found. In addition, there was no association between cognitive insight and clinical insight. CONCLUSION Better neurocognitive functioning was more related to higher levels of self-reflectiveness than to diminished self-certainty.
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Affiliation(s)
- L S C Van Camp
- a Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine , University of Antwerp , Antwerp , Belgium.,b University Department, Psychiatric Hospital , Duffel , Belgium
| | - J F E Oldenburg
- a Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine , University of Antwerp , Antwerp , Belgium.,b University Department, Psychiatric Hospital , Duffel , Belgium
| | - B G C Sabbe
- a Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine , University of Antwerp , Antwerp , Belgium.,b University Department, Psychiatric Hospital , Duffel , Belgium
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20
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Sapara A, Ffytche DH, Cooke MA, Williams SCR, Kumari V. Voxel-based magnetic resonance imaging investigation of poor and preserved clinical insight in people with schizophrenia. World J Psychiatry 2016; 6:311-321. [PMID: 27679770 PMCID: PMC5031931 DOI: 10.5498/wjp.v6.i3.311] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To define regional grey-matter abnormalities in schizophrenia patients with poor insight (Insight-), relative to patients with preserved clinical insight (Insight+), and healthy controls.
METHODS Forty stable schizophrenia outpatients (20 Insight- and 20 Insight+) and 20 healthy controls underwent whole brain magnetic resonance imaging (MRI). Insight in all patients was assessed using the Birchwood Insight Scale (BIS; a self-report measure). The two patient groups were pre-selected to match on most clinical and demographic parameters but, by design, they had markedly distinct BIS scores. Voxel-based morphometry employed in SPM8 was used to examine group differences in grey matter volumes across the whole brain.
RESULTS The three participant groups were comparable in age [F(2,57) = 0.34, P = 0.71] and the patient groups did not differ in age at illness onset [t(38) = 0.87, P = 0.39]. Insight- and Insight+ patient groups also did not differ in symptoms on the Positive and Negative Syndromes scale (PANSS): Positive symptoms [t(38) = 0.58, P = 0.57], negative symptoms [t(38) = 0.61, P = 0.55], general psychopathology [t(38) = 1.30, P = 0.20] and total PANSS scores [t(38) = 0.21, P = 0.84]. The two patient groups, as expected, varied significantly in the level of BIS-assessed insight [t(38) = 12.11, P < 0.001]. MRI results revealed lower fronto-temporal, parahippocampal, occipital and cerebellar grey matter volumes in Insight- patients, relative to Insight+ patients and healthy controls (for all clusters, family-wise error corrected P < 0.05). Insight+ patient and healthy controls did not differ significantly (P > 0.20) from each other.
CONCLUSION Our findings demonstrate a clear association between poor clinical insight and smaller fronto-temporal, occipital and cerebellar grey matter volumes in stable long-term schizophrenia patients.
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Gilleen J, David A, Greenwood K. Self-reflection and set-shifting mediate awareness in cognitively preserved schizophrenia patients. Cogn Neuropsychiatry 2016; 21:185-96. [PMID: 27112316 DOI: 10.1080/13546805.2016.1167031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Poor insight in schizophrenia has been linked to poor cognitive functioning, psychological processes such as denial, or more recently with impaired metacognitive capacity. Few studies, however, have investigated the potential co-dependency of multiple factors in determining level of insight, but such a model is necessary in order to account for patients with good cognitive functioning who have very poor awareness. As evidence suggests that set-shifting and cognitive insight (self-reflection (SR) and self-certainty) are strong predictors of awareness we proposed that these factors are key mediators in the relationship between cognition and awareness. We hypothesised that deficits specifically in SR and set-shifting determine level of awareness in the context of good cognition. METHODS Thirty schizophrenia patients were stratified by high and low awareness of illness and executive functioning scores. Cognitive insight, cognition, mood and symptom measures were compared between sub-groups. RESULTS A low insight/high executive functioning (LI-HE) group, a high insight/high executive functioning (HI-HE) group and a low insight/low executive functioning (LI-LE) group were revealed. As anticipated, the LI-HE patients showed significantly lower capacity for SR and set-shifting than the HI-HE patients. CONCLUSIONS This study indicates that good cognitive functioning is necessary but not sufficient for good awareness; good awareness specifically demands preserved capacity to self-reflect and shift-set. Results support Nelson and Narens' [1990. Metamemory: A theoretical framework and new findings. The Psychology of Learning and Motivation, 26, 125-173] model of metacognition by which awareness is founded on control (set-shifting) and monitoring (SR) processes. These specific factors could be targeted to improve insight in patients with otherwise unimpaired cognitive function.
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Affiliation(s)
- James Gilleen
- a Department of Psychology , University of Roehampton , London , UK.,b Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience , Kings College London , London , UK
| | - Anthony David
- b Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience , Kings College London , London , UK
| | - Kathryn Greenwood
- c School of Psychology , University of Sussex , Sussex , UK.,d Early Intervention in Psychosis Service , Sussex Partnership NHS Foundation Trust , Sussex , UK
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Gómez-de-Regil L. Insight and illness perception in Mexican patients with psychosis. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:33-38. [PMID: 29379759 PMCID: PMC5779292 DOI: 10.1016/j.scog.2015.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 01/21/2015] [Accepted: 01/26/2015] [Indexed: 11/19/2022]
Abstract
Background Insight and illness perception are two concepts of interest in the study of factors related to clinical outcome in patients with psychosis. Insight implies a risk of emotional distress for the patient. Illness perceptions, regardless of their accuracy, might be favorable or not to illness. Literature provides evidence of significant correlates of these factors with clinical outcome, but they are rarely included in a single study. Objectives 1) assessing insight and illness perception in a sample of Mexican patients who have experienced psychosis and, 2) analyzing how insight and illness perception relate to each other and how they relate to clinical status (i.e., positive, negative, and general psychopathology, depression, and anxiety). Methods Sixty-one participants (55.7% females) were recruited from a public psychiatric hospital; insight and illness perceptions were assessed with the SUMD and the Brief-IPQ, respectively. Clinical status was assessed with the PANSS, CDS and BAI scales. Results Participants showed good insight, favorable illness perceptions for the cognitive and comprehension dimensions, but unfavorable for the emotional dimension. Clinical status of sample was characterized by mild symptoms. Poor insight related to positive symptoms and general psychopathology. Cognitive and emotional perceptions of illness were significantly associated to most clinical status parameters, whereas comprehension showed no significant results. Conclusions The study not only replicates the significant association on insight and illness perception with clinical outcome, but shows how their patterns of interactions are different, reinforcing the idea that they are two distinct factors worthy of being habitually acknowledged in research and clinical practice.
