Awareness of illness and insight into obsessive-compulsive symptoms in schizophrenia patients with obsessive-compulsive disorder

Obsessive-compulsive symptoms (OCS) have been revealed in a substantial proportion of schizophrenia patients. We sought to evaluate insight into OCS in schizo-obsessive patients. We evaluated insight into OCS and awareness of schizophrenia, using the Brown Assessment of Beliefs Scale (BABS) and the Scale to Assess Unawareness of Mental Disorder (SUMD), respectively. Fifty-seven inpatients that met DSM-IV criteria for both schizophrenia and OCD were recruited. To determine a possible modifying effect of OCS on the awareness of schizophrenia, we included a comparison group of non-OCD schizophrenia patients (N = 80). Nine (15.8%) schizo-obsessive patients revealed lack of insight into OCS, whereas a majority (48 patients, 84.2%) exhibited good or fair insight. In the schizo-obsessive group, insight into OCS positively correlated with awareness of schizophrenia but not with awareness of delusions. Roughly 40% of the schizo-obsessive and non-OCD schizophrenia patients revealed unawareness of schizophrenia. Our findings indicate that OCS in schizophrenia represent an identifiable dimension of psychopathology independent of core schizophrenia symptoms.     

Awareness of being a patient and its relevance to insight into illness in patients with schizophrenia.

This article presents the development of the Awareness of Being a Patient Scale (ABPS), a 25-item self-report scale to measure the awareness of schizophrenic patients. Awareness is defined in terms of a patient's psychological attitude toward the psychiatric situation, and is to be evaluated from the standpoint of Parsons' sick-role concept by assessing the recognition of the need for treatment and acceptance of the treatment situation. It is hypothesized that awareness is a factor in the motivation to receive treatment. Closely related to the awareness is the insight into illness, a clinical construct comprising a patient's understanding of psychotic illness and symptoms. There also seems to be an overlap between them. However, the difference is that awareness principally pertains to a patient's perspective, not addressing the precise understanding of illness and symptoms, while the frame of reference in assessing insight is from the viewpoint of psychiatry. In examining properties of the ABPS, it is demonstrated that the ABPS has satisfactory reliability, favorable concurrent validity, and significant value in discriminating between long-term stable outpatients and recently admitted and long-term hospitalized patients. This study indicates that the awareness of being a patient has clinical importance and the ABPS is an efficient means of measuring such awareness.     

精神分裂症患者自知力与内在耻感的相关性研究(英文)

背景精神分裂症患者自知力和内在耻感的关系具有理论和实践上的重要性,因为这和患者寻找或接受治疗的意愿密切相关。目的研究中国大陆精神分裂症患者自知力和内在耻感的关系。方法共有65例住院治疗的精神分裂症患者和27例门诊治疗的精神分裂症患者(病程的中位数为4年)完成了两个中文版自评量表-精神疾病内在耻感量表(Internalized Stigma of Mental Illness,ISMI)和修订版病耻感经历问卷(Modified Consumer Experiences of Stigma Questionnaire,MCESQ)的测评。由高年资精神科医生采用阳性症状量表(Scale for Assessment of Positive Symptoms,SAPS)和阴性症状量表(Scale for Assessment of Negative Symptoms,SANS)评定了患者的精神病理症状。由两位高年资精神科医生采用简明精神病学量表中文版的自知力条目评定患者对自身精神疾病的认知,依据分数将患者分为有自知力组和无自知力组。结果有自知力组有49例患者,无自知力组为43例。无自知力患者的病程显著短于有自知力组,更可能为住院治疗者,并且具有更明显的阴性和阳性症状(仅仅表现在趋势上)。有自知力组患者在精神疾病内在耻感量表疏离分量表得分上显著高于无自知力组的患者,但是两个量表的其他分量表得分组间无统计学差异。两个量表48个条目中仅有4个条目得分存在组间差异。Logistic回归没有发现无自知力和两个耻感量表分数或症状量表得分之间存在相关性。结论在中国大陆精神分裂症门诊与住院患者中进行的本研究不支持以前的研究发现:即有自知力的精神分裂症患者会报告更多的耻感经历。本研究使用的耻感量表在中国地区的应用还需要进一步的修订和证实;未来需要对下列问题进行研究:选择不同诊断的患者、对自知力进行更精细的评估以及随时间推移自知力及病耻感经历的波动等等,进一步澄清精神分裂症患者中这两个现象间的复杂关系。     

