Insight into astrocyte activation after optic nerve injury

In response to optic nerve damage, astrocytes become reactive. This reactivity can be identified by the presence of morphological and molecular changes throughout the retina and optic nerve as well as the formation of a glial scar. The process of astrocyte activation exhibits spatial and temporal characteristics, and it is finely regulated by complex signaling mechanisms. Excessive astrocyte activation plays a crucial role in progressive optic nerve injury. This review focuses on the spatial and temporal characteristics and mechanisms of astrocyte activation and discusses the modulation of astrocyte activation. Further insight into astrocyte activation might provide targets for future therapeutic interventions. © 2014 Wiley Periodicals, Inc.     

Insight and psychosis

A row of analytical methods for determining neuroleptics in blood has been developed with the aim of improving antipsychotic treatment by plasma concentration monitoring. Perphenazine in an optimal therapeutic plasma concentration range between 2 and 3 nmol/1 (measured as minimum concentrations) has been found in orally treated patients. This range corresponds to the range 2-6 nmol/l during the entire dose interval. Consequently, the range 2-6 nmol/l is referred to during parenteral depot administration.

Depot treatment with perphenazine enanthate is often problematic, especially within the first few days of the injection. This can be explained by significant fluctuations of the plasma concentration within a depot interval. Therefore, lower doses with shorter intervals are to be recommended. Lately, a new depot preparation - perphenazine decanoate - has been introduced disclosing much smaller fluctuations of the plasma level and therefore fewer side effects.

It has been shown that both disulfiram and diazepam are able to change the plasma concentrations of perphenazine by enhancing the metabolic turnover of the last mentioned and thereby may provoke a deterioration of the mental condition.     

Insight and schizophrenia

Few clinical attributes, if any, have such a profound impact on the management of schizophrenia as that associated with lack of insight. Yet, despite its importance, the clinical correlates of lack of insight are poorly understood. In one present study of long-stay patients at a state facility, lack of insight showed modest associations with positive and negative symptoms and with diminished executive function on cognitive testing. Insight did not differ between patients receiving typical and atypical antipsychotic medications.     

Insight

Psychiatric Quarterly -     

Insight and neurocognition in schizophrenia

The relationship between neurocognitive impairments in schizophrenia remains unclear. Recent literature was reviewed and the most consistent finding was an association between perseverative errors on the Wisconsin Card Sort Test (WCST) and poor insight. The aim was to confirm and extend this finding using a range of assessments relevant to perseveration, and different dimensions of insight, in a sample of 33 acutely psychotic subjects within 5 years of onset of schizophrenia and related disorders. Results showed a correlation (r=-0.59) between insight and perseverative errors, rather than more general measures of abstraction. A factor representing relabelling symptoms, derived from insight scale items, correlated even more strongly; however, other insight factors correlated more weakly, suggesting they are less dependent on neuropsychological deficits. The ability to monitor output and correct errors appears to be closely related to the core features of insight in psychosis.     

Insight and hospital adjustment.

The relationship between insight and adjustment in schizophrenics was examined. Subjects who scored higher on a paper-and-pencil insight test were rated by hospital staff as better adjusted behaviourally but described themselves as more psychologically distressed than presumably less insightful subjects. Results were discussed in relation to the notion that insight in schizophrenics may intensify subjective distress while conducing to behavioural adaptation.     

Insight into delirium

Delirium is a common and serious disorder with high morbidity and mortality. It occurs in 35 to 80 percent of critically ill, hospitalized patients. It may lead to mortality if not detected early. Studies show that delirium causes death in as many as 22 to 76 percent of patients who are hospitalized with delirium. It is often unrecognized and inadequately treated, and this may lead to poor outcome, including long-term care, longer length of stay in hospital, and high impact on health and social expenditure. There may be many reasons that delirium goes undetected, such as not understanding full pathophysiology and not having enough diagnostic tools to detect delirium in the early phase. A clear understanding of neurochemical equilibrium and pathways of the brain will help the clinician to understand the signs and symptoms of delirium. Pathophysiology of delirium is complex, and multiple theories have been proposed to explain its exact pathophysiology, but none of these mechanisms have been fully understood. Early detection of delirium and reduction of modifiable risk factors, along with better management, can result in better outcomes. This article discusses the pathophysiology and parts of brain involved in delirium as well as mood and psychotic symptoms of delirium.     