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Affiliation(s)
- Lizzette Gómez-de-Regil
- Hospital Regional de Alta Especialidad de la Península de Yucatán, Calle 7, No. 433 por 20 y 22, Fracc, Altabrisa, Mérida, Yucatán, México, 97130. Tel.: + 52 999 942 7600; fax: + 52 999 254 3535.
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Sánchez-Torres AM, Zarzuela A, Peralta V, Cuesta MJ. The association of lifetime insight and cognition in psychosis. Schizophr Res 2015; 162:183-8. [PMID: 25583245 DOI: 10.1016/j.schres.2014.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 12/01/2022]
Abstract
Poor insight has been related to poor course in psychosis. However, the role of cognition in insight remains unclear. The aim of this study was to examine the influence of cognition and lifetime psychopathological dimensions on insight in psychosis. We followed up 42 patients with psychotic disorders over 10years. Lifetime psychopathological dimensions and cognitive performance were assessed. Patients were divided into two groups by lifetime patterns of insight and compared with 42 healthy volunteers. Lower IQ and poorer social cognition were associated with higher risks of poorer lifetime insight of feeling ill and global insight respectively. Lifetime negative symptoms were associated with a higher risk of poorer lifetime insight into symptoms. Lifetime lack of insight is independent of cognitive impairment in specific domains, except for social cognition. Higher IQ may contribute to better lifetime awareness of illness, while better ability to manage emotions is involved in lifetime global insight.
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Affiliation(s)
- Ana M Sánchez-Torres
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona Spain; Department of Basic Psychology I, Faculty of Psychology, National Distance Education University (UNED), Madrid Spain
| | - Amalia Zarzuela
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona Spain
| | - Victor Peralta
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona Spain
| | - Manuel J Cuesta
- Psychiatric Unit B, Complejo Hospitalario de Navarra, Pamplona Spain.
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Belvederi Murri M, Respino M, Innamorati M, Cervetti A, Calcagno P, Pompili M, Lamis DA, Ghio L, Amore M. Is good insight associated with depression among patients with schizophrenia? Systematic review and meta-analysis. Schizophr Res 2015; 162:234-47. [PMID: 25631453 DOI: 10.1016/j.schres.2015.01.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 12/23/2014] [Accepted: 01/02/2015] [Indexed: 12/22/2022]
Abstract
Among patients with schizophrenia, better insight may be associated with depression, but the findings on this issue are mixed. We examined the association between insight and depression in schizophrenia by conducting a systematic review and meta-analysis. The meta-analysis was based on 59 correlational studies and showed that global clinical insight was associated weakly, but significantly with depression (effect size r=0.14), as were the insight into the mental disorder (r=0.14), insight into symptoms (r=0.14), and symptoms' attributions (r=0.17). Conversely, neither insight into the social consequences of the disorder nor into the need for treatment was associated with symptoms of depression. Better cognitive insight was significantly associated with higher levels of depression. The exploratory meta-regression showed that methodological factors (e.g. the instrument used to assess depression and the phase of the illness) can significantly influence the magnitude of the association between insight and depression. Moreover, results from longitudinal studies suggest that the relation between insight and depression might be stronger than what is observed at the cross-sectional level. Finally, internalized stigma, illness perception, recovery attitudes, ruminative style, and premorbid adjustment seem to be relevant moderators and/or mediators of the association between insight and depression. In conclusion, literature indicates that among patients with schizophrenia, better insight is associated with higher levels of depressive symptoms. Thus, interventions aimed at promoting patients' insight should take into account the clinical implications of these findings.
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Affiliation(s)
- Martino Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK.
| | - Matteo Respino
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Italy
| | - Alice Cervetti
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Pietro Calcagno
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Lucio Ghio
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
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Joseph B, Narayanaswamy JC, Venkatasubramanian G. Insight in schizophrenia: relationship to positive, negative and neurocognitive dimensions. Indian J Psychol Med 2015; 37:5-11. [PMID: 25722504 PMCID: PMC4341311 DOI: 10.4103/0253-7176.150797] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Impairment of insight is considered as the hallmark of schizophrenia. Substantial proportion of patients with schizophrenia has either poor or absent insight. Insight is a multidimensional and dynamic construct which appears to have intricate links with other symptom dimensions of the psychotic illness. A better appreciation of the association that insight shares with other symptom clusters in psychosis could help us in gaining knowledge about aetiology, prognosis and treatment-related facets of the disorder. This is likely to have critical implications in the understanding and therapeutics of schizophrenia.
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Affiliation(s)
- Boban Joseph
- Department of Psychiatric Social Work, Schizophrenia Clinic, Translational Psychiatry Laboratory, Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Gerretsen P, Plitman E, Rajji TK, Graff-Guerrero A. The effects of aging on insight into illness in schizophrenia: a review. Int J Geriatr Psychiatry 2014; 29:1145-61. [PMID: 25055980 PMCID: PMC4472640 DOI: 10.1002/gps.4154] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/03/2014] [Accepted: 05/05/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Impaired insight into illness is a prevalent feature of schizophrenia, which negatively influences treatment adherence and clinical outcomes. Little is known about the effects of aging on insight impairment. We aimed to review the available research literature on the effects of aging on insight into illness in schizophrenia, in relation to positive, negative, and cognitive symptoms. Ultimately, we propose a trajectory of insight in schizophrenia across the lifespan. METHOD A systematic Medline® literature search was conducted, searching for English language studies describing the relationship of insight into illness in schizophrenia with aging. RESULTS We identified 62 studies. Insight impairment is associated with illness severity, premorbid intellectual function (i.e. IQ), executive function, and memory. Insight impairment improves modestly during midlife, worsening again in late life. It tends to fluctuate with each episode of psychosis, likely in relation to worsening positive symptoms that improve with antipsychotic treatment. The relationship between insight impairment and cognitive dysfunction appears to attenuate with age, while the relationship with lower premorbid intellectual function is preserved. The association between impaired insight and negative symptoms is unclear. CONCLUSIONS The available literature suggests that the course of insight impairment follows a U-shaped curve, where insight impairment is severe during the first episode of psychosis, modestly improves over midlife, and declines again in late life. Future studies are required to investigate the trajectory of insight into illness and its core domains across the lifespan from prodromal phase to late life.
