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The Dynamics of Insight in the Prodrome of Schizophrenia

Published online by Cambridge University Press:  07 November 2014

Robert G. Bota ,
J. Stuart Munro ,
Walter F. Ricci  and
Daniela A. Bota
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Abstract

Introduction

Schizophrenia is characterized by diminished insight, which fluctuates with disease progression. Insight deterioration in the prodrome of schizophrenia is poorly understood. Despite pharmacologic treatment, including early interventions, there is a high risk of relapse and need of acute care in schizophrenia patients.

Objective

To study if insight deterioration occurs during the prodrome and if insight preservation early in the illness might predict a better prognosis.

Methods

Data was collected retrospectively from the records of 24 patients initially diagnosed with schizophrenia during a 2-year period. Patients' progress was then tracked over a 3-year period. Insight was determined by a physician's subjective evaluation, patient interest and participation in treatment planning, and patient accuracy in reporting behaviors and symptoms when compared with reports from collaterals.

Results

Ten patients were determined to have insight regarding the developing illness at different presentations at the hospital. Insight preservation correlated with less need for emergency visits and fewer hospitalization days (P<.005). It was also associated with more depressive and anxious mood (P<.000). Patients and family members described early, ego-dystonic perceptual disturbances followed by diminished insight. Awareness into the illness, symptoms, and attribution of symptoms to the illness fluctuated at different presentations in the insight group. In the other group, insight was nil at each presentation after the psychotic debut.

Conclusion

Most patients maintain insight during the perceptual disturbance phase. Insight diminishes as the early delusional phase sets in. Higher levels of preserved insight seem to correlate with less need for acute treatment. Further research in this area is warranted for determining if early insight oriented interventions in the prodromal phase can improve the prognosis of schizophrenia.

Type
Original Research
Information
CNS Spectrums , Volume 11 , Issue 5 , May 2006 , pp. 355 - 362
Copyright
Copyright © Cambridge University Press 2006

