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Comparison of insight among schizophrenia and bipolar disorder patients in remission of affective and positive symptoms: Analysis and critique

Published online by Cambridge University Press:  11 May 2011

Y. Braw ,
R. Sitman ,
T. Sela ,
G. Erez ,
Y. Bloch  and
Y. Levkovitz
Y. Braw
Affiliation:
Department of Behavioral Sciences, Ariel University Center of Samaria, Ariel, Israel The Emotion-Cognition Research Center, Shalvata Mental Health Care Center (affiliated with the Sackler Faculty of Medicine, Tel-Aviv University), Hod-Hasharon, Israel
R. Sitman
Affiliation:
The Emotion-Cognition Research Center, Shalvata Mental Health Care Center (affiliated with the Sackler Faculty of Medicine, Tel-Aviv University), Hod-Hasharon, Israel
T. Sela
Affiliation:
Department of Psychology and the Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
G. Erez
Affiliation:
The Emotion-Cognition Research Center, Shalvata Mental Health Care Center (affiliated with the Sackler Faculty of Medicine, Tel-Aviv University), Hod-Hasharon, Israel
Y. Bloch
Affiliation:
The Emotion-Cognition Research Center, Shalvata Mental Health Care Center (affiliated with the Sackler Faculty of Medicine, Tel-Aviv University), Hod-Hasharon, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Y. Levkovitz*
Affiliation:
The Emotion-Cognition Research Center, Shalvata Mental Health Care Center (affiliated with the Sackler Faculty of Medicine, Tel-Aviv University), Hod-Hasharon, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
*
*Corresponding author. Tel.: +972 9 7478644; fax: +972 9 7478643. E-mail address:[email protected] (Y. Levkovitz).
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Abstract

Background

Schizophrenia and bipolar disorder are associated with impairments in insight, leading to a poorer clinical outcome and functioning. Earlier studies comparing the two disorders on the basis of insight included inpatients or patients who were clinically symptomatic. The current study therefore assessed patients in remission of affective symptoms and positive symptoms of schizophrenia.

Methods

Schizophrenia and bipolar disorder patients (n = 32, n = 34; respectively) underwent clinical and functional evaluations. Insight was assessed using the Scale to assess Unawareness of Mental Disorder (SUMD) and the Positive and Negative Syndrome Scale (PANSS). Attention was assessed using a continuous performance task (CANTAB's Rapid Visual Information Processing).

Results

Schizophrenia patients displayed poorer insight into having a mental disorder and into the social consequences thereof compared to the bipolar disorder patients. They were also less aware of their anhedonia-asociality. Age, however, was significantly correlated with insight and differences in insight between the patient groups became nonsignificant when age was used as a covariate in the statistical analyses. Age was not a moderating variable of the relationship between diagnosis and insight.

Conclusions

Significant differences in insight held by the two patient groups might be related to age disparities between patient groups. Earlier studies did not adequately address these age differences, their cause and their potential effects on findings. These issues are explored with regard to the findings of the current study, as well as earlier studies, emphasizing the need for further research of the relationship between age and insight.

Keywords

Schizophrenia and psychosisBipolar disorder and maniaEpidemiologyInsightIllness awareness
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 8 , November 2012 , pp. 612 - 618
Copyright
Copyright © European Psychiatric Association 2012