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Affiliation(s)
- Philip Gerretsen
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
| | - Eric Plitman
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
| | - Tarek K. Rajji
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
| | - Ariel Graff-Guerrero
- University of Toronto and the Centre for Addiction and Mental Health; Toronto ON Canada
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Chan SKW, Chan KKS, Hui CL, Wong GHY, Chang WC, Lee EHM, Tang JYM, Chen EYH. Correlates of insight with symptomatology and executive function in patients with first-episode schizophrenia-spectrum disorder: a longitudinal perspective. Psychiatry Res 2014; 216:177-84. [PMID: 24560612 DOI: 10.1016/j.psychres.2013.11.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 11/25/2013] [Accepted: 11/29/2013] [Indexed: 12/23/2022]
Abstract
The present study aimed to examine the relationships of insight with symptomatology and executive function, both cross-sectionally and longitudinally in patients with first-episode schizophrenia-spectrum disorders. Ninety-two medication-naïve patients were recruited and 71 completed the assessments. Insight, symptoms and executive function were assessed at baseline, 6 months and 1 year. Insight was measured with the abridged version of Scale of Unawareness of Mental Disorder (SUMD). Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Executive function was measured with the Modified Wisconsin Card Sorting Test (MCST). The most significant improvement of insight and symptomatology was found over the first 6 months, whereas the perseverative errors of MCST were significantly improved between 6 and 12 months. Differential correlations of perseverative errors of the MCST and PANSS scores with SUMD were found at different time points. This suggests the involvement of different mechanisms in insight deficit at different stages of the illness. The baseline MCST perseverative errors were correlated significantly with the SUMD total score at 6 months and the change of SUMD scores over the first 6 months. Although the variance explained was small, it suggests better set-shifting capacity facilitates the improvement of insight at an early stage of the illness.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Room 219, New Clinical Building, 102 Pokfulam Road, Hong Kong.
| | - Kevin Ka Shing Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Room 219, New Clinical Building, 102 Pokfulam Road, Hong Kong
| | - Christy Lai Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Room 219, New Clinical Building, 102 Pokfulam Road, Hong Kong
| | - Gloria Hoi Yan Wong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Room 219, New Clinical Building, 102 Pokfulam Road, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Room 219, New Clinical Building, 102 Pokfulam Road, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Room 219, New Clinical Building, 102 Pokfulam Road, Hong Kong
| | - Jennifer Yee Man Tang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Room 219, New Clinical Building, 102 Pokfulam Road, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Room 219, New Clinical Building, 102 Pokfulam Road, Hong Kong
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Lysaker PH, Buck KD, Salvatore G, Popolo R, Dimaggio G. Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches. Expert Rev Neurother 2014; 9:1035-43. [DOI: 10.1586/ern.09.55] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Capdevielle D, Norton J, Jaussent I, Prud'homme C, Raffard S, Gelly F, Boulenger JP, Ritchie K. A multi-dimensional approach to insight and its evolution in first-episode psychosis: a 1-year outcome naturalistic study. Psychiatry Res 2013; 210:835-41. [PMID: 24126187 DOI: 10.1016/j.psychres.2013.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 07/12/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Abstract
The aim of the study was to describe the evolution of the different dimensions of insight at 1 year and its associations with psychopathology and symptomatic remission. Participants included 55 patients hospitalized for a first psychosis episode and followed up at 6 and 12 months after discharge. Measures included the Scale to Assess Unawareness of Mental Disorder and the Positive and Negative Syndrome Scale (PANSS). Six dimensions of insight were evaluated, for current episode at hospital discharge and at 6 and 12 month FUs and past episode (at 6 and 12 month follow-ups). Our results show that concerning the current episode, only awareness of the social consequences and of the positive symptoms significantly improved during follow-up. Insight into the past episode improved for awareness of having a mental disorder, the social consequences and the positive symptoms of mental illness. Cross-sectional associations between insight and PANSS show weak to moderate, albeit significant, associations. Most of the dimensions of insight are positively and significantly associated with remission. Our findings suggest that the main underlying dimensions of insight evolve differently over time, which could suggest different inherent processes. This could be useful for developing psychotherapeutic programmes acting upon the different aspects of insight.
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Affiliation(s)
- Delphine Capdevielle
- University Department of Adult Psychiatry, CHU Montpellier, University Montpellier 1, Hôpital la Colombière, 39 avenue Charles Flahault, 34295 Montpellier cedex 5, France; INSERM U1061, Hôpital la Colombière, Pavillon 42, 39 avenue Charles Flahault, 34295 Montpellier, France.
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Rauch AS, Fleischhacker WW. Long-acting injectable formulations of new-generation antipsychotics: a review from a clinical perspective. CNS Drugs 2013; 27:637-52. [PMID: 23780619 DOI: 10.1007/s40263-013-0083-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Antipsychotics are the mainstay of the long-term treatment of patients with schizophrenia. In this context, the evidence also supports the effectiveness of long-acting injections (LAIs) or depots of antipsychotics regarding their relapse-preventing properties. When a LAI formulation of risperidone was launched as the first second-generation depot, there was a renaissance of interest in these formulations. In the meantime, olanzapine, paliperidone, and aripiprazole have been approved by regulatory authorities as LAIs in various countries. All studies using the new-generation depots have shown a clear advantage over placebo regarding relapse prevention and symptom reduction. Safety profiles of the long-acting compounds are comparable to their oral formulations with the exception of olanzapine pamoate injections, which can sometimes lead to a post-injection delirium. Despite the fact that many treatment guidelines recommend LAI antipsychotics as an important treatment option for the long-term management of schizophrenia, they are still most frequently used in chronically ill patients with considerable compliance problems. It is imperative to overcome this indication bias in order to be able to utilize all available treatment options in the long-term management of schizophrenia. There is little evidence on comparisons between LAIs and their oral mother compounds, and even less concerning effectiveness comparisons between different depots. The purpose of this manuscript is to review the recent clinical evidence on new-generation depot antipsychotics.
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Affiliation(s)
- Anna-Sophia Rauch
- Department of Psychiatry and Psychotherapy, Biological Psychiatry Division, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Insight in stable schizophrenia: relations with psychopathology and cognition. Compr Psychiatry 2013; 54:484-92. [PMID: 23332554 DOI: 10.1016/j.comppsych.2012.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This study evaluated the relationship among insight, sociodemographic and clinical variables, symptoms and cognitive functions in a population of outpatients with stable schizophrenia, in order to identify possible contributing factors to awareness. METHOD Two-hundred and seventy-six consecutive outpatients with stable schizophrenia were enrolled in a cross-sectional study. All subjects were assessed by psychiatric scales and interview, and a wide neuropsychological battery. A factor analysis was performed to identify cognitive factors and multiple regression analyses were executed to test the contribution of variables considered to insight. RESULTS Our results showed that positive and negative symptoms, executive functions, verbal memory-learning were contributors of awareness of mental illness; positive and negative symptoms explained variability in awareness of the need for treatment; positive symptoms and executive functions contributed to awareness of the social consequences of disorder. CONCLUSIONS These results suggested that insight was partially influenced by positive and negative symptoms and by cognitive functions. A complex system of overlapping variables may underlie impaired insight, contributing to a different extent to specific dimensions of poor insight in patients with stable schizophrenia.
