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The relationship between insight and neurological dysfunction in first-episode psychosis

Published online by Cambridge University Press:  15 April 2020

M. Hill ,
N. Crumlish ,
P. Whitty ,
M. Clarke ,
S. Browne ,
M. Gervin ,
A. Kinsella ,
J.L. Waddington ,
C. Larkin  and
E. O’Callaghan
M. Hill
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Massachusetts General Hospital and Harvard Medical School, Boston, USA
N. Crumlish
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, Trinity College, Dublin, Ireland
P. Whitty
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland
M. Clarke
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland
S. Browne
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland
M. Gervin
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland
A. Kinsella
Affiliation:
Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
J.L. Waddington
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
C. Larkin
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
E. O’Callaghan*
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
*
*Corresponding author. Tel.: +353 1 2791700. [email protected] (E. O’Callaghan).
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Abstract

Purpose

Impaired insight is commonly seen in psychosis and some studies have proposed that is a biologically based deficit. Support for this view comes from the excess of neurological soft signs (NSS) observed in patients with psychoses and their neural correlates which demonstrate a degree of overlap with the regions of interest implicated in neuroimaging studies of insight. The aim was to examine the relationship between NSS and insight in a sample of 241 first-episode psychosis patients.

Method

Total scores and subscale scores from three insight measures and two NSS scales were correlated in addition to factors representing overall insight and NSS which we created using principal component analysis.

Results

There were only four significant associations when we controlled for symptoms. “Softer” Condensed Neurological Evaluation (CNE) signs were associated with our overall insight factor (r = 0.19, P = 0.02), with total Birchwood (r = −0.24, P<0.01), and the Birchwood subscales; recognition of mental illness (r = −0.24, P<0.01) and need for treatment (r = −0.18, P = 0.02). Total Neurological Evaluation Scale (NES) and recognition of the achieved effects of medication were also weakly correlated (r = 0.14, P = 0.04).

Conclusion

This study does not support a direct link between neurological dysfunction and insight in psychosis. Our understanding of insight as a concept remains in its infancy.

Keywords

PsychosisFirst-episodeInsightNeurology
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 3 , April 2012 , pp. 200 - 205
Copyright
Copyright © Elsevier Masson SAS 2012

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