The dilemma of insight into illness in schizophrenia: self- and expert-rated insight and quality of life

Introduction A major subgroup of patients with acute schizophrenia lacks awareness of having a mental disorder. The aim of this study was to investigate the association of self- and expert-rated insight into illness with subjective quality of life (QOL). It was hypothesised that patients with greater self- and expert-rated insight into illness report lower QOL compared to patients with poor insight. Method For the present study, patients with schizophrenia or schizoaffective disorders were investigated during in-patient treatment. Insight into illness was measured by the scale to assess unawareness of a mental disorder (SUMD), the insight scale and the PANSS. QOL was assessed with the modular system of quality of life (MSQoL). Results Fifty-nine patients entered the study. Self- and expert-rated illness insight were associated with poor QOL. Patients with good insight into illness reported significantly lower physical health (p < 0.05), vitality (p < 0.01), psychosocial (p < 0.01), affective (p < 0.01) and general QOL (p < 0.001) compared to patients with poor insight. Good insight was significantly associated with other parameters of clinical and social functioning and depressive symptoms. Discussion The results indicate that patients with acute schizophrenia and greater insight realise their restrictions more clearly, which contribute to poor QOL, but were stronger integrated in social networks. The inclusion of modules focussing on QOL related aspects of treatment from the beginning as well as a greater awareness of the physician for these questions and a strengthening of the therapeutic alliance might help improving insight without the risk of deteriorating mood and QOL.     

集体心理治疗对慢性精神分裂症患者自知力的影响观察

目的 探讨集体心理干预时慢性精神分裂症自知力的影响,寻找提高患者对治疗依从性好方法.方法 将80例住院慢性精神病患者随机分成两组,干预组给予集体心理治疗和药物治疗,对照组只进行药物治疗.采用阳性和阴性症状量表(PANSS)、自知力与治疗态度问卷(ITAQ)和自制的依从性评估表,于入组前、结束时分别对每位患者各评定1次,共12周.结果 治疗结束时,干预组成员在自知力和依从性均优于对照组,精神症状改善比对照组明显,差异有统计学意义(P＜0.001).结论 集体心理治疗可提高慢性精神分裂症患者自知力,改善服药依从性,值得推广.     

The relationship between cognitive insight, clinical insight, and depression in patients with schizophrenia

Despite comorbid depression being relatively common even in subjects with schizophrenia, to the best of our knowledge, there is, to date, no report in the literature specifically and detailed examining the cognitive and clinical insight in subjects with schizophrenia and a comorbid depressive syndrome. Hence, in this study, we sought to compare the cognitive and clinical insight in our subjects with schizophrenia with and without a comorbid depressive syndrome. We found that participants in the depressive group scored significantly higher on self-reflectiveness and the reflectiveness-certainty (R-C) index scores than those in the nondepressive group. There was no significant difference among groups on the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and clinical insight scores assessed by the Scale to Assess Unawareness of Mental Disorder. In addition, self-reflectiveness scores significantly correlated with depression, observed depression, hopelessness, and suicidality subscores of the Calgary Depression Scale for Schizophrenia. A better understanding of the cognitive component of insight in schizophrenia with comorbid depression may contribute to develop more efficient cognitive strategies, thus improving patient outcome. However, clinicians should be aware of the possibility of exacerbating a sense of hopelessness and suicide risk during the interventions that improve cognitive insight.     

