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Bayir B, Ünal E, Küçükköseler AD. The effects of women's insight levels on breast cancer prevention behaviors: a cross-sectional study. Women Health 2023; 63:828-836. [PMID: 37933087 DOI: 10.1080/03630242.2023.2276146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
The aim of this study is to determine the effect of women's insight levels on their breast cancer prevention behaviors in primary health care services. A systematic sampling method was used to select a sample of 393 women in a province in Turkey. Socio-demographic Characteristics Form, Insight Scale and Scale for Determining Factors Affecting Women's Breast Cancer Prevention Behaviour were used as data collection tools. Data were collected face-to-face and then analyzed statistically using Student's t-test, one-way analysis of variance, Tukey HSD, Spearman correlation test and multiple regression analysis. The results showed that those who felt "healthy" had significantly higher mean breast cancer prevention behavior (p < .05). It was determined that there was a weak positive correlation between the level of insight and breast cancer prevention behaviors, and the increase in the level of insight had a significant positive effect of 0.37 ± 0.051 points on breast cancer prevention behaviors. It was found that there was a significant negative effect on prevention behaviors with 1.66 ± 0.796 points in those with a high education level and 1.58 ± 0.505 points in those with suspected disease. In conclusion, in this study, it was determined that insight level, education level, and awareness of early diagnosis affected the prevention behaviors of breast cancer.
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Affiliation(s)
- Berna Bayir
- School of Health Sciences, Department of Nursing, kto Karatay University, Konya, Turkey
| | - Esra Ünal
- School of Health Sciences, Department of Nursing, kto Karatay University, Konya, Turkey
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2
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Meroni G, Sentissi O, Kaiser S, Wullschleger A. Treatment without consent in adult psychiatry inpatient units: a retrospective study on predictive factors. Front Psychiatry 2023; 14:1224328. [PMID: 37636826 PMCID: PMC10447976 DOI: 10.3389/fpsyt.2023.1224328] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Background Coercion is one of the most important challenges in mental health. In Switzerland, forced medication can be applied during an emergency (Art. 435 of the Civil Code) or over a longer period in case of endangerment of others or oneself (Art. 434). We aimed to analyze the predictors of this specific treatment without consent. Methods Forced medication prescriptions in the Division of Adult Psychiatry of the Geneva University Hospitals between 2018 and 2021 were retrospectively analyzed. Medication under Article 434 was the main outcome variable. Age, gender, admission mode, main diagnosis, and the Health of the Nation Outcome Scales (HoNOS) score at admission were considered as potential predictors. T-test and Pearson's chi-square test were used to compare continuous and categorical variables. A logistic regression was performed to find significant predictors of forced medication. Results Seventy-one out of 4,326 inpatients were subjected to forced medication under Art. 434. HoNOS global scores at admission were not significantly different in the forced medication group compared to the control group. Aggressive behavior was lower in the former at the univariate level. Forced medication was associated at the multivariate level with female gender, involuntary admission, and psychosis. Conclusion Women suffering from psychosis are more at risk of receiving involuntary and repeated medication. The risk of deterioration in psychosocial functioning or behavioral disorganization seems to be the main argument for this coercive measure. Future studies should focus on the patient's perception of this coercion to prevent it and improve adherence to care. Follow-up after discharge might be useful to evaluate a long-term benefit.
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Affiliation(s)
- Giulia Meroni
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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Stabell L, Johnsen E, Kroken RA, Løberg E, Blindheim A, Joa I, Reitan S, Rettenbacher M, Munk-Jørgensen P, Gjestad R. Clinical insight among persons with schizophrenia spectrum disorders treated with amisulpride, aripiprazole or olanzapine: a semi-randomised trial. BMC Psychiatry 2023; 23:482. [PMID: 37386462 PMCID: PMC10311854 DOI: 10.1186/s12888-023-04981-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Antipsychotic treatment may improve clinical insight. However, previous studies have reported inconclusive findings on whether antipsychotics improve insight over and above the reduction in symptoms of psychosis. These studies assessed homogeneous samples in terms of stage of illness. Randomised studies investigating a mixed population of first- and multiepisode schizophrenia spectrum disorders might clarify this disagreement. METHODS Our data were derived from a pragmatic, rater-blinded, semi-randomised trial that compared the effectiveness of amisulpride, aripiprazole and olanzapine. A sample of 144 patients with first- or multiepisode schizophrenia spectrum disorders underwent eight assessments during a 1-year follow-up. Clinical insight was assessed by item General 12 from the Positive and Negative Syndrome Scale (PANSS). We analysed latent growth curve models to test if the medications had a direct effect on insight that was over and above the reduction in total psychosis symptoms. Furthermore, we investigated whether there were differences between the study drugs in terms of insight. RESULTS Based on allocation analysis, all three drugs were associated with a reduction in total psychosis symptoms in the initial phase (weeks 0-6). Amisulpride and olanzapine were associated with improved insight over and above what was related to the reduction in total psychosis symptoms in the long-term phase (weeks 6-52). However, these differential effects were lost when only including the participants that chose the first drug in the randomisation sequence. We found no differential effect on insight among those who were antipsychotic-naïve and those who were previously medicated with antipsychotics. CONCLUSIONS Our results suggest that antipsychotic treatment improves insight, but whether the effect on insight surpasses the effect of reduced total psychosis symptoms is more uncertain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01446328, 05.10.2011.
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Affiliation(s)
- L.A Stabell
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Research Department, Sandviken sykehus, Haukeland University Hospital, P. Box 1400, Bergen, 5021 Norway
| | - E. Johnsen
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R. A Kroken
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - E.M. Løberg
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - A. Blindheim
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - I. Joa
- Network for Clinical Research in psychosis, TIPS, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - S.K. Reitan
- Department of Mental Health, St. Olav University Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - M. Rettenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innrain 52, Innsbruck, Austria
| | - P. Munk-Jørgensen
- Department of Psychiatry, University of Southern Denmark, Odense, Denmark
| | - R. Gjestad
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic psychiatry, Haukeland University Hospital, Bergen, Norway
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4
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Gan J, Liu W, Fan J, Yi J, Tan C, Zhu X. Correlates of poor insight: A comparative fMRI and sMRI study in obsessive-compulsive disorder and schizo-obsessive disorder. J Affect Disord 2023; 321:66-73. [PMID: 36162685 DOI: 10.1016/j.jad.2022.09.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 09/01/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the several researches on the correlates of insight in psychosis, less is known regarding the specificity of disease diagnosis on the relationship between insight and the correlates. The current study sought to explore the effects of insight and disease diagnosis on those in patients with obsessive-compulsive disorder (OCD) and patients with schizo-obsessive disorder (SOD). METHODS We evaluated clinical symptoms and neurocognitions among 111 patients (including 41 OCD with good insight, 40 OCD with poor insight, 14 SOD with good insight and 16 SOD with poor insight. Gray matter volume and spontaneous neural activity were also examined by analyzing the voxel-based morphometry and amplitude of low frequency fluctuation (ALFF), respectively. RESULTS Interactive effects of insight and diagnosis was found on working memory and the gray matter volume in right superior and middle temporal gyrus. Main effect of insight was found on working and visual memory, compulsion and obsession, and ALFF in right middle and superior occipital cortex. Main effect of diagnosis was found on severity of compulsion, relative verbal IQ, executive function, verbal and visual memory, working memory and ALFF in precuneus, medial superior frontal gyrus, anterior cingulate and paracingulate gyri, and inferior parietal, postcentral gyrus, paracentral lobule. CONCLUSIONS As a common feature in mental disorders, insight has its own special influence on neurocognition and possible structural/functional alterations in brain, and the influence is partly dependent of disease diagnosis.
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Affiliation(s)
- Jun Gan
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; College of Education, Hunan Agricultural University, Changsha, Hunan 410128, China
| | - Wanting Liu
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medial Psychological institute of Central South University, Changsha, Hunan 410011, China
| | - Jie Fan
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medial Psychological institute of Central South University, Changsha, Hunan 410011, China.; National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Jinyao Yi
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medial Psychological institute of Central South University, Changsha, Hunan 410011, China
| | - Changlian Tan
- Department of Radiology, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan 410011, China.
| | - Xiongzhao Zhu
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Medial Psychological institute of Central South University, Changsha, Hunan 410011, China.; National Clinical Research Center for Mental Disorders, Changsha, Hunan, China.
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Arathimos R, Fabbri C, Vassos E, Davis KAS, Pain O, Gillett A, Coleman JRI, Hanscombe K, Hagenaars S, Jermy B, Corbett A, Ballard C, Aarsland D, Creese B, Lewis CM. Latent subtypes of manic and/or irritable episode symptoms in two population-based cohorts. Br J Psychiatry 2022; 221:722-731. [PMID: 35049489 DOI: 10.1192/bjp.2021.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mood disorders are characterised by pronounced symptom heterogeneity, which presents a substantial challenge both to clinical practice and research. Identification of subgroups of individuals with homogeneous symptom profiles that cut across current diagnostic categories could provide insights in to the transdiagnostic relevance of individual symptoms, which current categorical diagnostic systems cannot impart. AIMS To identify groups of people with homogeneous clinical characteristics, using symptoms of manic and/or irritable mood, and explore differences between groups in diagnoses, functional outcomes and genetic liability. METHOD We used latent class analysis on eight binary self-reported symptoms of manic and irritable mood in the UK Biobank and PROTECT studies, to investigate how individuals formed latent subgroups. We tested associations between the latent classes and diagnoses of psychiatric disorders, sociodemographic characteristics and polygenic risk scores. RESULTS Five latent classes were derived in UK Biobank (N = 42 183) and were replicated in the independent PROTECT cohort (N = 4445), including 'minimally affected', 'inactive restless', active restless', 'focused creative' and 'extensively affected' individuals. These classes differed in disorder risk, polygenic risk score and functional outcomes. One class that experienced disruptive episodes of mostly irritable mood largely comprised cases of depression/anxiety, and a class of individuals with increased confidence/creativity reported comparatively lower disruptiveness and functional impairment. CONCLUSIONS Findings suggest that data-driven investigations of psychopathological symptoms that include sub-diagnostic threshold conditions can complement research of clinical diagnoses. Improved classification systems of psychopathology could investigate a weighted approach to symptoms, toward a more dimensional classification of mood disorders.