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Adachi N, Kanemoto K, de Toffol B, Akanuma N, Oshima T, Mohan A, Sachdev P. Basic treatment principles for psychotic disorders in patients with epilepsy. Epilepsia 2013; 54 Suppl 1:19-33. [PMID: 23458463 DOI: 10.1111/epi.12102] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In patients with epilepsy, coexisting psychoses, either interictal (IIP) or postictal (PIP), are associated with serious disturbance in psychosocial function and well-being, and often require the care of a specialist. Unfortunately, evidence-based treatment systems for psychosis in patients with epilepsy have not yet been established. This article aims to propose concise and practical treatment procedures for IIP and PIP based on currently available data and international consensus statements, and primarily targeting nonpsychiatrist epileptologists who are often the first to be involved in the management of these complex patients. Accurate and early diagnosis of IIP and PIP and their staging in terms of acuity and severity form the essential first step in management. It is important to suspect the presence of psychosis whenever patients manifest unusual behavior. Knowledge of psychopathology and both individual and epilepsy-related vulnerabilities relevant to IIP and PIP facilitate early diagnosis. Treatment for IIP involves (1) obtaining consent to psychiatric treatment from the patient, whenever possible, (2) optimization of antiepileptic drugs, and (3) initiation of antipsychotic pharmacotherapy in line with symptom severity and severity of behavioral and functional disturbance. Basic psychosocial interventions will help reinforce adherence to treatment and should be made available. Due consideration must be given to patients' ability to provide informed consent to treatment in the short term, with the issue being revisited regularly over time. Given the often prolonged and recurrent nature of IIP, treatment frequently needs to be long-term. Treatment of PIP consists of two aspects, that is, acute protective measures and preventive procedures in repetitive episodes. Protective measures prioritize the management of risk in the early stages, and may involve sedation with or without the use of antipsychotic drugs, and the judicious application of local mental health legislation if appropriate. As for preventative procedures, optimizing seizure control by adjusting antiepileptic drugs or by surgical treatment is necessary.
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Relationships between psychopathological variables and insight in psychosis risk syndrome and first-episode and multiepisode schizophrenia. J Nerv Ment Dis 2013; 201:229-33. [PMID: 23407202 DOI: 10.1097/nmd.0b013e3182834315] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Insight may vary across psychosis risk syndrome (PRS), first-episode schizophrenia (FES), or multiepisode schizophrenia (MES). We aimed to compare insight domains (awareness, relabeling, and compliance) in PRS, FES, and MES groups and to correlate scores with psychopathological measures. Insight was assessed in 48 (14 PRS, 16 FES, and 18 MES) patients using the Schedule for the Assessment of Insight-Expanded Version. We conducted psychopathological assessment through the Brief Psychiatric Rating Scale (BPRS). In the whole group, the BPRS psychosis factor correlated with all insight domains. In the MES group, the more severe the anxiety/depression, the higher the insight score in the symptom relabeling domain. Insight did not differ significantly between the PRS, FES, and MES groups. Our results suggest that, across different phases of the illness, lack of insight behaves like a trait and is modulated by positive symptom severity. Anxiety and depression may be associated with increased insight in patients with chronic schizophrenia.
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Nandam LS, Hester R, Wagner J, Dean AJ, Messer C, Honeysett A, Nathan PJ, Bellgrove MA. Dopamine D₂ receptor modulation of human response inhibition and error awareness. J Cogn Neurosci 2012; 25:649-56. [PMID: 23163418 DOI: 10.1162/jocn_a_00327] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Response inhibition, comprising action cancellation and action restraint, and error awareness are executive functions of considerable clinical relevance to neuropsychiatric disorders. Nevertheless, our understanding of their underlying catecholamine mechanisms, particularly regarding dopamine, is limited. Here, we used the dopamine D2 agonist cabergoline to study its ability to improve inhibitory control and modulate awareness of performance errors. A randomized, double-blind, placebo-controlled, crossover design with a single dose of cabergoline (1.25 mg) and placebo (dextrose) was employed in 25 healthy participants. They each performed the stop-signal task, a well-validated measure of action cancellation, and the Error Awareness Task, a go/no-go measure of action restraint and error awareness, under each drug condition. Cabergoline was able to selectively reduce stop-signal RT, compared with placebo, indicative of enhanced action cancellation (p < .05). This enhancement occurred without concomitant changes in overall response speed or RT variability and was not seen for errors of commission on the Error Awareness Task. Awareness of performance errors on the go/no-go task was, however, significantly improved by cabergoline compared with placebo (p < .05). Our results contribute to growing evidence for the dopaminergic control of distinct aspects of human executive ability, namely, action cancellation and error awareness. The findings may aid the development of new, or the repurposing of existing, pharmacotherapy that targets the cognitive dysfunction of psychiatric and neurological disorders. They also provide further evidence that specific cognitive paradigms have correspondingly specific neurochemical bases.
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Lecomte T, Leclerc C, Wykes T. Group CBT for early psychosis--are there still benefits one year later? Int J Group Psychother 2012; 62:309-21. [PMID: 22468576 DOI: 10.1521/ijgp.2012.62.2.309] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Our team recently conducted a randomized controlled trial comparing group cognitive behavior therapy for psychosis (CBTp) to group social skills training for symptom management and a wait-list control group, for early psychosis. The results at post-therapy and six months provided considerable empirical support for the efficacy of the group CBTp. The results of the one-year follow-up are described here. Given the high attrition rates, mostly in the comparison and control conditions, imputations were not possible, so that only the results of those having completed more than 50% of the group CBTp are presented. Significant improvements at 12 months were found for social support and insight. Negative symptoms remained low, whereas positive symptoms went back to pre-therapy levels. Challenges regarding attrition with this clientele are discussed.
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Affiliation(s)
- Tania Lecomte
- Department of Psychology at the University of Montreal, Canada.