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References

Aguglia, E., De Vanna, M., Onor, M.L., Ferrara, D.Insight in persons with schizophrenia: effects of switching from conventional neuroleptics to atypical antipsychotics. Prog Neuropsychopharmacol Biol Psychiatry. 26 7–8: 2002 1229–1233.CrossRefGoogle ScholarPubMed
Aleman, A., Agrawal, N., Morgan, K.D., David, A.S.Insight in psychosis and neuropsychological function: meta-analysis. Br J Psychiatry. 2006; 189: 204–212.CrossRefGoogle ScholarPubMed
Amador, X.F., Strauss, D.H., Yale, S.A., Flaum, M.M., Endicott, J., Gorman, J.M.Assessment of insight in psychosis. Am J Psychiatry. 1993; 150 6: 873–879.Google ScholarPubMed
Amador, X.F., Flaum, M., Andreasen, N.C., Strauss, D.H., Yale, S.A., Clark, S.C.et al.Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry. 1994; 51 10: 826–836.CrossRefGoogle ScholarPubMed
Andreasen, N.C., Carpenter, W.T. Jr., Kane, J.M., Lasser, R.A., Marder, S.R., Weinberger, D.R.Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry. 2005; 162 3: 441–449.CrossRefGoogle ScholarPubMed
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 5: 338–341.CrossRefGoogle ScholarPubMed
Buchy, L., Torres, I.J., Liddle, P.F., Woodward, T.S.Symptomatic determinants of insight in schizophrenia spectrum disorders. Compr Psychiatry. 2009; 50 6: 578–583.CrossRefGoogle ScholarPubMed
Chen, E.Y., Kwok, C.L., Chen, R.Y., Kwong, P.P.Insight changes in acute psychotic episodes: a prospective study of Hong Kong Chinese patients. J Nerv Ment Dis. 2001; 189 1: 24–30.CrossRefGoogle ScholarPubMed
Clark, L., Kempton, M.J., Scarna, A., Grasby, P.M., Goodwin, G.M.Sustained attention-deficit confirmed in euthymic bipolar disorder but not in first-degree relatives of bipolar patients or euthymic unipolar depression. Biol Psychiatry. 2005; 57 2: 183–187.CrossRefGoogle ScholarPubMed
Cohen, J.Statistical power analyses for the behavioural sciences. 2nd ed.New York: Academic Press; 1988.Google Scholar
Cohen, J.A power primer. Psychol Bull. 1992; 112 1: 155–159.CrossRefGoogle ScholarPubMed
David, A.S.Insight psychosis. Br J Psychiatry. 1990; 156: 798–808.CrossRefGoogle ScholarPubMed
Dell’Osso, L., Pini, S., Cassano, G.B., Mastrocinque, C., Seckinger, R.A., Saettoni, M.et al.Insight into illness in patients with mania, mixed mania, bipolar depression and major depression with psychotic features. Bipolar Disord. 2002; 4 5: 315–322.CrossRefGoogle ScholarPubMed
Dennis, M., Francis, D.J., Cirino, P.T., Schachar, R., Barnes, M.A., Fletcher, J.M.Why IQ is not a covariate in cognitive studies of neurodevelopmental disorders. J Int Neuropsychol Soc. 2009; 15 3: 331–343.CrossRefGoogle Scholar
Dias, V.V., Brissos, S., Frey, B.N., Kapczinski, F.Insight, quality of life and cognitive functioning in euthymic patients with bipolar disorder. J Affect Disord. 110 1–2: 2008 75–83.CrossRefGoogle ScholarPubMed
Dias, V.V., Brissos, S., Carita, A.I.Clinical and neurocognitive correlates of insight in patients with bipolar I disorder in remission. Acta Psychiatr Scand. 2008; 117 1: 28–34.Google ScholarPubMed
Engh, J.A., Friis, S., Birkenaes, A.B., Jonsdottir, H., Ringen, P.A., Ruud, T.et al.Measuring cognitive insight in schizophrenia and bipolar disorder: a comparative study. BMC Psychiatry. 2007; 7: 71.CrossRefGoogle ScholarPubMed
Fennig, S., Everett, E., Bromet, E.J., Jandorf, L., Fennig, S.R., Tanenberg-Karant, M.et al.Insight in first-admission psychotic patients. Schizophr Res. 1996; 22 3: 257–263.CrossRefGoogle ScholarPubMed
Ghaemi, S.N., Rosenquist, K.J.Is insight in mania state-dependent? A meta-analysis. J Nerv Ment Dis. 2004; 192 11: 771–775.CrossRefGoogle ScholarPubMed
Ghaemi, S.N., Hebben, N., Stoll, A.L., Pope, H.G. Jr.Neuropsychological aspects of lack of insight in bipolar disorder: a preliminary report. Psychiatry Res. 1996; 65 2: 113–120.CrossRefGoogle ScholarPubMed
Govil, S., Sengupta, S.N., Sharma, P.A study of comparison of components of insight in patients with schizophrenia and bipolar affective disorder in remission phase. Eur Psychiatry. 2008; 23: S118.CrossRefGoogle Scholar
Kay, S.R., Opler, L.A., Fiszbein, A., Ramirez, P.M., White, L.Positive and Negative Syndrome Scale (PANSS): user's manual. 2nd ed.North Tonawanda, NY: Multi-Health Systems (MHS) Inc; 2000.Google Scholar
Kennedy, N., Boydell, J., Kalidindi, S., Fearon, P., Jones, P.B., van Os, J.et al.Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England. Am J Psychiatry. 2005; 162 2: 257–262.CrossRefGoogle Scholar