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Affiliation(s)
- Ryan Arathimos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Chiara Fabbri
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Katrina A S Davis
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK; and Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Oliver Pain
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Alexandra Gillett
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Ken Hanscombe
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Saskia Hagenaars
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Bradley Jermy
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Anne Corbett
- Faculty of Medicine, Department of Medicine, Imperial College London, UK
| | - Clive Ballard
- Medical School, College of Medicine and Health, University of Exeter, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Centre for Age-Related Research, Stavanger University Hospital, Norway
| | - Byron Creese
- Medical School, College of Medicine and Health, University of Exeter, UK
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK; and Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, UK
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6
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Smyth S, McFarland J, McGuiness D, Summerville S, Bainbridge E, Hallahan B, Higgins A, Casey D, Murphy K, McDonald C. A mixed methods study examining perceptions by service-users of their involuntary admission in relation to levels of insight. Int J Soc Psychiatry 2022; 68:1764-1773. [PMID: 34937408 DOI: 10.1177/00207640211061983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poor insight is associated with negative attitudes to involuntary admission and care in qualitative studies. AIMS The current paper aims to examine and compare retrospective qualitative perceptions of service-users in relation to their involuntary admission with their levels of clinical insight, using a mixed methods approach. METHODS Forty two participants were assessed 3 months after the revocation of their involuntary admission. Each provided qualitative data relating to their perceptions of the coercive care process, which was analysed using content analysis, along with a quantitative measurement of insight, the Schedule for the Assessment of Insight-Expanded (SAI-E). Employing a mixed methods design and incorporating NVivo matrix coding queries, the datasets were merged to enable qualitative themes to be identified against the quantitative data. RESULTS Differences were observed between those with high and low insight in terms of their understanding of the need for treatment, their levels of arousal at the time of admission and how they perceived the compassion of health professionals. Certain negative perceptions of care appeared more universal and were common across those with high and low insight. CONCLUSION Some negative perceptions of coercive practices appear linked to inherent elements of psychotic illness such as unawareness of illness. Individuals with higher levels of insight tended to perceive their involuntary admission and receiving a diagnosis as beneficial. Negative views that persist amongst service users with high insight levels can highlight areas for successful service improvement, including increased emphasis on non-pharmacotherapy based supports during the coercive care process.
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Affiliation(s)
- Siobhan Smyth
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - John McFarland
- Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - David McGuiness
- College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Sarah Summerville
- College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Emma Bainbridge
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Brian Hallahan
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Agnes Higgins
- Faculty of Health Sciences, Trinity College Dublin, Ireland
| | - Dympna Casey
- College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Kathy Murphy
- College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Colm McDonald
- School of Medicine, National University of Ireland, Galway, Ireland
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Relationships between cognitive performance, clinical insight and regional brain volumes in schizophrenia. SCHIZOPHRENIA 2022; 8:33. [PMID: 35853892 PMCID: PMC9261092 DOI: 10.1038/s41537-022-00243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/23/2022] [Indexed: 11/22/2022]
Abstract
Impairments in cognitive performance are common in schizophrenia, and these contribute to poor awareness of symptoms and treatment (‘clinical insight’), which is an important predictor of functional outcome. Although relationships between cognitive impairment and reductions in regional brain volumes in patients are relatively well characterised, less is known about the brain structural correlates of clinical insight. To address this gap, we aimed to explore brain structural correlates of cognitive performance and clinical insight in the same sample. 108 patients with schizophrenia (SZH) and 94 age and gender-matched controls (CON) (from the Northwestern University Schizophrenia Data and Software Tool (NUSDAST) database) were included. SZH had smaller grey matter volume across most fronto-temporal regions and significantly poorer performance on all cognitive domains. Multiple regression showed that higher positive symptoms and poorer attention were significant predictors of insight in SZH; however, no significant correlations were seen between clinical insight and regional brain volumes. In contrast, symptomology did not contribute to cognitive performance, but robust positive relationships were found between regional grey matter volumes in fronto-temporal regions and cognitive performance (particularly executive function). Many of these appeared to be unique to SZH as they were not observed in CON. Findings suggest that while there exists a tight link between cognitive functioning and neuropathological processes affecting gross brain anatomy in SZH, this is not the case for clinical insight. Instead, clinical insight levels seem to be influenced by symptomology, attentional performance and other subject-specific variables.
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Gan J, He J, Fu H, Zhu X. Association between obsession, compulsion, depression and insight in obsessive-compulsive disorder: a meta-analysis. Nord J Psychiatry 2022; 76:489-496. [PMID: 34895018 DOI: 10.1080/08039488.2021.2013532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous studies examining potential relationships of impaired insight with severity obsessive-compulsive (O-C) symptoms and depressive symptoms in patients diagnosed with obsessive-compulsive disorder (OCD) have produced mixed results. Here, we examined differences in these clinical characteristics and their changes after treatment in adult patients with OCD who have poor insight (OCD-PI) versus in those who have good insight (OCD-GI). METHODS Fifty-nine full-text articles were screened for eligibility with 20 studies ultimately being included in the present meta-analysis. RESULTS The OCD-PI and OCD-GI groups differed from each other with respect to O-C symptom (p < 0.001, g > 0.7) and depressive symptom (p < 0.001, g = 0.614) severity. Significant and moderate correlations were observed between insight and treatment outcomes (O-C symptoms, r = 0.33; depressive symptoms, r = 0.47). Exploratory meta-regression showed that methodological factors influenced the magnitudes of inter-group O-C symptom differences. CONCLUSIONS The current meta-analysis indicates that poorer insight is associated with more severe O-C and depression, and less improvement of symptoms in patients with OCD. Insight impairment may be a critical and core OCD-related deficit.
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Affiliation(s)
- Jun Gan
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Jing He
- Department of Psychology, Hunan First Normal University, Changsha, China.,Hunan Key Laboratory of Children's Psychological Development and Brain Cognitive Science, Hunan the First Normal University, Changsha, China
| | - Hong Fu
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Xiongzhao Zhu
- Medical Psychological center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medial Psychological Institute of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
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Gebreegziabhere Y, Habatmu K, Mihretu A, Cella M, Alem A. Cognitive impairment in people with schizophrenia: an umbrella review. Eur Arch Psychiatry Clin Neurosci 2022; 272:1139-1155. [PMID: 35633394 PMCID: PMC9508017 DOI: 10.1007/s00406-022-01416-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/11/2022] [Indexed: 01/08/2023]
Abstract
Cognitive impairment is one of the core symptoms of schizophrenia. Quite a number of systematic reviews were published related to cognitive impairment in people with schizophrenia (PWS). This umbrella review, therefore, aimed at reviewing and synthesizing the findings of systematic reviews related to domains of cognition impaired and associated factors in PWS. We searched four electronic databases. Data related to domains, occurrence, and associated factors of cognitive impairment in PWS were extracted. The quality of all eligible systematic reviews was assessed using A MeaSurement Tool to Assess methodological quality of systematic Review (AMSTAR) tool. Results are summarized and presented in a narrative form. We identified 63 systematic reviews fulfilling the eligibility criteria. The included reviews showed that PWS had lower cognitive functioning compared to both healthy controls and people with affective disorders. Similar findings were reported among psychotropic free cases and people with first episode psychosis. Greater impairment of cognition was reported in processing speed, verbal memory, and working memory domains. Greater cognitive impairment was reported to be associated with worse functionality and poor insight. Cognitive impairment was also reported to be associated with childhood trauma and aggressive behaviour. According to our quality assessment, the majority of the reviews had moderate quality. We were able to find a good number of systematic reviews on cognitive impairment in PWS. The reviews showed that PWS had higher impairment in different cognitive domains compared to healthy controls and people with affective disorders. Impairment in domains of memory and processing speed were reported frequently.
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Affiliation(s)
- Yohannes Gebreegziabhere
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia.
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Kassahun Habatmu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Awoke Mihretu
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - Atalay Alem
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Lopez-Morinigo JD, Escobedo-Aedo PJ, Sánchez-Escribano Martínez A, González Ruiz-Ruano V, Sánchez-Alonso S, Mata-Iturralde L, Muñoz-Lorenzo L, Baca-García E, David AS. Investigating the Contribution of Decision-Making, Cognitive Insight, and Theory of Mind in Insight in Schizophrenia: A Cross-Sectional Study. Psychopathology 2022; 55:104-115. [PMID: 35176740 DOI: 10.1159/000521915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 01/03/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Insight in schizophrenia spectrum disorders (SSD) is associated with outcomes. Although the neurocognitive basis of insight is widely accepted, the specific contribution of decision-making (Jumping to Conclusions [JTC]), Cognitive Insight (CI), and Theory of Mind (ToM) to insight remains unclear. METHODS The sample included N = 77 SSD outpatients aged 18-64 years from a randomized controlled trial of metacognitive training. Assessments included JTC-Beads Task, CI-Beck Cognitive Insight Scale, ToM-Hinting Task, and the Emotions Recognition Test Faces. STATISTICS hierarchical multivariable linear regression models tested their contribution to total insight (TI) and three insight dimensions - illness recognition (IR), symptom relabelling (SR), and treatment compliance (TC) - measured with the Schedule for the Assessment of Insight - Expanded version, whilst adjusting for potential confounders. RESULTS Bivariate analyses showed that CI was associated with TI (R2 change = 0.214; p < 0.001), IR (R2 change = 0.154; p = 0.003), and SR (R2 change = 0.168; p = 0.003), while JTC predicted IR (R2 change = 0.790; p = 0.020). Multivariable regression models showed that CI predicted TI (R2 change = 0.116; p = 0.036) and SR (R2 change = 0.166, p = 0.011), whereas JTC was linked with IR (R2 change = 0.710; p = 0.026). ToM was not linked with any insight score. No cognitive variable was associated with treatment compliance. DISCUSSION Results supported the (meta)cognitive model of insight in SSD. JTC and CI emerged as the main (meta)cognitive processes underlying insight. Metacognitive interventions may therefore improve insight in SSD, although these therapies alone may fail to address treatment compliance.
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Affiliation(s)
- Javier-David Lopez-Morinigo
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain.,Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain.,Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | | | | | - Verónica González Ruiz-Ruano
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain.,Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | | | | | - Enrique Baca-García
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain.,Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain.,Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Departamento de Psiquiatría, Universidad Católica Del Maule, Talca, Chile.,Department of Psychiatry, Centre Hospitalier Universitaire de Nimes, Nimes, France
| | - Anthony S David
- Institute of Mental Health, University College London, London, United Kingdom
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Kim J, Amaev A, Quilty LC, Selby P, Shah P, Caravaggio F, Ueno F, Pollock BG, Graff-Guerrero A, Gerretsen P. A Measure to Assess Illness Awareness in Problem Gambling: Gambling Awareness and Insight Scale (GAS). J Gambl Stud 2021; 38:1029-1043. [PMID: 34169396 DOI: 10.1007/s10899-021-10037-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
Impaired subjective awareness of problem gambling may act as a barrier to help-seeking and treatment adherence. However, the impact of impaired problem gambling awareness on clinical and social outcomes has received little empirical study. The aim of this study was to develop and investigate the psychometric properties of a novel scale that measures impaired illness awareness in individuals with problem gambling. We developed the Gambling Awareness and Insight Scale (GAS), a self-report measure that assesses the core theoretical constructs of illness awareness in problem gambling, namely General Disorder or Problem Awareness, Accurate Symptom Attribution, Awareness of Need for Treatment and the Negative Consequences attributable to problem gambling ( www.illnessawarenessscales.com ). Data were acquired from an online survey platform, Dynata, to evaluate the psychometric properties of the GAS. A total of 100 participants aged 18 years or older with problem gambling defined by a score of 4 or more on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Pathological Gambling Diagnostic Form were included. The GAS demonstrated good convergent (r = 0.57, p < 0.001) and discriminant validity (r = - 0.18, p = 0.080). It also demonstrated good internal consistency (Cronbach's α = 0.80) and one-month test-retest reliability (intra-class correlation = 0.86). An exploratory factor analysis suggested retention of two components. The GAS is a novel psychometric tool designed to evaluate impaired subjective illness awareness in problem gambling. Initial evidence suggests that the GAS can be used in research and clinical settings to evaluate the impact of impaired problem gambling awareness on adherence to treatment programs, clinical and psychosocial outcomes. Replication in applied settings is needed.