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Nieto L, Cobo J, Pousa E, Blas-Navarro J, García-Parés G, Palao D, Obiols JE. Insight, symptomatic dimensions, and cognition in patients with acute-phase psychosis. Compr Psychiatry 2012; 53:502-8. [PMID: 22036010 DOI: 10.1016/j.comppsych.2011.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 08/27/2011] [Accepted: 08/29/2011] [Indexed: 02/08/2023] Open
Abstract
AIMS This study was designed to evaluate the relationship between insight and the severity of psychotic symptomatology in a sample of patients in an acute phase of psychosis, as well as to analyze the relationship between insight and the symptomatic profile of the patient. In addition, the role of general cognitive abilities in this relationship was explored. METHOD Cross-sectional observational study of 96 acute psychotic adults. To evaluate psychopathology we used the Positive and Negative Syndrome Scale; for insight, the Scale of Unawareness of Mental Disorder; and for general cognitive abilities, the Screen for Cognitive Impairment in Psychiatry. RESULTS Insight showed significant and moderate positive correlations with positive and general symptoms but not with negative symptoms. In the subgroup with positive symptomatic profile, awareness of the disorder and of the effects of medication were positively associated with severity of positive and general psychotic symptoms. Awareness of social consequences of the disease was positively associated with positive symptoms. In the subgroup with a negative symptomatic profile, awareness of the disorder and of the effects of medication were positively associated with severity of positive and general psychotic symptoms. In this subgroup, these relationships were significantly affected by general cognitive abilities. CONCLUSIONS Insight was not related with the severity of negative psychotic symptoms. The symptomatic profile of subjects played an important role in determining the relationship between insight and its dimensions and the severity of psychotic symptoms. Cognitive function moderated these relationships only in the negative symptomatic profile.
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Affiliation(s)
- Lourdes Nieto
- Department of Clinical and Health Psychology, Psychopathology and Neuropsychology Research Unit, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain.
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Schennach R, Meyer S, Seemüller F, Jäger M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Möller HJ, Riedel M. Insight in schizophrenia-course and predictors during the acute treatment phase of patients suffering from a schizophrenia spectrum disorder. Eur Psychiatry 2012; 27:625-33. [PMID: 22542652 DOI: 10.1016/j.eurpsy.2012.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 12/23/2011] [Accepted: 01/04/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To analyse insight of illness during the course of inpatient treatment, and to identify influencing factors and predictors of insight. METHODS Insight into illness was examined in 399 patients using the item G12 of the Positive and Negative Syndrome Scale ("lack of insight and judgement"). Ratings of the PANSS, HAMD, UKU, GAF, SOFAS, SWN-K and Kemp's compliance scale were performed and examined regarding their potential association with insight. The item G12 was kept as an ordinal variable to compare insight between subgroups of patients. RESULTS Almost 70% of patients had deficits in their insight into illness at admission. A significant improvement of impairments of insight during the treatment (p<0.0001) was observed. At admission more severe positive and negative symptoms, worse functioning and worse adherence were significantly associated with poorer insight. Less depressive symptoms (p=0.0004), less suicidality (p=0.0218), suffering from multiple illness-episodes (p<0.0001) and worse adherence (p=0.0012) at admission were identified to be significant predictors of poor insight at discharge. CONCLUSION The revealed predictors might function as treatment targets in order to improve insight and with it outcome of schizophrenia.
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Affiliation(s)
- R Schennach
- Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstraße 7, 80336 Munich, Germany.
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Abstract
How the brain monitors ongoing behavior for performance errors is a central question of cognitive neuroscience. Diminished awareness of performance errors limits the extent to which humans engage in corrective behavior and has been linked to loss of insight in a number of psychiatric syndromes (e.g., attention deficit hyperactivity disorder, drug addiction). These conditions share alterations in monoamine signaling that may influence the neural mechanisms underlying error processing, but our understanding of the neurochemical drivers of these processes is limited. We conducted a randomized, double-blind, placebo-controlled, cross-over design of the influence of methylphenidate, atomoxetine, and citalopram on error awareness in 27 healthy participants. The error awareness task, a go/no-go response inhibition paradigm, was administered to assess the influence of monoaminergic agents on performance errors during fMRI data acquisition. A single dose of methylphenidate, but not atomoxetine or citalopram, significantly improved the ability of healthy volunteers to consciously detect performance errors. Furthermore, this behavioral effect was associated with a strengthening of activation differences in the dorsal anterior cingulate cortex and inferior parietal lobe during the methylphenidate condition for errors made with versus without awareness. Our results have implications for the understanding of the neurochemical underpinnings of performance monitoring and for the pharmacological treatment of a range of disparate clinical conditions that are marked by poor awareness of errors.
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Murphy PR, Robertson IH, Allen D, Hester R, O'Connell RG. An electrophysiological signal that precisely tracks the emergence of error awareness. Front Hum Neurosci 2012; 6:65. [PMID: 22470332 PMCID: PMC3314233 DOI: 10.3389/fnhum.2012.00065] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/12/2012] [Indexed: 11/13/2022] Open
Abstract
Recent electrophysiological research has sought to elucidate the neural mechanisms necessary for the conscious awareness of action errors. Much of this work has focused on the error positivity (Pe), a neural signal that is specifically elicited by errors that have been consciously perceived. While awareness appears to be an essential prerequisite for eliciting the Pe, the precise functional role of this component has not been identified. Twenty-nine participants performed a novel variant of the Go/No-go Error Awareness Task (EAT) in which awareness of commission errors was indicated via a separate speeded manual response. Independent component analysis (ICA) was used to isolate the Pe from other stimulus- and response-evoked signals. Single-trial analysis revealed that Pe peak latency was highly correlated with the latency at which awareness was indicated. Furthermore, the Pe was more closely related to the timing of awareness than it was to the initial erroneous response. This finding was confirmed in a separate study which derived IC weights from a control condition in which no indication of awareness was required, thus ruling out motor confounds. A receiver-operating-characteristic (ROC) curve analysis showed that the Pe could reliably predict whether an error would be consciously perceived up to 400 ms before the average awareness response. Finally, Pe latency and amplitude were found to be significantly correlated with overall error awareness levels between subjects. Our data show for the first time that the temporal dynamics of the Pe trace the emergence of error awareness. These findings have important implications for interpreting the results of clinical EEG studies of error processing.