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References

REFERENCES

1.Kane, JM, McGlashan, TH. Treatment of schizophrenia. Lancet. 1995;346:820–825.CrossRefGoogle ScholarPubMed
2.Wyatt, RJ. Neuroleptics and the natural course of schizophrenia. Schizophr Bull. 1991;17:325–351.CrossRefGoogle ScholarPubMed
3.Peterson, D, Olson, G. First admitted schizophrenics in drug era: follow-up anoka schizophrenic cohort, 1956-1958. Arch Gen Psychiatry. 1964;11:137–144.CrossRefGoogle ScholarPubMed
4.Loebel, AD, Lieberman, JA, Alvir, JM, Mayerhoff, DI, Geisler, SH, Szymanski, SR. Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry. 1992;149:1183–1188.Google ScholarPubMed
5.Larsen, TK, McGlashan, TH, Moe, LC. First-episode schizophrenia: I. Early course parameters. Schizophr Bull. 1996;22:241–256.CrossRefGoogle ScholarPubMed
6.Malla, AK, Norman, RM, Manchanda, R, et al.One year outcome in first episode psychosis: influence of DUP and other predictors. Schizophr Res. 2002;54:231–242.CrossRefGoogle ScholarPubMed
7.Malla, AK, Norman, RM, Manchanda, R, et al.Status of patients with first-episode psychosis after one year of phase-specific community-oriented treatment. Psychiatr Serv. 2002;53:458–463.CrossRefGoogle ScholarPubMed
8.Norman, RM, Malla, AK. Duration of untreated psychosis: a critical examination of the concept and its importance. Psychol Med. 2001;31:381–400.CrossRefGoogle ScholarPubMed
9.McGlashan, TH. Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Biol Psychiatry. 1999;46:899–907.CrossRefGoogle ScholarPubMed
10.Larsen, TK, Moe, LC, Vibe-Hansen, L, Johannessen, JO. Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis. Schizophr Res. 2000;45:1–9.CrossRefGoogle ScholarPubMed
11.Larsen, TK, McGlashan, TH, Johannessen, JO, et al.Shortened duration of untreated first episode of psychosis: changes in patient characteristics at treatment. Am J Psychiatry. 2001;158:1917–1919.CrossRefGoogle ScholarPubMed
12.Harrigan, SM, McGorry, PD, Krstev, H. Does treatment delay in first-episode psychosis really matter? Psychol Med. 2003;33:97–110.CrossRefGoogle ScholarPubMed
13.Craig, TJ, Bromet, EJ, Fennig, S, Tanenberg-Karant, M, Lavelle, J, Galambos, N. Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series? Am J Psychiatry. 2000;157:60–66.CrossRefGoogle Scholar
14.Robinson, DG, Woerner, MG, Alvir, JM, et al.Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder [comment]. Am J Psychiatry. 1999;156:544–549.CrossRefGoogle ScholarPubMed
15.Robinson, D, Woerner, MG, Alvir, JM, et al.Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Phychiatry. 1999;56:241–247.CrossRefGoogle ScholarPubMed
16.Mintz, AR, Dobson, KS, Romney, DM. Insight in schizophrenia: a meta-analysis. Schizophr Res. 2003;61:75–88.CrossRefGoogle ScholarPubMed
17.Fonagy, P. Attachment and borderline personality disorder. J Am Psychoanal Assoc. 2000;48:1129–1146; discussion 1175-1187.CrossRefGoogle ScholarPubMed
18.Amador, XF, Strauss, DH, Yale, SA, Flaum, MM, Endicott, J, Gorman, JM. Assessment of insight in psychosis. Am J Psychiatry. 1993;150:873–879.Google ScholarPubMed
19.Smith, TE, Hull, JW, Israel, LM, et al.Insight, symptoms, and neurocognition in schizophrenia and schizoaffective disorder. Schizophr Bull. 2000;26:193–200.CrossRefGoogle ScholarPubMed
20.Sevy, S, Nathanson, K, Visweswaraiah, H, Amador, X. The relationship between insight and symptoms in schizophrenia. Compr Psychiatry. 2004;45:16–19.CrossRefGoogle ScholarPubMed
21.Heinrichs, DW, Cohen, BP, Carpenter, WT Jr.Early insight and the management of schizophrenic decompensation. J Nerv Ment Dis. 1985;173:133–138.CrossRefGoogle ScholarPubMed
22.Smith, TE, Hull, JW, Huppert, JD, Silverstein, SM, Anthony, DT, McClough, JF. Insight and recovery from psychosis in chronic schizophrenia and schizoaffective disorder patients. J Psychiatr Res. 2004;38:169–176.CrossRefGoogle ScholarPubMed
23.Donohoe, G, Donnell, CO, Owens, N, O'Callaghan, E. Evidence that health attributions and symptom severity predict insight in schizophrenia. J Nerv Ment Dis. 2004;192:635–637.CrossRefGoogle ScholarPubMed
24.Keshavan, MS, Rabinowitz, J, DeSmedt, G, Harvey, PD, Schooler, N. Correlates of insight in first episode psychosis. Schizophr Res. 2004;70:187–194.CrossRefGoogle ScholarPubMed
25.Shad, MU, Muddasani, S, Prasad, K, Sweeney, JA, Keshavan, MS. Insight and prefrontal cortex in first-episode schizophrenia. Neuroimage. 2004;22:1315–1320.CrossRefGoogle ScholarPubMed
26.Drake, RJ, Pickles, A, Bentall, RP, et al.The evolution of insight, paranoia and depression during early schizophrenia. Psychol Med. 2004;34:285–292.CrossRefGoogle ScholarPubMed
27.Freudenreich, O, Deckersbach, T, Goff, DC. Insight into current symptoms of schizophrenia. Association with frontal cortical function and affect. Acta Psychiatr Scand. 2004;110:14–20.CrossRefGoogle ScholarPubMed
28.Arduini, L, Kalyvoka, A, Stratta, P, Rinaldi, O, Daneluzzo, E, Rossi, A. Insight and neuropsychological function in patients with schizophrenia and bipolar disorder with psychotic features. Can J Psychiatry. 2003;48:338–341.CrossRefGoogle ScholarPubMed