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Affiliation(s)
- Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Aron Amaev
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Institute Research Program, CAMH, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Institute Research Program, CAMH, University of Toronto, Toronto, ON, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Fumihiko Ueno
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, ON, Canada
- Campbell Institute Research Program, CAMH, University of Toronto, Toronto, ON, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, ON, Canada
- Campbell Institute Research Program, CAMH, University of Toronto, Toronto, ON, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, ON, Canada.
- Campbell Institute Research Program, CAMH, University of Toronto, Toronto, ON, Canada.
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12
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Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa. Healthcare (Basel) 2021; 9:healthcare9040461. [PMID: 33919729 PMCID: PMC8070736 DOI: 10.3390/healthcare9040461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders.
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Pijnenborg GHM, Larabi DI, Xu P, Hasson-Ohayon I, de Vos AE, Ćurčić-Blake B, Aleman A, Van der Meer L. Brain areas associated with clinical and cognitive insight in psychotic disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 116:301-336. [PMID: 32569706 DOI: 10.1016/j.neubiorev.2020.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 06/13/2020] [Indexed: 02/06/2023]
Abstract
In the past years, ample interest in brain abnormalities related to clinical and cognitive insight in psychosis has contributed several neuroimaging studies to the literature. In the current study, published findings on the neural substrates of clinical and cognitive insight in psychosis are integrated by performing a systematic review and meta-analysis. Coordinate-based meta-analyses were performed with the parametric coordinate-based meta-analysis approach, non-coordinate based meta-analyses were conducted with the metafor package in R. Papers that could not be included in the meta-analyses were systematically reviewed. Thirty-seven studies were retrieved, of which 21 studies were included in meta-analyses. Poorer clinical insight was related to smaller whole brain gray and white matter volume and gray matter volume of the frontal gyri. Cognitive insight was predominantly positively associated with structure and function of the hippocampus and ventrolateral prefrontal cortex. Impaired clinical insight is not associated with abnormalities of isolated brain regions, but with spatially diffuse global and frontal abnormalities suggesting it might rely on a range of cognitive and self-evaluative processes. Cognitive insight is associated with specific areas and appears to rely more on retrieving and integrating self-related information.
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Affiliation(s)
- G H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands; Department of Clinical and Developmental Neuropsychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands.
| | - D I Larabi
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - P Xu
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China; Center for Neuroimaging, Shenzhen Institute of Neuroscience, Shenzhen 518054, China; Great Bay Neuroscience and Technology Research Institute (Hong Kong), Kwun Tong, Hong Kong
| | - I Hasson-Ohayon
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | - A E de Vos
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands
| | - B Ćurčić-Blake
- University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands
| | - A Aleman
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, A. Deusinglaan 2, 9713 AW, Groningen, the Netherlands; Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen 518060, China
| | - L Van der Meer
- Department of Rehabilitation, Lentis Mental Health Care, PO box 128, 9470 KA, Zuidlaren, the Netherlands; Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
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14
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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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15
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De Hert M, Simon V, Vidovic D, Franic T, Wampers M, Peuskens J, van Winkel R. Evaluation of the association between insight and symptoms in a large sample of patients with schizophrenia. Eur Psychiatry 2020; 24:507-12. [DOI: 10.1016/j.eurpsy.2009.04.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 04/15/2009] [Accepted: 04/17/2009] [Indexed: 11/15/2022] Open
Abstract
AbstractBackgroundThe objective of the present study was to examine the association of insight into the illness with demographic variables and symptomatology in a sample of 1213 patients with schizophrenia.MethodData were collected with the Psychosis Evaluation tool for Common use by Caregivers (PECC), a semi-structured interview evaluating five symptom domains of schizophrenia and the insight items ‘awareness of having a mental disorder’ and ‘attributing symptoms to a mental disorder’.ResultsInsight was positively associated with educational level and inversely with overall symptom severity, and the positive, negative, excitatory and cognitive symptom domains. At symptom level, the items ‘delusions’, ‘grandiosity’, ‘poor rapport’, ‘social withdrawal’ and ‘guilt feelings’ showed the strongest associations with both insight items. Overall, correlations between insight and symptomatology were modest, explaining less than 30% of the variance in insight.ConclusionLack of insight in schizophrenia is partially explained by clinical symptoms and demographic measures.
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16
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Lopez-Morinigo JD, Ruiz-Ruano VG, Martínez ASE, Estévez MLB, Mata-Iturralde L, Muñoz-Lorenzo L, Sánchez-Alonso S, Artés-Rodríguez A, David AS, Baca-García E. Study protocol of a randomised clinical trial testing whether metacognitive training can improve insight and clinical outcomes in schizophrenia. BMC Psychiatry 2020; 20:30. [PMID: 31996174 PMCID: PMC6990523 DOI: 10.1186/s12888-020-2431-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/06/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although insight in schizophrenia spectrum disorders (SSD) has been associated with positive outcomes, the effect size of previous treatments on insight has been relatively small to date. The metacognitive basis of insight suggests that metacognitive training (MCT) may improve insight and clinical outcomes in SSD, although this remains to be established. METHODS This single-center, assessor-blind, parallel-group, randomised clinical trial (RCT) aims to investigate the efficacy of MCT for improving insight (primary outcome), including clinical and cognitive insight, which will be measured by the Schedule for Assessment of Insight (Expanded version) (SAI-E) and the Beck Cognitive Scale (BCIS), respectively, in (at least) n = 126 outpatients with SSD at three points in time: i) at baseline (T0); ii) after treatment (T1) and iii) at 1-year follow-up (T2). SSD patients receiving MCT and controls attending a non-intervention support group will be compared on insight level changes and several clinical and cognitive secondary outcomes at T1 and T2, whilst adjusting for baseline data. Ecological momentary assessment (EMA) will be piloted to assess functioning in a subsample of participants. DISCUSSION To the best of our knowledge, this will be the first RCT testing the effect of group MCT on multiple insight dimensions (as primary outcome) in a sample of unselected patients with SSD, including several secondary outcomes of clinical relevance, namely symptom severity, functioning, which will also be evaluated with EMA, hospitalizations and suicidal behaviour. TRIAL REGISTRATION ClinicalTrials.gov: NCT04104347. Date of registration: 26/09/2019 (Retrospectively registered).
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Affiliation(s)
- Javier-David Lopez-Morinigo
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain. .,Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain. .,Centro de Especialidades Pontones, Salud Mental, 2ªPlanta, Ronda de Segovia, 52, 28005, Madrid, Spain.
| | - Verónica González Ruiz-Ruano
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain ,0000000119578126grid.5515.4Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
| | - Adela Sánchez Escribano Martínez
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain ,0000000119578126grid.5515.4Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Luisa Barrigón Estévez
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain ,0000000119578126grid.5515.4Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
| | - Laura Mata-Iturralde
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Laura Muñoz-Lorenzo
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Antonio Artés-Rodríguez
- 0000 0001 2168 9183grid.7840.bDepartamento de Teoría de Señal y de la Comunicación, Universidad Carlos III, Madrid, Spain
| | - Anthony S. David
- 0000000121901201grid.83440.3bInstitute of Mental Health, University College London, London, UK
| | - Enrique Baca-García
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain ,0000000119578126grid.5515.4Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain ,grid.459654.fDepartment of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain ,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain ,0000 0004 0425 3881grid.411171.3Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain ,0000 0000 9314 1427grid.413448.eCIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain ,0000 0001 2224 0804grid.411964.fUniversidad Católica del Maule, Talca, Chile
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17
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Gaughran F, Stahl D, Patel A, Ismail K, Smith S, Greenwood K, Atakan Z, Gardner-Sood P, Stringer D, Hopkins D, Lally J, Forti MD, Stubbs B, Lowe P, Arbuthnott M, Heslin M, David AS, Murray RM. A health promotion intervention to improve lifestyle choices and
health outcomes in people with psychosis: a research programme including the
IMPaCT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background
People with psychotic disorders have reduced life expectancy largely because
of physical health problems, especially cardiovascular disease, that are
complicated by the use of tobacco and cannabis.
Objectives
We set out to (1) chart lifestyle and substance use choices and the emergence
of cardiometabolic risk from the earliest presentation with psychosis, (2)
develop a pragmatic health promotion intervention integrated within the
clinical teams to improve the lifestyle choices and health outcomes of
people with psychosis and (3) evaluate the clinical effectiveness and
cost-effectiveness of that health promotion intervention.
Design
We performed a longitudinal cohort study of people presenting with their
first episode of psychosis in three mental health trusts and followed up
participants for 1 year [work package 1, physical health and substance use
measures in first episode of psychosis (PUMP)]. We used an iterative Delphi
methodology to develop and refine a modular health promotion intervention,
improving physical health and reducing substance use in psychosis (IMPaCT)
therapy, which was to be delivered by the patient’s usual care
co-ordinator and used motivational interviewing techniques and
cognitive–behavioural therapy to improve health choices of people
with psychosis (work package 2). We then conducted a multicentre, two-arm,
parallel-cluster, randomised controlled trial to determine the clinical
effectiveness and cost-effectiveness of using the intervention with people
with established psychosis (work package 3: IMPaCT randomised controlled
trial) in five UK mental health trusts. The work took place between 2008 and
2014.
Participants
All people aged between 16 and 65 years within 6 months of their first
presentation with a non-organic psychosis and who were proficient in English
were eligible for inclusion in the PUMP study. Participants in the work
package 2 training development were staff selected from a range of settings,
working with psychosis. Participants in the phase 3 Delphi consensus and
manual development comprised three expert groups of (1)
therapists/researchers recruited from the local and national community, (2)
clinicians and (3) service users, each of whom took part in two iterative
review and feedback sessions. For work package 3, IMPaCT randomised
controlled trial, care co-ordinators in participating community mental
health teams who were permanently employed and had a minimum of four
eligible patients (i.e. aged between 18 and 65 years with a diagnosis of a
psychotic disorder) on their caseload were eligible to participate. In
studies 1 and 3, patient participants were ineligible if they were pregnant
or had a major illness that would have had an impact on their metabolic
status or if they had a significant learning disability. All participants
were included in the study only after giving written confirmed consent.