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Affiliation(s)
- Peter R Murphy
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin Dublin, Ireland
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Clinical and cognitive correlates of insight in first-episode schizophrenia. Schizophr Res 2012; 135:40-5. [PMID: 22245186 DOI: 10.1016/j.schres.2011.12.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 12/01/2011] [Accepted: 12/19/2011] [Indexed: 11/23/2022]
Abstract
This study aims to explore the relationship between clinical symptoms and cognitive functions with different insight dimensions in patients with first-episode schizophrenia. Seventy-nine patients were assessed following six months of treatment. Insight was assessed using the abridged version of Scale of Unawareness of Mental Disorder (SUMD). Symptoms were assessed using Positive and Negative Syndrome Scale (PANSS). Cognitive functions were assessed using the Modified Wisconsin Card Sorting Test (MWCST), semantic verbal fluency and the letter-number sequencing (LNS) test from the Wechsler Adult Intelligence Scale (WAIS). Positive, negative and disorganized symptoms were found to be correlated with overall insight and all three general insight dimensions. Only perseverative errors and categories completed of MWCST were correlated with overall insight. Perseverative errors and non-perseverative errors of MWCST were correlated with the awareness of medication effects; perseverative errors of MWCST were also correlated with the awareness of social consequence of the illness. These support the link between poor insight and impaired executive function particularly measured by MWCST. The specific correlation of cognitive functions and different dimensions of insight suggests different underlying mechanism within each dimension of insight. The combined model of symptomatology and cognitive function explained 20.6% to 36.4% of the variance in the lack of insight within the different dimensions. The modest combined relationship of clinical and cognitive function with insight suggests that the exploration of other models in relationship to different insight dimensions is important.
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Xiang YT, Wang Y, Wang CY, Chiu HFK, Chen Q, Chan SSM, Lai KYC, Lee EHM, Ungvari GS. Association of insight with sociodemographic and clinical factors, quality of life, and cognition in Chinese patients with schizophrenia. Compr Psychiatry 2012; 53:140-4. [PMID: 21632041 DOI: 10.1016/j.comppsych.2011.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 04/05/2011] [Accepted: 04/06/2011] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The aims of this study were to assess insight in Chinese patients with schizophrenia and to identify its relationship with sociodemographic and clinical factors, cognition, and quality of life (QOL). METHODS A cohort of 139 patients with clinically stable schizophrenia was selected by consecutively screening patients who had been diagnosed with schizophrenia and who were attending the outpatient department of a university-affiliated psychiatric hospital in China. Participants' sociodemographic and clinical characteristics, including psychotic and depressive symptoms and insight, as well as their social functioning, QOL, and flexibility of cognition, were assessed with standardized rating instruments. RESULTS Thirty-three patients (23.7%) had good insight into their illness. In univariate analyses, poor insight was associated with the positive, negative, and general symptom scores of the Positive and Negative Syndrome Scale (PANSS), and with higher scores on the physical and mental components of QOL. In multivariate analysis, poor insight was independently associated with a higher negative symptom score on the PANSS, a shorter length of illness, and with a high score on the physical components of QOL. CONCLUSIONS Poor insight is common in patients with clinically stable schizophrenia. In this study, insight was not associated with basic sociodemographic characteristics or had it any associations with depression or the flexibility of cognitive processes.
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Affiliation(s)
- Yu-Tao Xiang
- Beijing Anding Hospital, Capital Medical University, China
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Wang Y, Xiang YT, Wang CY, Chiu HFK, Zhao JP, Chen Q, Chan SSM, Lee EHM, Tang WK, Ungvari GS. Insight in Chinese schizophrenia patients: a 12-month follow-up. J Psychiatr Ment Health Nurs 2011; 18:751-7. [PMID: 21985677 DOI: 10.1111/j.1365-2850.2010.01677.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study aimed to assess insight in Chinese schizophrenia patients and to identify its relationship with socio-demographic and clinical factors, executive functions and quality of life (QOL). A cohort of 139 clinically stable schizophrenia patients was selected by consecutively screening patients diagnosed with schizophrenia who were attending the outpatient department of a university-affiliated psychiatric hospital in China. Participants' socio-demographic and clinical characteristics, including psychotic symptoms, depression and insight, as well as QOL and executive functions, were periodically assessed with standardized rating instruments. Patients received standard psychiatric care and were followed up for 1 year. Impaired insight was found to be common in stable Chinese schizophrenia patients (76.3%), with merely 5% showing improvement over the 1-year follow-up. Insight was inversely correlated with positive and negative symptoms at all but the 12-month assessment and with both the physical and mental components of QOL at baseline and the 12-month assessment. Insight was not associated with depressive symptoms or executive functions. Standard psychiatric care does not improve the level of insight in clinically stable Chinese schizophrenia outpatients, which warrants the introduction of specific therapeutic interventions that enhance insight.
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Affiliation(s)
- Y Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
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Abstract
The purpose of the present study was to explore the relationship between suicidal behavior and socio-demographic and clinical factors, including insight into illness, in patients with schizophrenia spectrum disorders. We evaluated 104 inpatients using the Self-Appraisal of Illness Questionnaire (SAIQ) for insight assessment, several Beck-related symptoms rating scales, and the Positive and Negative Syndrome Scale (PANSS) for psychopathology. These patients were also evaluated for suicidal behavior and risk using the critical items of the Scale for Suicide Ideation (SSI) and lifetime suicide attempts. Patients with suicidal behavior generally had greater insight into illness than those who were non-suicidal. After controlling for depressive symptoms, the association of insight into illness with current suicidal ideation remained significant, whereas the association between insight and lifetime suicide attempts was no longer significant. As predicted, the regression analyses revealed that those with greater suicide risk had significantly higher levels of depressive symptoms and hopelessness and more lifetime suicide attempts. Moreover, greater insight into illness appeared to have a close, independent connection to suicidal behavior. Our findings suggest that depression, hopelessness, and greater insight into illness are major risk factors for suicide in patients with schizophrenia. It is plausible that depression mediates the relationship between greater insight into illness and suicidal behavior. Aggressive improvement of insight without the risk of deteriorating depressive symptoms may be warranted to reduce the risk of suicide.