The relation between neurocognitive dysfunction and impaired insight in patients with schizophrenia

ObjectivesThe present study aimed to (i) evaluate the association between insight and measures of executive functions and working memory in a sample of 132 patients with schizophrenia and (ii) to explore to what proportion neurocognitive dysfunction contributed to the variance in insight after controlling for symptomatology.MethodsSubjects were evaluated with a standardized neurocognitive test battery and a semi-structured interview, the Psychosis Evaluation tool for Common use by Caregivers (PECC). PECC, apart from evaluating symptoms and side-effects, measures insight on a 4-point scale by two of its dimensions: awareness of having a mental illness (AMI) and awareness of having symptoms attributed to a mental illness (ASAMI). Executive functioning was measured by the Wisconsin Card Sort Test (WCST) and the Trail Making B (TMB). Working memory was measured by the Letter Number Sequencing (LNS) test from the Wechsler Adult Intelligence Scale (WAIS).ResultsOnly one significant association was found after correction for multiple testing, between WCST categories completed and AMI (r = ?0.29, p = 0.0006). WCST categories completed explained only 7.9% of the variance in AMI, while symptomatology explained 20% of variance in AMI and 16.5% of variance in ASAMI.ConclusionsThe current results show a significant but subtle association with the WCST, which is in agreement with earlier literature. No other associations between cognitive functioning and insight were found. In general, these findings seem to suggest that factors other than cognition have a greater impact on insight in patients with schizophrenia.     

精神分裂症患者的自知力及其对精神症状认识的研究

目的研究精神分裂症患者对症状的认识及其与自知力、精神病理症状及疾病严重程度的关系.方法由患者和医生分别评定4个阳性症状和4个阴性症状在患者身上的表现程度.同时由医生对患者进行ITAQ、BPRS、SANS、SAPS、CGI评定.结果患者对自身阳性和阴性症状的总评分分别为(16.79±3.67)和(16.02±3.81),明显高于医生评定的(15.46±4.25)和(13.22±4.22),患者对自身症状的评分ITAQ、BPRS、SANS、SAPS、CGI均具有一定程度的相关.结论患者对自身症状的认识明显不足,特别是阴性症状.患者对症状的认识与其自知力、疾病严重程度、精神病理症状有关.     

精神分裂症患者住院天数对自知力的影响

目的探讨住院时间长短对精神分裂症患者出院时的自知力影响。方法在广州市脑科医院连续入组且符合《国际疾病分类(第10版)》(ICD-10)精神分裂症诊断标准的住院患者265例,采用阳性和阴性症状量表(PANSS)、自知力和治疗态度问卷(ITAQ)分别测评患者的精神症状和自知力。采用相关性分析及线性回归分析探索自知力和治疗态度的影响因素。结果本组患者住院天数中位数为61(35~97)天,出院时ITAQ评分(11.1±5.8)分。PANSS各分量表、总评分及住院天数与ITAQ评分均有相关性(P0.05)。线性回归分析显示PANSS阳性症状、阴性症状和住院1年以上是自知力的危险因素(B=-0.403,-0.232,-2.979,P0.05),住院天数对ITAQ的解释度仅为1.9%。结论患者出院时的自知力主要受精神症状影响,住院时间长短对自知力的影响不大,适度缩短精神分裂症患者住院天数对自知力恢复可能不会产生负面影响。     

Cortical brain development in nonpsychotic siblings of patients with childhood-onset schizophrenia