Main outcome measures
Cardiometabolic risk markers, including rates of obesity and central obesity,
and levels of glycated haemoglobin (HbA1c) and lipids, were the
main outcomes in work package 1 (PUMP), with descriptive data presented on
substance use. Our primary outcome measure for the IMPaCT randomised
controlled trial was the physical or mental health component Short Form
questionnaire-36 items quality-of-life scores at 12 months.
Results
Obesity rates rose from 18% at first presentation with psychosis to 24% by 1
year, but cardiometabolic risk was not associated with baseline lifestyle
and substance use choices. Patterns of increase in the levels of
HbA1c over the year following first presentation showed
variation by ethnic group. We recruited 104 care co-ordinators, of whom 52
(with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with
193 patients) were randomised to deliver treatment as usual, in keeping with
our power calculations. Of these 406 participants with established
psychosis, 318 (78%) and 301 (74%) participants, respectively, attended the
12- and 15-month follow-ups. We found no significant effect of IMPaCT
therapy compared with treatment as usual on the physical or mental health
component Short Form questionnaire-36 items scores at either time point in
an intention-to-treat analysis [physical health score (‘d’)
–0.17 at 12 months and –0.09 at 15 months; mental health score
(‘d’) 0.03 at 12 months and –0.05 at 15 months] or on
costs. Nor did we find an effect on other cardiovascular risk indicators,
including diabetes, except in the case of high-density lipoprotein
cholesterol, which showed a trend for greater benefit with IMPaCT therapy
than with treatment as usual (treatment effect 0.085, 95% confidence
interval 0.007 to 0.16; p = 0.034).
Limitations
Follow-up in work package 1 was challenging, with 127 out of 293 participants
attending; however, there was no difference in cardiometabolic measures or
demographic factors at baseline between those who attended for follow-up and
those who did not. In work package 3, the IMPaCT randomised controlled
trial, care co-ordinators struggled to provide additional time to their
patients that was devoted to the health promotion intervention on top of
their usual clinical care contact with them.
Conclusions
Cardiometabolic risk is prominent even soon after first presentation with
psychosis and increases over time. Lifestyle choices and substance use
habits at first presentation do not predict those who will be most
cardiometabolically compromised 1 year later. Training and supervising care
co-ordinators to deliver a health promotion intervention to their own
patients on top of routine care is not effective in the NHS for improving
quality of life or reducing cardiometabolic risk.
Future work
Further work is needed to develop and evaluate effective, cost-effective and
affordable ways of preventing the emergence of and reversing existing
cardiometabolic risk indicators in people with psychosis.
Trial registration
Current Controlled Trials ISRCTN58667926.
Funding
This project was funded by the National Institute for Health Research (NIHR)
Programme Grants for Applied Research programme and will be published in
full in Programme Grants for Applied Research; Vol. 8, No.
1. See the NIHR Journals Library website for further project
information.
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Affiliation(s)
- Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, London, UK
- Centre for Primary Care and Public Health, Blizard Institute,
Queen Mary University of London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College London, London, UK
- Forensic Services, South London and Maudsley NHS Foundation
Trust, London, UK
| | - Kathryn Greenwood
- Sussex Partnership NHS Foundation Trust, Worthing, UK
- School of Psychology, University of Sussex, Brighton, UK
| | - Zerrin Atakan
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King’s
Health Partners, London, UK
| | - John Lally
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland,
Beaumont Hospital, Dublin, Ireland
| | - Marta Di Forti
- Social, Genetic & Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Physiotherapy Department, South London and Maudsley NHS
Foundation Trust, London, UK
| | | | | | - Margaret Heslin
- King’s Health Economics, Health Service & Population
Research Department, Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, London, UK
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, University
College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
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18
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Kaminga AC, Dai W, Liu A, Myaba J, Banda R, Wen SW. Effects of socio-demographic characteristics, premorbid functioning, and insight on duration of untreated psychosis in first-episode schizophrenia or schizophreniform disorder in Northern Malawi. Early Interv Psychiatry 2019; 13:1455-1464. [PMID: 30706661 PMCID: PMC6900171 DOI: 10.1111/eip.12794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/24/2018] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Abstract
AIM Long duration of untreated psychosis (DUP) is prevalent and has been shown to be associated with poorer prognosis. Thus, knowledge of its determinants may help to target early interventions to reduce DUP on the needed population. Previous studies seeking to understand determinants of DUP have been inconclusive. Therefore, this study aimed to investigate the effects of socio-demographic characteristics, premorbid functioning, and insight on DUP in patients with first-episode schizophrenia or schizophreniform disorder. METHODS This cross-sectional study recruited 110 subjects (aged 18-65) during a pilot early intervention service for psychosis in Northern Malawi, between June 2009 and September 2012. Short DUP was defined as ≤6 months, whereas long DUP was defined as >6 months. Unadjusted and adjusted analyses were performed to identify determinants of DUP. RESULTS Of the 110 subjects, 99 (90%) had schizophrenia. Median DUP was 27.5 months, while mean (SD) DUP was 71.24 (92.32) months. In addition, at least 75% had long DUP, which was associated with lower level of education, poor insight, younger age at onset, and at least one parent deceased. CONCLUSIONS Long DUP is prevalent in Northern Malawi. Thus, early interventions to reduce DUP are warranted in this population. Although having at least one parent deceased predicted long DUP in this study, this remains speculative because factors, such as timing of parents' death and grief reactions of the patients were not assessed. Therefore, further investigations incorporating these factors are needed to ascertain this result.
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Affiliation(s)
- Atipatsa C. Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
- Department of Mathematics and StatisticsMzuzu UniversityMzuzuMalawi
| | - Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Japhet Myaba
- Department of Clinical Medicine, Mental Health Research SectionSaint John of God Community ServicesMzuzuMalawi
| | - Richard Banda
- Department of Clinical Medicine, Mental Health Research SectionSaint John of God Community ServicesMzuzuMalawi
| | - Shi W. Wen
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
- OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramOttawaOntarioCanada
- School of Epidemiology, Public Health, and Preventive Medicine, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
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19
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Abstract
Although the psychological denial model argues that poor insight is a result of defense mechanisms, the direct relationship between the two remains unclear. This study aimed to examine the relationship between insight into illness and defense mechanisms while considering cognitive dysfunction in schizophrenia. A total of 38 patients with schizophrenia were evaluated for level of insight (Schedule for the Assessment of Insight), defense mechanisms (Defense Style Questionnaire), neurocognitive function (Brief Assessment of Cognition in Schizophrenia), and psychotic symptoms (Brief Psychiatric Rating Scale). Regarding level of insight, partial correlation analysis controlling neurocognitive and psychotic variables showed that "recognition of illness" was positively correlated with immature defense styles and negatively correlated with mature defense styles. Stepwise regression analyses revealed that "recognition of illness" was significantly predicted by immature defense styles. Our findings suggest that patients who tend to use immature defense styles are more likely to accept their own mental illness.
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20
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Kim J, Plitman E, Nakajima S, Alshehri Y, Iwata Y, Chung JK, Caravaggio F, Menon M, Blumberger DM, Pollock BG, Remington G, De Luca V, Graff-Guerrero A, Gerretsen P. Modulation of brain activity with transcranial direct current stimulation: Targeting regions implicated in impaired illness awareness in schizophrenia. Eur Psychiatry 2019; 61:63-71. [DOI: 10.1016/j.eurpsy.2019.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/15/2019] [Accepted: 06/21/2019] [Indexed: 01/29/2023] Open
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21
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Ceylan ME, Evrensel A, Dönmez A, Önen Ünsalver B, Kaya Yertutanol FD, Çom AM. The psycho-periodic cube. Med Hypotheses 2019; 126:69-77. [PMID: 31010503 DOI: 10.1016/j.mehy.2019.03.020] [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: 02/14/2019] [Revised: 03/04/2019] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
The current diagnostic classification systems in psychiatry have been developed primarily for evidence-based clinical decision making with both categorical and dimensional approaches having their own advantages and disadvantages. Efforts have been made to improve these classification systems, and we are now at the point where we must expand beyond the one-dimensionality of these systems. In this paper, we propose that psychiatric disorders can be arranged in a three-dimensional classification system according to the degree of dysfunctions on three specific axes in a way that is similar to the arrangement of chemical elements according to their atomic weights in Mendeleyev's periodic table. For the three axes, we chose externalization, drive, and attention to represent the three-dimensional descriptions of mental health, namely, well-being in social, motivational, and cognitive areas, respectively. Throughout the paper, we explain our reasons for choosing these three axes and compare our hypothesis with categorical diagnostic systems as well as Cloninger's dimensional diagnostic system using personality disorders, affective disorders, and schizophrenia as the specific diagnostic samples.
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Affiliation(s)
- Mehmet Emin Ceylan
- Departments of Psychology and Philosophy, Üsküdar University, İstanbul, Turkey
| | - Alper Evrensel
- Department of Psychology, Üsküdar University, İstanbul, Turkey.
| | - Aslıhan Dönmez
- Department of Psychology, Üsküdar University, İstanbul, Turkey
| | - Barış Önen Ünsalver
- Vocational School of Health Services, Department of Medical Documentation and Secretariat, Üsküdar University, İstanbul, Turkey
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22
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Pijnenborg GHM, de Vos AE, Timmerman ME, Van der Gaag M, Sportel BE, Arends J, Koopmans EM, Van der Meer L, Aleman A. Social cognitive group treatment for impaired insight in psychosis: A multicenter randomized controlled trial. Schizophr Res 2019; 206:362-369. [PMID: 30429078 DOI: 10.1016/j.schres.2018.10.018] [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: 05/03/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The majority of people with schizophrenia has impaired insight, which is related to a poorer outcome. In this study, we evaluate a new psychosocial intervention 'REFLEX' aimed at improving insight in people with schizophrenia. REFLEX focuses on targeting stigma-sensitivity, perspective taking and self-reflection in people with schizophrenia and low insight. Primary objective is to improve insight and subsequently to improve functional outcome and symptoms. METHOD A total of 121 people diagnosed with schizophrenia according to DSM IV criteria with impaired insight was included in 2012-2015 from seven sites in a multicenter randomized controlled trial. REFLEX was compared to an active control condition consisting of group-wise simplified cognitive remediation training. Primary outcome of the study were the preconditions of insight: internalized stigma, self-reflection, mental flexibility and perspective taking. Clinical insight and cognitive insight were secondary outcomes. RESULTS Although perspective taking, self-reflection, mental flexibility and stigma sensitivity remained unchanged after the intervention, results showed a significant improvement of clinical insight in both conditions directly after treatment (SAI-E Rater, p < .001, PANSS G12, p < .005) and at follow-up (SAI-E Rater, p < .01, SAI-E interview, p < .001, PANSS G12, p < .0001). Improvement of clinical insight directly after treatment was larger in the REFLEX condition (SAI-E Rater, p < .05). Other outcomes (self-esteem, quality of life and depression) remained unchanged. CONCLUSION Though insight improved in both conditions, REFLEX was not superior to simplified drill-and-practice cognitive remediation training. Nevertheless, this study indicates that structured interventions can significantly improve insight. Further research on the underlying mechanisms of both conditions is needed, as insight is unlikely to improve spontaneously in chronic patients.