Insight and recovery in schizophrenic patients

Objective: To investigate the correlation between insight and recovery in schizophrenic patients according to criteria for both symptomatic and functional remission. Methods: Seventy patients affected by paranoid schizophrenia were recruited and treated with olanzapine, risperidone, aripiprazole, haloperidol and ziprasidone; visits were scheduled at baseline, 12 and 36 months. We administered PANSS (Positive and Negative Syndrome Scale), GAF (Global Assessment of Functioning), SF-36 (Short Form 36 Health Survey), PGWBI (Psychological General Well-Being index) and SAI (Schedule for the Assessment of Insight). Results: After 1 year, 50% of the subjects obtained symptom remission and 25.5% had adequate social functioning for 2 years or more. Only 12% of subjects met full recovery criteria for 2 years or longer. The recovery group also showed an improvement in insight levels, especially patients treated with second-generation antipsychotics (SGA). Recovery was predicted by female sex, higher age, SGA treatment, pre-morbid social adaptation and low level of negative symptoms at baseline. Conclusions: Only a small proportion of schizophrenic patients achieved recovery, therefore greater patient’s insight could have prognostic validity in terms of treatment outcome. More sensitive instruments and a larger sample are necessary to confirm these results.     

Insight and work performance in schizophrenia

Research has linked impaired insight in schizophrenia to poorer medication compliance and poorer treatment outcome. The current study attempts to replicate previous findings that impaired insight is related to deficits in work function. To examine this question, 121 participants with schizophrenia or schizoaffective disorder enrolled in vocational rehabilitation were classified as having unimpaired (N = 65), or impaired (N = 56) insight. Next, participants were assigned a work placement and their work performance assessed on the third, fifth, and seventh weeks of work by using the Work Behavior Inventory. Among the 85 participants who completed these weeks of work, a multivariate analysis of variance and subsequent analysis of variance showed participants with impaired insight had significantly poorer ratings of work quality, work habits, cooperativeness, and personal presentation. When measures of global intelligence and executive function were entered as covariates in individual analysis of covariance, groups differed on measures of cooperativeness and personal presentation. Implications for rehabilitation are discussed.     

Insight and danger in Alzheimer's disease

To determine the frequency, and demographic and clinical correlates of dangerous behaviours in Alzheimer's disease (AD). We assessed a consecutive series of 278 patients with AD and 45 age-comparable healthy controls with a comprehensive psychiatric and neuropsychological evaluation. Caregivers rated the frequency of patients' exposure to dangerous situations or commission of dangerous behaviours. The frequency of dangerous behaviours was 16% in the AD group and 2% in the healthy control group. The presence of anosognosia was associated with a threefold increase in the risk of dangerous behaviours, but there was no significant association between dangerous behaviours and patients' age, years of education, diagnosis of major or minor depression and presence of suicide ideation. Sixteen per cent of a consecutive series of patients with AD had dangerous behaviours during the month preceding the clinical evaluation. Anosognosia was the main clinical correlate of dangerous behaviours in this population.     

Insight and psychopathology in never-treated schizophrenia

Insight is a feature of schizophrenia related to psychopathology, which could be modified by treatment. The real relationship will be more evident in the never-treated state. This study compared insight and its relationship to psychopathology in 143 never-treated patients with chronic schizophrenia with 183 treated patients. The treated patients had not received any structured intervention for improvement of insight. The item on insight and judgment from the Positive and Negative Syndrome Scale for schizophrenia was used as a measure of insight. Never-treated patients were more ill and poorer in insight than the TT group. Sex, age, duration of illness, negative symptoms related to insight only in the TT group. Positive symptoms score correlated with insight in both the groups, but negative symptoms correlated with insight only among the treated patients. Delusions, uncooperativeness, and poor attention predicted 27% of variation in the level of insight in the never-treated, whereas age; duration of illness; and symptoms of emotional withdrawal, difficulty in abstract thinking, and uncooperativeness predicted 30.3% of variation in insight of the TT group. The observed differences between the never-treated and treated subjects were due to influence of treatment on the association between insight and psychopathology. A subgroup of patients with a treatment-resistant trait of negative symptoms associated with poor insight was hypothesized.