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Can insight be predicted in first-episode psychosis patients? A longitudinal and hierarchical analysis of predictors in a drug-naïve sample. Schizophr Res 2011; 130:148-56. [PMID: 21632216 DOI: 10.1016/j.schres.2011.04.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/20/2011] [Accepted: 04/30/2011] [Indexed: 11/23/2022]
Abstract
Poor insight is a ubiquitous phenomenon in psychosis with great repercussions on clinical practise and the outcomes of patients. Poor insight comprises "state" and "trait" components. This paper targeted predictors of global insight and insight dimensions at baseline in the drug-naïve status of first-episode psychosis patients and during a 6-month follow up after episode remission. Seventy-seven consecutive and previously unmedicated patients with first-episode schizophrenia-spectrum disorders (FESSD) completed baseline and 6-month insight, premorbid, symptomatological and neuropsychological assessments. Insight measures served as dependent variables for a set of hierarchical multiple regression models. Premorbid personality abnormalities and duration of untreated psychosis (DUP) significantly predicted 'state' and 'trait' insight global scores. Duration of untreated psychosis (DUP) significantly predicted 'state' insight, measured as refusal of treatment at baseline. Moreover, premorbid personality abnormalities and DUP with minor contributions of demographic variables, cognitive functioning and psychopathological dimensions predicted 'trait insight', defined as insight after remission of the psychosis episode 'Insight improver' FESSD patients showed better late adolescent premorbid adjustment, lower personality disturbances (sociopathic, schizoid and schizotypy dimensions), shorter DUP, and lower positive, negative and disorganisation symptoms and better cognitive performance on the Trail Making B test at the 6-month follow-up assessment. Premorbid personality abnormalities and DUP were predictors of 'state' and 'trait' insight, both at global scores and dimension levels. Moreover, insight improvement in patients with FESSD was related to premorbid abnormalities (in both adjustment and personality), shorter DUP, fewer positive and negative symptoms and better performance in cognitive tests at the 6-month follow up.
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Lysaker PH, Dimaggio G, Buck KD, Callaway SS, Salvatore G, Carcione A, Nicolò G, Stanghellini G. Poor insight in schizophrenia: links between different forms of metacognition with awareness of symptoms, treatment need, and consequences of illness. Compr Psychiatry 2011; 52:253-60. [PMID: 21497218 DOI: 10.1016/j.comppsych.2010.07.007] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 06/28/2010] [Accepted: 07/09/2010] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Many persons with schizophrenia experience poor insight or reflexive unawareness of the symptoms and consequences of their illness and, as a result, are at risk for treatment nonadherence and a range of negative outcomes. One recent theory regarding the origins of poor insight in schizophrenia has suggested that it may result, in part, from deficits in metacognitive capacity, or the ability to think about thinking, both one's own and the thinking of others. METHODS Participants were 65 adults with a schizophrenia spectrum disorder in a postacute phase of illness living in the community. For all participants, we obtained measures of three domains of metacognition, including self-reflectivity, mastery, and perspective taking, using the Metacognitive Assessment Scale and the hinting test and three domains of insight, which were awareness of symptoms, treatment need, and consequences of illness, using the Scale to Assess Unawareness of Mental Disorder. Measures of neurocognition were also collected for potential use as covariates. RESULTS Univariate correlations followed by stepwise multiple regressions, which controlled for neurocognition, indicated that self-reflectivity was significantly linked with awareness of symptoms, mastery with treatment need, and mastery and perspective taking were linked with awareness of consequences of illness. CONCLUSIONS Results suggest that metacognition may be linked to insight in persons with schizophrenia independent of concurrent impairments in neurocognition.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center (116H), Indianapolis, IN 46202, USA.
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Brent BK, Giuliano AJ, Zimmet SV, Keshavan MS, Seidman LJ. Insight into illness in patients and caregivers during early psychosis: a pilot study. Schizophr Res 2011; 127:100-6. [PMID: 21315560 DOI: 10.1016/j.schres.2010.12.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/16/2010] [Accepted: 12/21/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Impaired insight into illness is common during early psychosis and has been associated with treatment delays and poorer long-term outcomes. The relationship between patients' insight into illness and their caregivers' knowledge about psychosis is putatively associated with treatment outcome but there is limited research about this. This pilot study was designed to test the hypothesis that caregivers' levels of insight into illness is associated with patients' insight into illness in early psychosis and would be related to caregivers' levels of critical, rejecting attitudes toward patients. METHODS Patients with schizophrenia or schizoaffective disorder within 5 years of psychosis onset (n=14) and caregivers (n=14) of the patients' choosing were studied. Insight into illness was assessed in patients using the Scale to assess Unawareness of Mental Disorder (SUMD). Caregiver insight into illness was assessed with a modified version of the SUMD with questions rephrased to probe caregivers' understanding of the patients' illness. Caregivers' critical attitudes toward patients were assessed with the Patient Rejection Scale (PRS). RESULTS Significant correlations were found between patients' and caregivers' awareness of need for treatment (r=.55, p=.02), awareness of symptoms (r=.48, p=.04) and between caregivers' awareness of illness and critical attitudes toward patients (r=.65, p=.01). CONCLUSIONS These findings suggest that caregivers' emotional characteristics and levels of insight into illness may be related to insight into illness in patients. Implications for family psychoeducational approaches to impairments of insight into illness during early psychosis are discussed.
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Affiliation(s)
- Benjamin K Brent
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA.
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Campos MS, Garcia-Jalon E, Gilleen JK, David AS, Peralta MD V, Cuesta MJ. Premorbid personality and insight in first-episode psychosis. Schizophr Bull 2011; 37:52-60. [PMID: 20974749 PMCID: PMC3004187 DOI: 10.1093/schbul/sbq119] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Insight in psychosis and schizophrenia is considered a complex biopsychosocial phenomenon. Premorbid personality is regarded by some authors as part of the substrate to many psychiatric phenomena, but it is not clear if this applies to insight. AIM To examine longitudinal relationships between personality traits and insight dimensions in first-episode psychosis. METHODS One hundred consecutive antipsychotic-naïve first-episode nonaffective psychotic patients admitted to hospital were included in the study. Eighty-one patients completed at 1 month a premorbid personality evaluation, plus baseline, and 6-month insight assessments. We used the Assessment and Documentation of Psychopathology inventory for assessing insight dimensions (not feeling ill, lack of insight, and refusal of treatment) and the Personality Assessment Schedule for ascertaining 5 dimensions of premorbid personality (schizoid, passive-dependent, anancastic, sociopathic, and schizotypy). RESULTS At baseline, personality dimensions did not show any association with insight dimensions, with the exception of schizotypy traits. At 6 months, schizoid and sociopathic personality showed a significant association with not feeling ill (r = .30, P ≤ .007; r = .27, P = .01) and lack of insight (r = .36, P = .001; r = .41, P < .001), respectively. When we calculated insight change, schizoid and sociopathic personality had moderate correlation with the lack of insight dimension (r = -.34, P = .002; r = .38, P < .001, respectively). After applying partial correlations for potential confounders and Bonferroni correction, the associations remained significant. Moreover, using a regression model, sociopathic and schizoid personality significantly predicted lack of insight at 6 months and change from baseline to the 6 months assessment. CONCLUSIONS Sociopathic and schizoid personality dimensions were not only significantly associated with lack of insight at 6 months but also predicted change on lack of insight over 6 months. Therefore, exploring premorbid personality traits at the beginning of a psychotic episode may be helpful in identifying patients at high risk for lack of insight during the initial course of the illness.