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Affiliation(s)
- G H M Pijnenborg
- Dept. of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA Assen, the Netherlands; Dept. of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands.
| | - A E de Vos
- Dept. of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA Assen, the Netherlands
| | - M E Timmerman
- Dept. of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
| | - M Van der Gaag
- Dept. of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Dept. of Psychosis Research, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands
| | - B E Sportel
- Dept. of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA Assen, the Netherlands
| | - J Arends
- Dept. of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA Assen, the Netherlands
| | - E M Koopmans
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands
| | - L Van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands; Rob Giel Research Center, University Medical Center Groningen, Groningen, the Netherlands
| | - A Aleman
- Dept. of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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23
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Abstract
The concept of insight is used to indicate the propensity of patients with schizophrenia and other severe mental disorders to recognize their illness and engage in treatment. Thus, insight may have notable consequences for the ill individual: Those who lack insight are at higher risk of nonadherence to treatments, negative clinical outcomes, and worse community functioning. Although insight is an intuitive concept, its essence remains difficult to capture. However, many rating scales are available to aid assessment, both for clinical and research purposes. Insight cannot be reduced to a symptom, a psychological mechanism, or a neuropsychological function. It is likely to have dynamic relationships with all these dimensions and with responses to personal events and contextual factors. In particular, social consequences of mental illness and explanatory models that are alternative to the medical model may fundamentally shape insight and treatment choice. Moreover, the cultural or individual stigmatization of mental illness may turn the acquisition of insight into a painful event and increase the risk of depression. Clinicians need to carefully evaluate and promote insight through a personalized approach to aid patient process of care and personal growth.
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Affiliation(s)
- Martino Belvederi Murri
- Psychiatric Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mario Amore
- Psychiatric Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Ospedale Policlinico San Martino, Genoa, Italy
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24
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Insight and emotion regulation in schizophrenia: A brain activation and functional connectivity study. NEUROIMAGE-CLINICAL 2018; 20:762-771. [PMID: 30261360 PMCID: PMC6154769 DOI: 10.1016/j.nicl.2018.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/10/2018] [Accepted: 09/13/2018] [Indexed: 11/21/2022]
Abstract
Background Insight is impaired in the majority of schizophrenia patients. The exact neural correlates of impaired insight remain unclear. We assume that the ability to regulate emotions contributes to having good clinical insight, as patients should be able to regulate their emotional state in such a way that they can adapt adequately in order to cope with impaired functioning and negative stigma associated with a diagnosis of schizophrenia. Numerous studies have shown emotional dysregulation in schizophrenia. We investigated the association between insight and brain activation and connectivity during emotion regulation. Methods Brain activation during emotion regulation was measured with functional MRI in 30 individuals with schizophrenia. Two emotion regulation strategies were examined: cognitive reappraisal and expressive suppression. Clinical insight was measured with the Schedule for the Assessment of Insight – Expanded, and cognitive insight was measured with the Beck Cognitive Insight Scale. Whole brain random effects multiple regression analyses were conducted to assess the relation between brain activation during emotion regulation and insight. Generalized psychophysiological interaction (gPPI) was used to investigate the relation between task-related connectivity and insight. Results No significant associations were found between insight and neural correlates of cognitive reappraisal. For clinical insight and suppression, significant positive associations were found between symptom relabeling and activation in the left striatum, thalamus and insula, right insula and caudate, right pre- and postcentral gyrus, left superior occipital gyrus and cuneus and right middle and superior occipital gyrus and cuneus. Furthermore, reduced clinical insight was associated with more connectivity between midline medial frontal gyrus and right middle occipital gyrus. For cognitive insight and suppression, significant positive associations were found between self-reflectiveness and activation in pre- and postcentral gyrus and left middle cingulate gyrus. Conclusions Our results suggest an association between the capacity to relabel symptoms and activation of brain systems involved in cognitive-emotional control and visual processing of negative stimuli. Furthermore, poorer self-reflectiveness may be associated with brain systems subserving control and execution. We examined the association between emotion regulation and insight in schizophrenia. Patients with poorer insight engage different neural pathways during suppression. This finding was strengthened by connectivity measures of corresponding brain areas. No relationship between cognitive reappraisal and insight was found.
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25
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Gerretsen P, Kim J, Shah P, Quilty L, Balakumar T, Caravaggio F, Plitman E, Chung JK, Iwata Y, Pollock BG, Dash S, Sockalingam S, Graff-Guerrero A. Reprint of OASIS - Obesity Awareness and Insight Scale. Prim Care Diabetes 2018; 12:371-378. [PMID: 29752221 DOI: 10.1016/j.pcd.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIMS Impaired illness awareness or not accepting that one has obesity is an understudied phenomenon that may negatively influence treatment adherence and clinical outcomes. The purpose of this study was to perform a systematic review of available measures of obesity awareness, and subsequently develop and validate a novel scale that measures the core domains of obesity awareness. METHODS A systematic review of the literature revealed no illness specific measure of subjective obesity awareness. As such, we designed the Obesity Awareness and Insight Scale (OASIS) to assess the following core domains of illness awareness: General Illness Awareness, Symptom Attribution, Awareness of Need for Treatment and the Negative Consequences attributable to the illness (www.illnessawarenessscales.com). Participants (n=100) were recruited from an online survey platform to assess the psychometric properties of OASIS. RESULTS The OASIS demonstrated strong internal consistency (Cronbach's alpha=0.89), convergent (r(98)=0.65, p<0.001) and discriminant validity, and test-retest reliability (intra-class correlation=0.76). An exploratory factor analysis of OASIS revealed a single latent component. CONCLUSIONS OASIS is an obesity-specific instrument that comprehensively measures subjective obesity awareness. OASIS can be used in epidemiological studies, intervention trials, and clinical practice to assess the impact of obesity awareness on treatment adherence and outcomes.
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Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
| | - Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science
| | - Lena Quilty
- Institute of Medical Science; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Thushanthi Balakumar
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Eric Plitman
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science
| | - Jun Ku Chung
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Bruce G Pollock
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Satya Dash
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Institute of Medical Science; Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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26
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Gerretsen P, Kim J, Shah P, Quilty L, Balakumar T, Caravaggio F, Plitman E, Chung JK, Iwata Y, Pollock BG, Dash S, Sockalingam S, Graff-Guerrero A. OASIS: The Obesity Awareness and Insight Scale. ACTA ACUST UNITED AC 2018; 9:38-44. [PMID: 30505975 DOI: 10.1016/j.obmed.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aims Impaired illness awareness or not accepting that one has obesity is an understudied phenomenon that may negatively influence treatment adherence and clinical outcomes. The purpose of this study was to perform a systematic review of available measures of obesity awareness, and subsequently develop and validate a novel scale that measures the core domains of obesity awareness. Methods A systematic review of the literature revealed no illness specific measure of subjective obesity awareness. As such, we designed the Obesity Awareness and Insight Scale (OASIS) to assess the following core domains of illness awareness: General Illness Awareness,, Symptom Attribution,, Awareness of Need for Treatment and the Negative Consequences attributable to the illness (www.illnessawarenessscales.com). Participants (n=100) were recruited from an online survey platform to assess the psychometric properties of OASIS. Results The OASIS demonstrated strong internal consistency (Cronbach's alpha=0.89), convergent (r(98)=0.65, p<0.001) and discriminant validity, and test-retest reliability (intra-class correlation=0.76). An exploratory factor analysis of OASIS revealed a single latent component. Conclusions OASIS is an obesity-specific instrument that comprehensively measures subjective obesity awareness. OASIS can be used in epidemiological studies, intervention trials and clinical practice to assess the impact of obesity awareness on treatment adherence and outcomes.
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Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, 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, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Lena Quilty
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Thushanthi Balakumar
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Eric Plitman
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Jun Ku Chung
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Bruce G Pollock
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, 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, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Satya Dash
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, 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, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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27
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Bauer IE, Diniz BS, Meyer TD, Teixeira AL, Sanches M, Spiker D, Zunta-Soares G, Soares JC. Increased reward-oriented impulsivity in older bipolar patients: A preliminary study. J Affect Disord 2018; 225:585-592. [PMID: 28886499 PMCID: PMC5626658 DOI: 10.1016/j.jad.2017.08.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/02/2017] [Accepted: 08/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Impulsivity is a well-established trait of bipolar disorder (BD) that persists across mood phases. It is, however, still unknown whether, in BD, impulsivity remains stable or varies in intensity over the lifespan. This cross-sectional study compared impulsive behavior in older euthymic BD patients and healthy individuals using a range of self-rating and behavioral measures of impulsivity. METHODS 28 BD patients (56.07 ± 4.08 years, 16 women) and 15 healthy controls (HC; 55.1 ± 3.95 years, 6 women) were administered the Barratt Impulsivity Scale (BIS) and selected tasks of the Cambridge Neuropsychological Test Automated Batter (CANTAB) reflecting impulsivity. Multivariate analysis of variance controlled for age compared impulsivity measures across BD and HC. RESULTS BD patients displayed poor decision making, risk taking, and increased delay aversion. Other measures of impulsivity such as response inhibition, sustained cognitive control, and BIS scores were, overall, comparable between BD and HC. CONCLUSIONS These preliminary findings suggest that, in BD, aspects of impulsivity related to reward-based decision making persist into late adulthood. Large scale, longitudinal studies are needed to evaluate the relationship of age to impulsivity over time, and explore the link between impulsivity and illness progression in elderly individuals with BD.
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Affiliation(s)
- Isabelle E. Bauer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Breno Satler Diniz
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Thomas D. Meyer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Antonio Lucio Teixeira
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Marsal Sanches
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States,Archway Mental Health Services, 58502 Bismarck, ND, United States
| | - Danielle Spiker
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Giovana Zunta-Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Jair C. Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
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28
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Relationship between insight and theory of mind in schizophrenia: A meta-analysis. Schizophr Res 2017; 190:11-17. [PMID: 28302393 DOI: 10.1016/j.schres.2017.03.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 11/21/2022]
Abstract
Poor insight in schizophrenia has been associated with executive dysfunction and deficits in general cognitive ability. The overall outcome of available neurocognitive studies suggests that there is a significant but modest relationship between cognitive deficits and poor insight in schizophrenia. However, social cognitive abilities, particularly, theory of mind (ToM), might also play a role in poor insight in schizophrenia. A novel meta-analysis of the relationship between ToM and insight in schizophrenia was conducted. Current meta-analysis included 16 studies including 1085 patients with schizophrenia-spectrum disorders. There was a significant association between ToM and clinical insight (r=0.28, CI=0.20-0.36). By contrast, there was no significant relationship between ToM and cognitive insight. Current findings suggest that there is a small but significant relationship between ToM and clinical insight in schizophrenia. ToM impairment is one of the factors contributing to poor insight in schizophrenia.