29.Tsuang, MT, Stone, WS, Tarbox, SI, Faraone, SV. Validating schizotaxia and its place in studies of preventing schizophrenia by psychopharmacological intervention. Essent Psychopharmacol. 2005;6:91–103.Google ScholarPubMed
30.Yung, AR, McGorry, PD. The initial prodrome in psychosis: descriptive and qualitative aspects. Aust N Z J Psychiatry. 1996;30:587–599.CrossRefGoogle ScholarPubMed
31.Gibbs, AA, David, AS. Delusion formation and insight in the context of affective disturbance. Epidemiol Psichiatr Soc. 2003;12:167–174.CrossRefGoogle ScholarPubMed
32.Aguglia, E, De Vanna, M, Onor, ML, Ferrara, D. Insight in persons with schizophrenia: effects of switching from conventional neuroleptics to atypical antipsychotics. Prog Neuropsychopharmacol Biol Psychiatry. 2002;26:1229–1233.CrossRefGoogle ScholarPubMed
33.Nieznanski, M, Czerwinska, M, Chojnowska, A, Walczak, S, Dunski, W. Effectiveness of cognitive skills training in schizophrenia [Polish]. Psychiatr Pol. 2002;36:745–757.Google ScholarPubMed
34.Rusch, N, Corrigan, PW. Motivational interviewing to improve insight and treatment adherence in schizophrenia. Psychiatr Rehabil J. 2002;26:23–32.CrossRefGoogle ScholarPubMed
35.Silver, AL. The psychotherapy of schizophrenia: its place in the modern world. J Am Acad Psychoanal Dyn Psychiatry. 2003;31:325–341.CrossRefGoogle ScholarPubMed
36.Meehl, PE. Schizotaxia revisited. Arch Gen Psychiatry. 1989;46:935–944.CrossRefGoogle ScholarPubMed
37.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
38.Amador, XF, Flaum, M, Andreasen, NC, et al.Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry. 1994;51:826–836.CrossRefGoogle ScholarPubMed
39.Flemenbaum, A, Zimmermann, RL. Inter- and intra-rater reliability of the Brief Psychiatric Rating Scale. Psychol Rep. 1973;32:783–792.CrossRefGoogle ScholarPubMed
40.Kay, SR, Fiszbein, A, Opler, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13:261–276.CrossRefGoogle ScholarPubMed
41.Pompili, M, Ruberto, A, Kotzalidis, GD, Girardi, P, Tatarelli, R. Suicide and awareness of illness in schizophrenia: an overview. Bull Menninger Clin. 2004;68:297–318.CrossRefGoogle ScholarPubMed
42.Evren, EC, Evren, B, Erkiran, M. Suicidal ideation in schizophrenia: relationship with positive and negative symptoms, depression and insight [Turkish]. Turk Psikiyatri Derg. 2002;13:255–264.Google ScholarPubMed
43.Yen, CF, Yeh, ML, Chen, CS, Chung, HH. Predictive value of insight for suicide, violence, hospitalization, and social adjustment for outpatients with schizophrenia: a prospective study. Compr Psychiatry. 2002;43:443–447.CrossRefGoogle ScholarPubMed
44.Kim, CH, Jayathilake, K, Meltzer, HY. Hopelessness, neurocognitive function, and insight in schizophrenia: relationship to suicidal behavior. Schizophr Res. 2003;60:71–80.CrossRefGoogle ScholarPubMed
45.Crumlish, N, Whitty, P, Kamali, M, et al.Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder. Acta Psychiatr Scand. 2005;112:449–455.CrossRefGoogle ScholarPubMed
46.Harkavy-Friedman, JM, Nelson, EA. Assessment and intervention for the suicidal patient with schizophrenia. Psychiatr Q. 1997;68:361–375.CrossRefGoogle ScholarPubMed
47.Lewis, L. Mourning, insight, and reduction of suicide risk in schizophrenia. Bull Menninger Clin. 2004;68:231–244.CrossRefGoogle ScholarPubMed
48.Bota, RG, Munro, S, Sagduyu, K. Identification of the prodrome of schizophrenia: PSN-2. South Med J. 2004;97:S65.Google Scholar
49.Bota, RG, Munro, JS, Sagduyu, K. Identification of the schizophrenia prodrome in a hospital-based patient population. Mo Med. 2005;102:142–146.Google Scholar
50.Preda, A, Miller, TJ, Rosen, JL, Somjee, L, McGlashan, TH, Woods, SW. Treatment histories of patients with a syndrome putativeiy prodromal to schizophrenia. Psychiatr Serv. 2002;53:342–344.CrossRefGoogle ScholarPubMed
51.Yung, AR, McGorry, PD, McFarlane, CA, Jackson, HJ, Patton, GC, Rakkar, A. Monitoring and care of young people at incipient risk of psychosis. Schizophr Bull. 1996;22:283–303.CrossRefGoogle ScholarPubMed
52.Ebel, H, Gross, G, Klosterkotter, J, Huber, G. Basic symptoms in schizophrenic and affective psychoses. Psychopathology. 1989;22:224–232.CrossRefGoogle ScholarPubMed
53.McGorry, PD, Edwards, J, Mihalopoulos, C, Harrigan, SM, Jackson, HJ. EPPIC: an evolving system of early detection and optimal management. Schizophr Bull. 1996;22:305–326.CrossRefGoogle ScholarPubMed
54.Huber, G, Gross, G. The concept of basic symptoms in schizophrenic and schizoaffective psychoses. Recenti Prog Med. 1989;80:646–652.Google ScholarPubMed
55.Cornblatt, B, Lencz, T, Obuchowski, M. The schizophrenia prodrome: treatment and high-risk perspectives. Schizophr Res. 2002;54:177–186.CrossRefGoogle ScholarPubMed
56.Bota, RG, Sagduyu, K, Munro, JS. Factors associated with the prodromal progression of schizophrenia that influence the course of the illness. CNS Spectr. 2005;10:937–942.CrossRefGoogle ScholarPubMed