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Affiliation(s)
- Maria S. Campos
- Psychiatric Unit of Virgen del Camino Hospital, c/Irunlarrea 4, E-31008 Pamplona, Spain
| | - Elena Garcia-Jalon
- Psychiatric Unit of Virgen del Camino Hospital, c/Irunlarrea 4, E-31008 Pamplona, Spain
| | - James K. Gilleen
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King’s College London, UK
| | - Anthony S. David
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King’s College London, UK
| | - Victor Peralta MD
- Psychiatric Unit of Virgen del Camino Hospital, c/Irunlarrea 4, E-31008 Pamplona, Spain
| | - Manuel J. Cuesta
- Psychiatric Unit of Virgen del Camino Hospital, c/Irunlarrea 4, E-31008 Pamplona, Spain,To whom correspondence should be addressed; tel: +34-848-422488, fax: +34-848-422488, e-mail:
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Wiffen BDR, Rabinowitz J, Fleischhacker WW, David AS. Insight: demographic differences and associations with one-year outcome in schizophrenia and schizoaffective disorder. ACTA ACUST UNITED AC 2010; 4:169-75. [PMID: 20880827 DOI: 10.3371/csrp.4.3.3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Insight is increasingly seen as an important variable for study in psychotic illness, particularly in relation to treatment adherence. This study aims to quantify the association of insight with outcome, sociodemographic variables and diagnosis in a large stable patient sample. METHOD Data are from a one-year, open-label, international, multicenter trial (n=670) of long-acting risperidone in adult symptomatically stable patients with schizophrenia or schizoaffective disorder. Psychopathology and insight were quantified using the Positive and Negative Syndrome Scale (PANSS). Patients were assessed at four time points over the year of the study. RESULTS 31.2% of the sample showed clinically significant deficits in insight at baseline. There were no differences based on sex, but significant differences in age and diagnosis, with oldest patients and schizophrenia patients (cf., schizoaffective disorder) showing more deficits. Baseline insight impairment was correlated with change in PANSS score at one year (r=-0.243, p<0.001). Recursive partitioning showed that, of those whose symptoms improved, those whose insight also improved were more likely to complete the trial. CONCLUSIONS Insight is important above and beyond the effects of symptoms for predicting continuation in drug trials. This may have implications for the design and analysis of such trials, as well as suggesting the importance of targeting insight in treatment to increase likelihood of adherence to treatment. There also appear to be small but significant differences in insight based on age and diagnosis within the schizophrenia spectrum.
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Affiliation(s)
- Benjamin D R Wiffen
- Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, UK.
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Segarra R, Ojeda N, Peña J, García J, Rodriguez-Morales A, Ruiz I, Hidalgo R, Burón JA, Eguiluz JII, Gutiérrez M. Longitudinal changes of insight in first episode psychosis and its relation to clinical symptoms, treatment adherence and global functioning: one-year follow-up from the Eiffel study. Eur Psychiatry 2010; 27:43-9. [PMID: 20813506 DOI: 10.1016/j.eurpsy.2010.06.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 05/26/2010] [Accepted: 06/11/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The Eiffel study is a longitudinal, naturalistic study of patients with first episode psychosis (FEP) designed to evaluate the predictive value of defective insight on treatment adherence and global functioning. METHODS Five hundred seventy-seven patients with FEP were assessed at baseline and at a 1-year follow-up. They were compared in terms of sociodemographic factors, psychopathology, insight, treatment adherence and functional outcome. Longitudinal functionality was prospectively assessed with the clinical global impression (CGI) and global assessment of functioning (GAF) rating scales. RESULTS At baseline, up to 50% of our sample presented with a lack of insight. Most clinical symptoms, including insight, improved over the follow-up period. Insight, education and social withdrawal significantly predicted CGI and GAF at follow-up. Insight and level of education were predictive of treatment adherence. CONCLUSIONS Insight significantly predicted the general clinical course, treatment adherence and functional outcome in our FEP sample after 1 year. Only education additionally accounted for the longitudinal course. Since our results suggest that better insight improves treatment adherence and consequently clinical course and functional outcome, insight could be a specific target of treatment in early intervention programs.
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Affiliation(s)
- R Segarra
- First Episode Psychosis Unit, Psychiatry Department, Cruces Hospital, Plaza de Cruces, s/n. 48903 Baracaldo, Spain.
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Wiffen BDR, Rabinowitz J, Lex A, David AS. Correlates, change and 'state or trait' properties of insight in schizophrenia. Schizophr Res 2010; 122:94-103. [PMID: 20382507 DOI: 10.1016/j.schres.2010.03.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/04/2010] [Accepted: 03/07/2010] [Indexed: 01/13/2023]
Abstract
BACKGROUND The associations of insight into illness and clinical and socio-demographic variables in schizophrenia have been examined, yet little attention has been given to premorbid functioning, insight change and outcomes. OBJECTIVES We examined these associations in a large cohort of recent onset schizophrenia spectrum disorder patients. METHODS This was a prospective 6-month, open-label, multicentre, phase IV trial in 303 subjects with recent onset (<or=2 years) schizophrenia treated with risperidone long-acting injection (RLAI). Insight (Schedule for the Assessment of Insight - Expanded), treatment efficacy (Positive and Negative Syndrome Scale, Clinical Global Impression) and quality of life (Short Form-36) were assessed at baseline and after 2, 4 and 6 months. The Premorbid Adjustment Scale was administered at baseline. RESULTS Insight was positively associated with better premorbid functioning, more education and schizoaffective disorder versus schizophrenia. Insight improved modestly, but significantly throughout treatment, particularly illness beliefs. Baseline insight was negatively correlated with quality of life and positive symptoms and positively correlated with anxiety/depression. It was not significantly associated with change in symptom severity or time in trial, but was positively associated with age. CONCLUSIONS Insight, at least in this stable, comparatively high-insight sample, improved during treatment but this is not closely related to improvement in psychotic symptoms. Insight appears to have trait-like qualities demonstrated by association with premorbid factors. While insight is generally a favorable attribute and is associated with fewer psychotic symptoms, it is also associated with increased depression and lower perceived quality of life. Some components of insight are more amenable to improvement; particularly the ability to adopt less fixed illness attributions.
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Affiliation(s)
- Benjamin D R Wiffen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
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