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29
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Pousa E, Ochoa S, Cobo J, Nieto L, Usall J, Gonzalez B, Garcia-Ribera C, Pérez Solà V, Ruiz AI, Baños I, Cobo J, García-Ribera C, González B, Massons C, Nieto L, Monserrat C, Ochoa S, Pousa E, Ruiz AI, Ruiz I, Sanchez-Cabezudo D, Usall J. A deeper view of insight in schizophrenia: Insight dimensions, unawareness and misattribution of particular symptoms and its relation with psychopathological factors. Schizophr Res 2017; 189:61-68. [PMID: 28237605 DOI: 10.1016/j.schres.2017.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/08/2017] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE 1. To describe insight in a large sample of schizophrenia subjects from a multidimensional point of view, including unawareness of general insight dimensions as well as unawareness and misattribution of particular symptoms. 2. To explore the relationship between unawareness and clinical and socio-demographic variables. METHODS 248 schizophrenia patients were assessed with the Positive and Negative Syndrome Scale (PANSS, five factor model of Lindenmayer) and the full Scale of Unawareness of Mental Disorder (SUMD). Bivariate associations and multiple linear regression analyses were used to investigate the relationship between unawareness, symptoms and socio-demographic variables. RESULTS Around 40% of the sample showed unawareness of mental disorder, of the need for medication and of the social consequences. Levels of unawareness and misattribution of particular symptoms varied considerably. General unawareness dimensions showed small significant correlations with positive, cognitive and excitement factors of psychopathology, whereas these symptom factors showed higher correlations with unawareness of particular symptoms. Similarly, regression models showed a small significant predictive value of positive symptoms in the three general unawareness dimensions while a moderate one in the prediction of particular symptoms. Misattribution showed no significant correlations with any symptom factors. CONCLUSIONS Results confirm that insight in schizophrenia is a multi-phased phenomenon and that unawareness into particular symptoms varies widely. The overlap between unawareness dimensions and psychopathology is small and seems to be restricted to positive and cognitive symptoms, supporting the accounts from cognitive neurosciences that suggest that besides basic cognition poor insight may be in part a failure of self-reflection or strategic metacognition.
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Affiliation(s)
- Esther Pousa
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain.
| | - Susana Ochoa
- Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain
| | - Jesús Cobo
- Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Spain
| | - Lourdes Nieto
- Department of Research; Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz.Calzada México-Xochimilco 101. 14370 San Lorenzo Huipulco - Tlalpan, México D. F. México
| | - Judith Usall
- Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain
| | - Beatriz Gonzalez
- Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain
| | - Carles Garcia-Ribera
- Servicio de Psiquiatría del Hospital de la Santa Creu i Sant Pau Barcelona, IIB-Sant Pau, Sant Quintí 89, 08025 Barcelona, Spain
| | - Victor Pérez Solà
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Spain; Servicio de Psiquiatría del Hospital de la Santa Creu i Sant Pau Barcelona, IIB-Sant Pau, Sant Quintí 89, 08025 Barcelona, Spain; Centro de Investigación Biomédica En Red de Salud Mental, CIBERSAM, Spain
| | - Ada-I Ruiz
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Iris Baños
- Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain
| | - Jesús Cobo
- Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain; Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain
| | - Carles García-Ribera
- Servicio de Psiquiatría del Hospital de la Santa Creu i Sant Pau Barcelona, IIB-Sant Pau, Sant Quintí 89, 08025 Barcelona, Spain
| | - Beatriz González
- Mental Health Department, Hospital Benito Menni, Sant Boi de Llobregat, Barcelona, Spain
| | - Carmina Massons
- Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain
| | - Lourdes Nieto
- Department of Research; Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz.Calzada México-Xochimilco 101. 14370 San Lorenzo Huipulco - Tlalpan, México D. F. México
| | - Clara Monserrat
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | - Susana Ochoa
- Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain
| | - Esther Pousa
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain
| | - Ada-Inmaculada Ruiz
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Isabel Ruiz
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Spain
| | | | - Judith Usall
- Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain
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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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Abstract
In spite of the increasing number of studies on insight in psychiatry and also in neurology and psychology, its nature is still elusive. It encompasses at least three fundamental characteristics: the awareness of suffering from an illness, an understanding of the cause and source of this suffering, and an acknowledgment of the need for treatment. As such, insight is fundamental for patients' management, prognosis, and treatment. Not surprisingly, the majority of available data, which have been gathered on schizophrenia, show a relationship between low insight and poorer outcomes. For mood disorders, however, insight is associated with less positive results. For other psychiatric disorders, insight has rarely been investigated. In neurology, the impaired ability to recognize the presence of sensory, perceptual, motor, affective, or cognitive functioning-referred to as anosognosia-has been related to damage of specific brain regions. This article provides a comprehensive review of insight in different psychiatric and neurological disorders, with a special focus on brain areas and neurotransmitters that serve as the substrate for this complex phenomenon.
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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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Margariti M, Ploumpidis D, Economou M, Christodoulou GN, Papadimitriou GN. Quality of life in schizophrenia spectrum disorders: associations with insight and psychopathology. Psychiatry Res 2015; 225:695-701. [PMID: 25544550 DOI: 10.1016/j.psychres.2014.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 09/25/2014] [Accepted: 11/07/2014] [Indexed: 11/15/2022]
Abstract
Therapeutic interventions in chronic mental illness face the important challenge to pursuit the quality of life (QOL) of patients. Insight into chronic mental illness, though a prerequisite for treatment adherence and a positive therapeutic outcome, has shown adverse associations with subjective QOL. This study aims to explore the contribution of psychopathological symptoms on the ambiguous role of insight on QOL. Seventy-two outpatients with schizophrenia spectrum disorders were assessed using the positive and negative syndrome scale, the scale to assess unawareness of mental disorder, and the WHOQOL-100 instrument for the assessment of quality of life. Insight was found to associate inversely with quality of life. Among psychopathological symptoms, depressive symptoms were the strongest negative contributor on QOL. Mediation analysis revealed that the effects of awareness of the consequences of illness on QOL were largely mediated by depressive symptoms (full mediation for the effect on physical and psychological domain and partial mediation for the effect on independence and environment domain of the QOL). Our results suggest that the inverse relationship between insight and subjective quality of life is partially mediated by depressive symptoms. We discuss theoretical and therapeutic implications of the findings, in conjunction with similar recent research data.
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Affiliation(s)
- Maria Margariti
- University of Athens, 1st. Department of Psychiatry, Eginition Hospital, 72-74 Vas. Sofias Avenue, Athens 11528, Greece.
| | - Dimitris Ploumpidis
- University of Athens, 1st. Department of Psychiatry, Eginition Hospital, 72-74 Vas. Sofias Avenue, Athens 11528, Greece
| | - Marina Economou
- University of Athens, 1st. Department of Psychiatry, Eginition Hospital, 72-74 Vas. Sofias Avenue, Athens 11528, Greece
| | | | - George N Papadimitriou
- University of Athens, 1st. Department of Psychiatry, Eginition Hospital, 72-74 Vas. Sofias Avenue, Athens 11528, Greece
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Giusti L, Ussorio D, Tosone A, Di Venanzio C, Bianchini V, Necozione S, Casacchia M, Roncone R. Is personal recovery in schizophrenia predicted by low cognitive insight? Community Ment Health J 2015; 51:30-7. [PMID: 25064088 DOI: 10.1007/s10597-014-9767-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
Recovery is a widely discussed concept in the field of research, treatment, and public policy regarding serious mental illness, and mainly schizophrenia. Aim of our study was to assess the relationship between personal recovery and prediction variables, as psychopathology, neurocognition, clinical and cognitive insight, and social functioning in inpatients affected by schizophrenia, with a special interest on cognitive insight. We assessed 76 inpatients affected by schizophrenia at their hospital discharge. Instruments included the Beck Cognitive Insight Scale, the Insight Scale and the Recovery Assessment Scale to assess the cognitive and clinical insight, and personal recovery. The neurocognitive assessment was represented by a single factor score produced by a principal components analysis of a neurocognitive test battery. Social functioning was measured also. Low self-reflectiveness of cognitive insight represented the best predictors of personal recovery. The relationship between cognitive insight and recovery found in this study may contribute to develop tailored interventions, taking into account the personal sense of recovery, despite the psychopathological evaluation.
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Affiliation(s)
- Laura Giusti
- Department of Health, Life and Environmental Sciences, Unit of Psychiatry, University of L'Aquila, Via Vetoio, Coppito, 67100, L'Aquila, Italy
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Impact of interpersonal factors on insight in schizophrenia. Schizophr Res 2014; 159:527-32. [PMID: 25239126 DOI: 10.1016/j.schres.2014.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 07/25/2014] [Accepted: 08/06/2014] [Indexed: 12/28/2022]
Abstract
Whereas clinical insight in schizophrenia has been consistently associated with personal factors (i.e. sociodemographic characteristics, symptoms or cognition), little is known about its relationships with interpersonal factors (i.e. close environment and personal characteristics involved in social interactions). Most of the few studies available have focused on one particular interpersonal factor, such as social cognition, contact frequencies or therapeutic alliance. To date, no study has explored the specificity of associations between clinical insight and different levels of interpersonal factors, neither if these associations are independent of personal factors. Associations between insight and interpersonal factors were explored through multiple regression in a sample of 80 outpatients with schizophrenia spectrum disorders. Lower insight was associated with lower interpersonal functioning, independently from personal factors such as age, gender, age at first hospitalization, executive functioning and symptoms. Our findings replicate previous studies with regard to the associations between clinician-rated insight and social cognition or social contact frequencies. They also provide new information about specific associations between clinician-rated insight and perceived social support as well as between patient-rated insight and therapeutic alliance. Finally, models of insight based on personal factors were significantly improved by the inclusion of interpersonal factors. These results strongly support the crucial role of interpersonal factors in insight, both from the clinician's and the patient's point of view. These exploratory data require further replication.
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Abstract
PURPOSE This study aimed to clarify the phenomenon and definition of self-stigma in schizophrenia. CONCLUSION Self-stigma in schizophrenia affects patients' well-being and attitudes to treatment. Although stigma and self-stigma have interactive and different characteristics, theses definitions are not clearly distinguished. Mental illnesses may have different stereotypes but are treated equally in some studies. Lack of awareness of illness is a common feature in schizophrenia but has not been focused in self-stigma studies. PRACTICE IMPLICATION Further studies are needed to clarify the phenomenon of self-stigma in people with schizophrenia and to develop interventions targeted at reducing self-stigma.