CONTEXT: Cortical gray matter (GM) loss is marked and progressive in childhood-onset schizophrenia (COS) during adolescence but becomes more circumscribed by early adulthood. Nonpsychotic siblings of COS probands could help evaluate whether the cortical GM abnormalities are familial/trait markers. OBJECTIVE: To map cortical development in nonpsychotic siblings of COS probands. DESIGN: Using an automated measurement and prospectively acquired anatomical brain magnetic resonance images, we mapped cortical GM thickness in healthy full siblings (n = 52, 113 scans; age 8 through 28 years) of patients with COS, contrasting them with age-, sex-, and scan interval-matched healthy controls (n = 52, 108 scans). The false-discovery rate procedure was used to control for type I errors due to multiple comparisons. SETTING: An ongoing COS study at the National Institute of Mental Health. PARTICIPANTS: Fifty-two healthy full siblings of patients with COS, aged 8 through 28 years, and 52 healthy controls. MAIN OUTCOME MEASURES: Longitudinal trajectories of cortical GM development in healthy siblings of patients with COS compared with matched healthy controls and exploratory measure of the relationship between developmental GM trajectories and the overall functioning as defined by the Global Assessment Scale (GAS) score. RESULTS: Younger, healthy siblings of patients with COS showed significant GM deficits in the left prefrontal and bilateral temporal cortices and smaller deficits in the right prefrontal and inferior parietal cortices compared with the controls. These cortical deficits in siblings disappeared by age 20 years and the process of deficit reduction correlated with overall functioning (GAS scores) at the last scan. CONCLUSIONS: Prefrontal and temporal GM loss in COS appears to be a familial/trait marker. Amelioration of regional GM deficits in healthy siblings was associated with higher global functioning (GAS scores), suggesting a relationship between brain plasticity and functional outcome for these nonpsychotic, nonspectrum siblings.     

Increased positive thought disorder with illness duration in patients with schizophrenia

It is unclear whether the severity of positive formal thought disorder, a core clinical feature of schizophrenia, is stable or worsening through the chronic course of the illness. The neurocognitive basis for positive thought disorder also remains unclear. The aim of the present paper was to examine the relationship between thought disorder as measured by the Thought Disorder Index (TDI) and duration of illness and neuropsychological indices in 79 patients with schizophrenia. TDI scores increased in proportion to illness duration. TDI scores were not associated with verbal memory or executive functioning. These results indicate an ongoing worsening of positive thought disorder through the course of illness in schizophrenia.     

Relationship of awareness of dyskinesia in schizophrenia to insight into mental illness.

OBJECTIVE: The purpose of this study was to determine whether lack of awareness of motor dysfunction and lack of insight into mental dysfunction are related and to evaluate the longitudinal stability of lack of awareness of abnormal movements in schizophrenia. METHOD: Forty-three patients with schizophrenia and tardive dyskinesia participated in the study. The Scale of Unawareness of Mental Disorder was used to assess insight. All patients still meeting inclusion criteria after 2 years (N = 16) were reevaluated at follow-up. RESULTS: Twenty (46.5%) of the 43 patients had at least moderate unawareness of their tardive dyskinesia. Awareness of tardive dyskinesia was only modestly related to two of the five dimensions of insight into mental disorder assessed. Patients with the deficit syndrome showed significantly less awareness of their tardive dyskinesia than patients without the deficit syndrome. Lack of awareness of tardive dyskinesia was stable over time. CONCLUSIONS: Lack of awareness of tardive dyskinesia is a common feature in schizophrenia and is stable over time. Since patients are often unaware of dyskinesia, direct clinical examination is required to identify early tardive dyskinesia.     

Correlates of insight and insight change in schizophrenia

Various theories have been proposed to account for poor insight in schizophrenia. This study examined the relationships between insight, mood, schizophrenic symptoms and cognitive functioning. The relationship between longitudinal changes in insight and changes in symptoms and mood was also investigated. One-hundred patients with DSM-III-R schizophrenia, recently recovered from a relapse of their illness, were rated on the Insight and Treatment Attitudes Questionnaire (ITAQ), the Positive and Negative Syndrome Scale (PANSS), the Montgomery Asberg Depression Rating Scale (MADRS), the Rivermead Behavioural Memory Test and tests of current and premorbid IQ. A random sample of 53 were then given an educational package (video and booklets) designed to improve their insight. Follow-up ratings on the ITAQ, PANSS and MADRS were subsequently obtained. At baseline, better insight was significantly correlated with lower mood and fewer positive symptoms. It was not related to cognitive functioning. Improvement in insight at follow up was related to worsening of mood, but not to change in positive symptoms. The results are consistent with the concept that poor insight, at least in part, results from the psychotic disease process itself. In addition, they suggest that poor insight may protect against depression in the early stages of recovery from schizophrenia.