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Affiliation(s)
- Yoshimi Omori
- University of Tsukuba, Tsukuba, Ibaraki, Japan; University of Southern Indiana, Evansville, Indiana, USA
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Pruß L, Wiedl KH, Waldorf M. Der Beitrag subjektiver Krankheitsrepräsentationen zur Erklärung beeinträchtigter Krankheitseinsicht bei Schizophrenie. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2014. [DOI: 10.1026/1616-3443/a000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Theoretischer Hintergrund: Die Genese von Defiziten der Krankheitseinsicht bei Schizophrenie wird bisher unzureichend und teilweise widersprüchlich erklärt. Mehrfaktorielle Einsichtsmodelle, die inkonsistente Befunde integrieren, existieren kaum. Fragestellung: Kann ein typologischer Ansatz und die Erweiterung um die gesundheitspsychologische Perspektive subjektiver Krankheitskonzepte bisherige klinisch-psychiatrische Einsichtsmodelle verbessern? Methode: Für 95 Personen mit Diagnosen aus dem Schizophrenie-Spektrum wurden Krankheitseinsicht, subjektive Krankheitskonzepte, Symptomatik und Neurokognition querschnittlich erhoben. Ergebnisse: Eine einsichtige, kognitiv intakte sowie zwei uneinsichtige Subgruppen (kognitiv beeinträchtigt vs. unbeeinträchtigt) wurden clusteranalytisch identifiziert. Letztere ließ sich anhand von mehr Positivsymptomen, Bewertungen von verringerter Kontrollierbarkeit und emotionaler Bedeutung ihrer Problematik multinomial vorhersagen (R2N = .56). Schlussfolgerungen: Der Einschluss subjektiver Krankheitskonzepte in klinisch-psychiatrische Einsichtsmodelle erscheint fruchtbar. Neben einer defizitbasierten Uneinsichtigkeit lassen sich angesichts spezifischer Krankheitsbewertungen motivationale Einsichtsbarrieren vermuten.
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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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López-Moríñigo JD, Wiffen B, O'Connor J, Dutta R, Di Forti M, Murray RM, David AS. Insight and suicidality in first-episode psychosis: understanding the influence of suicidal history on insight dimensions at first presentation. Early Interv Psychiatry 2014; 8:113-21. [PMID: 23489389 DOI: 10.1111/eip.12042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 12/28/2012] [Indexed: 11/29/2022]
Abstract
AIM Lack of insight is a cardinal feature of psychosis with crucial implications for outcome. Concerns have been raised regarding a link between insight and suicidality. This study aimed to test the relationship between suicidal behaviour preceding first-episode psychosis (FEP) and insight dimensions at treatment onset. METHODS A total of 112 FEP inpatients were recruited. Suicidal events prior to admission were recorded. Insight was assessed multidimensionally with the Schedule for the Assessment of Insight - Expanded version shortly after admission. Suicidal and non-suicidal patients were compared regarding scores on 'total insight' and three insight domains: 'awareness of mental illness', 'relabeling of psychotic experiences as abnormal' and 'compliance'. This analysis was also adjusted for a set of sociodemographic, clinical, neurocognitive and psychopathological variables. RESULTS Bivariate analyses demonstrated a direct association between previous suicidality and all insight domains. However, these associations did not survive multivariable regression models, which demonstrated gender (female), shorter duration of untreated psychosis (DUP) and psychopathological symptoms - depression and disorganization - to mediate the influence of suicidal history on insight, and therefore to underlie the latter. CONCLUSIONS Insight dimensions in FEP patients are influenced by having suicidal antecedents through some mediating variables such as gender, DUP and depression. Further prospective studies are needed to clarify the potential implications of these findings on the management of insight in FEP. As suicidal history is associated with greater levels of both depression and insight at first presentation, these three variables might be useful in predicting further suicidal events.
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Sapara A, ffytche DH, Birchwood M, Cooke MA, Fannon D, Williams SC, Kuipers E, Kumari V. Preservation and compensation: the functional neuroanatomy of insight and working memory in schizophrenia. Schizophr Res 2014; 152:201-9. [PMID: 24332795 PMCID: PMC3906535 DOI: 10.1016/j.schres.2013.11.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 11/12/2013] [Accepted: 11/18/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Poor insight in schizophrenia has been theorised to reflect a cognitive deficit that is secondary to brain abnormalities, localized in the brain regions that are implicated in higher order cognitive functions, including working memory (WM). This study investigated WM-related neural substrates of preserved and poor insight in schizophrenia. METHOD Forty stable schizophrenia outpatients, 20 with preserved and 20 with poor insight (usable data obtained from 18 preserved and 14 poor insight patients), and 20 healthy participants underwent functional magnetic resonance imaging (fMRI) during a parametric 'n-back' task. The three groups were preselected to match on age, education and predicted IQ, and the two patient groups to have distinct insight levels. Performance and fMRI data were analysed to determine how groups of patients with preserved and poor insight differed from each other, and from healthy participants. RESULTS Poor insight patients showed lower performance accuracy, relative to healthy participants (p=0.01) and preserved insight patients (p=0.08); the two patient groups were comparable on symptoms and medication. Preserved insight patients, relative to poor insight patients, showed greater activity most consistently in the precuneus and cerebellum (both bilateral) during WM; they also showed greater activity than healthy participants in the inferior-superior frontal gyrus and cerebellum (bilateral). Group differences in brain activity did not co-vary significantly with performance accuracy. CONCLUSIONS The precuneus and cerebellum function contribute to preserved insight in schizophrenia. Preserved insight as well as normal-range WM capacity in schizophrenia sub-groups may be achieved via compensatory neural activity in the frontal cortex and cerebellum.
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Affiliation(s)
- Adegboyega Sapara
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Dominic H. ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, London, UK,Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - Max Birchwood
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Michael A. Cooke
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Dominic Fannon
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Steven C.R. Williams
- Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Veena Kumari
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
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Kumar A, Sharma P, Das S, Nath K, Talukdar U, Bhagabati D. Insight in psychotic disorder: relation with psychopathology and frontal lobe function. Psychopathology 2014; 47:32-8. [PMID: 23711569 DOI: 10.1159/000348486] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 12/26/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Through conceptualising poor insight in psychotic disorders as a form of anosognosia, frontal lobe dysfunction is often ascribed a vital role in its pathogenesis. The objective of this study was to compare the relation of insight in patients with psychotic illness to that of psychopathology and frontal lobe function. METHODS Forty patients with psychotic disorder were selected from those attending the Department of Psychiatry in a tertiary care teaching hospital. The evaluation of insight was carried out using the Schedule for Assessment of Insight (SAI), that of frontal lobe function by the Frontal Assessment Battery (FAB) and psychopathology by the Brief Psychiatric Rating Scale (BPRS). The correlation coefficients were determined. RESULTS A negative correlation between SAI and BPRS scores means that the BPRS score is opposite to SAI scores. When the SAI total score was compared with the FAB total score, the correlation coefficient demonstrated a positive correlation. Better insight predicted lesser psychopathology and also that poor insight would exist with greater psychopathology. Better insight predicted a higher functional status of frontal lobes and prefrontal cortex in particular. CONCLUSION Insight deficits in schizophrenia and other psychotic illnesses are multidimensional. Integration of different aetiological factors like biological, psychopathological, environmental ones and others are necessary for a better understanding of insight in psychosis.
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Affiliation(s)
- Atmesh Kumar
- Silchar Medical College and Hospital, Silchar, India
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Medication adherence, knowledge about psychosis, and insight among patients with a schizophrenia-spectrum disorder. J Nerv Ment Dis 2014; 202:25-9. [PMID: 24375208 DOI: 10.1097/nmd.0000000000000068] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to explore the relationship between knowledge about psychosis, insight, and medication adherence among patients at an early stage of a schizophrenia-spectrum disorder. Eighty patients were recruited from a specialized outpatient clinic. Knowledge was assessed with the modified Knowledge About Schizophrenia Test (KAST). Medication adherence was determined with the Chinese abridged Medication Adherence Ratings Scale. Insight was measured with the abridged Scale to Assess Unawareness of Mental Disorder (SUMD). The KAST total score was correlated with the SUMD. A trend correlation between KAST subscores of cause and SUMD was found. The nonadherence rate was 43.8%. The medication-adherent patients had lower SUMD (z = -4.338, p < 0.0001) and higher KAST subscore of cause (z = -2.767, p = 0.006). These two variables explained 38.9% of the variance in adherence behavior, with SUMD being the mediator. This study highlights the importance of patients' understanding of etiology of the illness and its relationship with insight and medication adherence.
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Nair A, Palmer EC, Aleman A, David AS. Relationship between cognition, clinical and cognitive insight in psychotic disorders: a review and meta-analysis. Schizophr Res 2014; 152:191-200. [PMID: 24355529 DOI: 10.1016/j.schres.2013.11.033] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 11/20/2013] [Indexed: 11/16/2022]
Abstract
The neurocognitive theory of insight posits that poor insight in psychotic illnesses is related to cognitive deficits in cognitive self-appraisal mechanisms. In this paper we perform a comprehensive meta-analysis examining relationships between clinical insight and neurocognition in psychotic disorders. We have also completed a meta-analysis of studies examining 'cognitive insight', as measured by the Beck Cognitive Insight Scale (BCIS), and its relationship with neurocognitive function in patients with psychosis. The clinical insight analysis included data from 72 studies and a total population of 5429 patients. We found that insight in psychosis was significantly associated with total cognition (r=0.16, p<0.001), IQ (r=0.16, p<0.001), memory (r=0.13, p<0.001) and executive function (r=0.14, p<0.001). All of these correlations were stronger when examined in patients with schizophrenia only. In the BCIS analysis we included 7 studies and 466 patients in total. We found that no significant associations were found between the self-reflectiveness sub-component and neurocognition. By contrast there were significant correlations between the self-certainty subcomponent and memory (r=-0.23, p<0.001), IQ (r=-0.19, p<0.001) and total cognition (r=-0.14, p=0.01). We did not find evidence of significant publication bias in any analyses. Overall, our results indicate that there is a small but significant relationship between clinical insight, some aspects of cognitive insight and neurocognition. These findings reflect the complexity of the insight construct and indicate that while the neurocognitive model is important it is likely to be one of many which contribute to the understanding of this phenomenon.
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Affiliation(s)
- Akshay Nair
- NIHR Academic Clinical Fellow, South London & Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry, King's College, London, UK.
| | - Emma Claire Palmer
- Department of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College, London, UK
| | - André Aleman
- Cognitive Neuropsychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anthony S David
- Cognitive Neuropsychiatry, Institute of Psychiatry, King's College, London, UK
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Wiffen BDR, O'Connor JA, Russo M, Falcone MA, Joseph C, Kolliakou A, Di Forti M, Murray RM, David AS. Do psychosis patients with poor insight show implicit awareness on the emotional stroop task? Psychopathology 2014; 47:93-100. [PMID: 24021460 DOI: 10.1159/000350452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/09/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The insight into psychosis can be assessed reliably by clinicians from interviews with patients. However, patients may retain implicit awareness of illness while lacking explicit awareness. SAMPLING AND METHODS In a sample of first-episode psychosis patients, we used a test of processing of mental illness-related and other negative words as a measure of implicit awareness to see how this varied in relation to insight. An emotional-counting Stroop task tested reaction times to words of three types: psychosis-related (e.g. 'crazy'), general negative (e.g. 'cancer') and neutral (e.g. 'oyster'). Data were available from 43 patients and 23 healthy controls. Patients' insight was assessed using the Schedule for the Assessment of Insight (SAI-E). RESULTS Patients reacted slower than controls to words across all conditions, and both patients and controls reacted slower to salient and negative words than neutral words. There was a near significant interaction between word type and group (Wilks' lambda = 0.53, p = 0.055); patients experienced greater interference from negative rather than psychosis-related words (p = 0.003), and controls experienced greater interference from salient rather than negative words (p = 0.01). Within the patient group, there was a correlation between insight and interference on salient words (r = 0.33, p = 0.05), such that those with less insight experienced less interference on psychosis-related words. CONCLUSIONS Psychosis-related words were less threatening and less self-relevant to psychosis patients with less insight. This suggests that the lack of awareness such patients have of their illness is genuine and more likely to be mediated by lower-level information processing mechanisms than strategies such as conscious, motivated denial.
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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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45
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Restifo S. A review of the concepts, terminologies and dilemmas in the assessment of decisional capacity: a focus on alcoholism. Australas Psychiatry 2013; 21:537-40. [PMID: 23884961 DOI: 10.1177/1039856213497812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The formal assessment of a person's capacity for making reasoned decisions is an infrequent and usually unappealing clinical task. The purpose of this paper is to dissect the task, consider the component parts, clarify those aspects that can be problematic and highlight those that remain so. METHOD The paper reviews the concepts, terminologies and dilemmas around alcoholism, insight, lack of insight, denial, judgement, will, decisional capacity and competence. CONCLUSION Assessments of patients suffering from alcoholism (or any other dyscontrol problem such as deliberate self-harm, problem gambling or eating disorders) are likely to evoke unease because of the interweaving of potentially disputable phenomenological, clinical, ethical, semantic and legal aspects. Familiarity with the concepts and terms around decisional capacity helps to orientate clinicians in their work. There remain some particular conceptual issues that are in need of further scholarly attention.
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Affiliation(s)
- Sam Restifo
- Psychiatrist, North Metropolitan Area Mental Health Service, Shenton Park, WA, Australia
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46
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van der Meer L, de Vos AE, Stiekema APM, Pijnenborg GHM, van Tol MJ, Nolen WA, David AS, Aleman A. Insight in schizophrenia: involvement of self-reflection networks? Schizophr Bull 2013; 39:1288-95. [PMID: 23104865 PMCID: PMC3796073 DOI: 10.1093/schbul/sbs122] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Impaired insight is a common feature in psychosis and an important predictor of variables such as functional outcome, prognosis, and treatment adherence. A cognitive process that may underlie insight in psychosis is self-reflection, or the conscious evaluation of one's traits and characteristics. The current study aims to investigate the neural correlates of self-reflective processing and its relationship with insight in schizophrenia. METHODS Forty-seven schizophrenia patients and 21 healthy controls performed a self-reflection task in a functional magnetic resonance imaging (fMRI) scanner. The tasks comprised a self-reflection, close other-reflection, and a semantic (baseline) condition. Insight scores were obtained with the Schedule of Assessment of Insight Expanded. In addition, cognitive insight scores were obtained (Beck Cognitive Insight Scale [BCIS]). RESULTS Schizophrenia patients demonstrated less activation in the posterior cingulate cortex in the self- and other-reflection conditions and less activation in the precuneus in the other-reflection condition compared with healthy controls. Better insight was associated with greater response in the inferior frontal gyrus, anterior insula, and inferior parietal lobule during self-reflection. In addition, better cognitive insight was associated with higher activation in ventromedial prefrontal cortex during self-reflection. CONCLUSION In the current study, evidence for a relationship between self-reflection and insight in patients with schizophrenia was found in brain areas related to self-reflection, self/other distinction and source attribution. The findings support the rationale for a treatment that is currently under evaluation, which attempts to increase insight by enhancing self-reflection.
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Affiliation(s)
- Lisette van der Meer
- To whom correspondence should be addressed; Psychosecircuit, GGZ Drenthe, Denneweg 9, 9404 LA Assen, The Netherlands; tel: +31 6 31674876, fax: +31 50 3638875, e-mail:
| | - Annerieke E. de Vos
- Department of Neuroscience, University Medical Center Groningen, Groningen, The Netherlands;,Department of Experimental Psychopathology, University of Groningen, Groningen, The Netherlands;,Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands;,To whom correspondence should be addressed; Psychosecircuit, GGZ Drenthe, Denneweg 9, 9404 LA Assen, The Netherlands; tel: +31 6 31674876, fax: +31 50 3638875, e-mail:
| | | | - Gerdina H. M. Pijnenborg
- Department of Experimental Psychopathology, University of Groningen, Groningen, The Netherlands;,Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands
| | - Marie-José van Tol
- Department of Neuroscience, University Medical Center Groningen, Groningen, The Netherlands;,Clinical Affective Neuroimaging Laboratory, Center for Behavioral Brain Sciences, Leibniz Institute for Neurobiology, Otto von Guericke University, Magdeburg, Germany
| | - Willem A. Nolen
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | | | - André Aleman
- Department of Neuroscience, University Medical Center Groningen, Groningen, The Netherlands;,Department of Experimental Psychopathology, University of Groningen, Groningen, The Netherlands;,Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands
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Konstantakopoulos G, Ploumpidis D, Oulis P, Soumani A, Nikitopoulou S, Pappa K, Papadimitriou GN, David AS. Is insight in schizophrenia multidimensional? Internal structure and associations of the Greek version of the Schedule for the Assessment of Insight-Expanded. Psychiatry Res 2013; 209:346-52. [PMID: 23489595 DOI: 10.1016/j.psychres.2013.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 08/17/2012] [Accepted: 02/12/2013] [Indexed: 11/16/2022]
Abstract
Despite the general agreement that insight is a multidimensional phenomenon, the studies on the factorial structure of the scales for its assessment have yielded rather inconsistent results. The present study aimed to assess the internal structure of the Schedule for the Assessment of Insight (SAI-E). Seventy-two chronic patients with schizophrenia were assessed with SAI-E. Hierarchical cluster analysis and multidimensional scaling (MDS) were used to identify insight components and assess their inter-relationships. The associations of the extracted components with demographic, clinical and cognitive characteristics were also examined. The SAI-E demonstrated good psychometric properties. Three subscales of SAI-E were identified measuring awareness of illness, relabeling of symptoms, and treatment compliance. Moreover, the MDS disclosed two underlying dimensions--degree of 'specificity' and 'spontaneity'--within the insight construct. Treatment compliance was more strongly correlated with symptom relabeling than illness awareness. Excitement symptoms, global functioning and general intelligence were correlated with all the components of insight. Depressive symptoms were more strongly correlated with illness awareness. Impaired relabeling ability was linked to cognitive rigidity and greater severity of disorganization and positive symptoms. Education and severity of negative symptoms specifically affect treatment compliance. Our results support the hypothesis that insight is a multidimensional construct.
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Affiliation(s)
- George Konstantakopoulos
- Athens University Medical School, First Department of Psychiatry, Greece; King's College, London, Institute of Psychiatry, Section of Cognitive Neuropsychiatry, UK.
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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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McFarland J, Cannon DM, Schmidt H, Ahmed M, Hehir S, Emsell L, Barker G, McCarthy P, Elliott MA, McDonald C. Association of grey matter volume deviation with insight impairment in first-episode affective and non-affective psychosis. Eur Arch Psychiatry Clin Neurosci 2013; 263:133-41. [PMID: 22673767 DOI: 10.1007/s00406-012-0333-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 05/23/2012] [Indexed: 12/21/2022]
Abstract
The neurobiological correlates of impaired insight in psychotic illness remain uncertain and may be confounded by factors such as illness progression and medication use. Our study consisted of two separate experiments. In the first experiment, we examined the association between measures of insight and regional brain volume in thirty-two patients with first-episode psychosis. In the second experiment, we looked at similar associations in thirty individuals with chronic schizophrenia. Detailed measures of symptom awareness and symptom attribution were obtained using the Scale to assess Unawareness of Mental Disorder. MRI scans were acquired and analysed using Statistical Non-Parametric Mapping for voxel-based analyses of grey matter maps. Regression models were used to assess the relationship between insight and grey matter volume in both the first-episode psychosis and the chronic schizophrenia experiments whilst controlling for potential confounds. In first-episode psychosis patients, symptom misattribution was associated with increased grey matter in the right and left caudate, right thalamus, left insula, putamen and cerebellum. In the chronic schizophrenia study, there were no significant associations between regional grey matter volume and measures of insight. These findings suggest that neuroplastic changes within subcortical and frontotemporal regions are associated with impaired insight in individuals during their first episode of psychosis.
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Affiliation(s)
- John McFarland
- Department of Psychiatry, School of Medicine, National University of Ireland, Galway, Co., Galway, Ireland.
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David AS, Bedford N, Wiffen B, Gilleen J. Failures of metacognition and lack of insight in neuropsychiatric disorders. Philos Trans R Soc Lond B Biol Sci 2012; 367:1379-90. [PMID: 22492754 DOI: 10.1098/rstb.2012.0002] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Lack of insight or unawareness of illness are the hallmarks of many psychiatric disorders, especially schizophrenia (SCZ) and other psychoses and could be conceived of as a failure in metacognition. Research in this area in the mental health field h as burgeoned with the development and widespread use of standard assessment instruments and the mapping out of the clinical and neuropsychological correlates of insight and its loss. There has been a growing appreciation of the multi-faceted nature of the concept and of the different 'objects' of insight, such as the general awareness that one is ill, to more specific metacognitive awareness of individual symptoms, impairments and performance. This in turn has led to the notion that insight may show modularity and may fractionate across different domains and disorders, supported by work that directly compares metacognition of memory deficits and illness awareness in patients with SCZ, Alzheimer's disease and brain injury. The focus of this paper will be on the varieties of metacognitive failure in psychiatry, particularly the psychoses. We explore cognitive models based on self-reflectiveness and their possible social and neurological bases, including data from structural and functional MRI. The medial frontal cortex appears to play an important role in self-appraisal in health and disease.
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Affiliation(s)
- Anthony S David
- Section of Cognitive Neuropsychology, Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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