Michalakeas, A., Skoutas, C., Charalambous, A., Peristeris, A., Marinos, V., Keramari, E.et al.Insight in schizophrenia and mood disorders and its relation to psychopathology. Acta Psychiatr Scand. 1994; 90 1: 46–49.CrossRefGoogle ScholarPubMed
Mohamed, S., Rosenheck, R., McEvoy, J., Swartz, M., Stroup, S., Lieberman, J.A.Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia. Schizophr Bull. 2009; 35 2: 336–346.CrossRefGoogle ScholarPubMed
Murray, R.M., Sham, P., Van Os, J., Zanelli, J., Cannon, M., McDonald, C.A developmental model for similarities and dissimilarities between schizophrenia and bipolar disorder. Schizophr Res. 2004; 71: 405–416.CrossRefGoogle ScholarPubMed
Pini, S., Cassano, G.B., Dell’Osso, L., Amador, X.F.Insight into illness in schizophrenia, schizoaffective disorder, and mood disorders with psychotic features. Am J Psychiatry. 2001; 158 1: 122–125.CrossRefGoogle ScholarPubMed
Pini, S., de Queiroz, V., Dell’Osso, L., Abelli, M., Mastrocinque, C., Saettoni, M.et al.Cross-sectional similarities and differences between schizophrenia, schizoaffective disorder and mania or mixed mania with mood-incongruent psychotic features. Eur Psychiatry. 2004; 19 1: 8–14.CrossRefGoogle ScholarPubMed
Raymont, V., Bettany, D., Frangou, S.The Maudsley bipolar disorder project. Clinical characteristics of bipolar disorder I in a Catchment area treatment sample. Eur Psychiatry. 2003; 18 1: 13–17.CrossRefGoogle Scholar
Rodriguez-Aranda, C., Sundet, K.The frontal hypothesis of cognitive aging: factor structure and age effects on four frontal tests among healthy individuals. J Genet Psychol. 2006; 167 3: 269–287.CrossRefGoogle ScholarPubMed
Sharmilla, K., Ahmad, H.S.A comparison of insight in schizophrenia, bipolar affective disorder with psychosis and major depressive disorder with psychosis. Malays J Psychiatry. 2006; 14 1: 35–40.Google Scholar
Sobel, M.E.Asymptotic confidence intervals for indirect effects in structural equation models.Leinhart, .Sociological Methodology. 1982 Jossey-Bass San Francisco290–312.Google Scholar
Spitzer, R.L., Williams, J.B., Gibbon, M., First, M.B.The Structured Clinical Interview for DSM-III-R (SCID). I: history, rationale, and description. Arch Gen Psychiatry. 1992; 49 8: 624–629.CrossRefGoogle ScholarPubMed
Strakowski, S.M., Delbello, M.P., Adler, C.M.The functional neuroanatomy of bipolar disorder: a review of neuroimaging findings. Mol Psychiatry. 2005; 10 1: 105–116.CrossRefGoogle ScholarPubMed
Tohen, M., Frank, E., Bowden, C.L., Colom, F., Ghaemi, S.N., Yatham, L.N.et al.The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders. Bipolar Disord. 2009; 11 5: 453–473.CrossRefGoogle ScholarPubMed
Varga, M., Magnusson, A., Flekkoy, K., David, A.S., Opjordsmoen, S.Clinical and neuropsychological correlates of insight in schizophrenia and bipolar I disorder: does diagnosis matter?. Compr Psychiatry. 2007; 48 6: 583–591.CrossRefGoogle ScholarPubMed
Weiler, M.A., Fleisher, M.H., McArthur-Campbell, D.Insight and symptom change in schizophrenia and other disorders. Schizophr Res. 45 1–2: 2000 29–36.CrossRefGoogle ScholarPubMed
West, R.In defense of the frontal lobe hypothesis of cognitive aging. J Int Neuropsychol Soc. 2000; 6 6: 727–729[discussion 730].CrossRefGoogle ScholarPubMed
Wiffen, B.D., Rabinowitz, J., Fleischhacker, W.W., David, A.S.Insight: demographic differences and associations with one-year outcome in schizophrenia and schizoaffective disorder. Clin Schizophr Relat Psychoses. 2010; 4 3: 169–175.CrossRefGoogle ScholarPubMed
Yen, C.F., Chen, C.S., Yeh, M.L., Ker, J.H., Yang, S.J., Yen, J.Y.Correlates of insight among patients with bipolar I disorder in remission. J Affect Disord. 2004; 78 1: 57–60.CrossRefGoogle ScholarPubMed
Yen, C.F., Chen, C.S., Ko, C.H., Yeh, M.L., Yang, S.J., Yen, J.Y.et al.Relationships between insight and medication adherence in outpatients with schizophrenia and bipolar disorder: prospective study. Psychiatry Clin Neurosci. 2005; 59 4: 403–409.CrossRefGoogle ScholarPubMed
Yen, C.F., Chen, C.S., Ko, C.H., Yen, J.Y., Huang, C.F.Changes in insight among patients with bipolar I disorder: a 2-year prospective study. Bipolar Disord. 2007; 9 3: 238–242.CrossRefGoogle ScholarPubMed
Yen, C.F., Chen, C.C., Cheng, C.P., Yen, C.N., Lin, H.C., Ko, C.H.et al.Comparisons of insight in schizophrenia, bipolar I disorder, and depressive disorders with and without comorbid alcohol use disorder. Psychiatry Clin Neurosci. 2008; 62 6: 685–690.CrossRefGoogle ScholarPubMed
Yen, C.F., Cheng, C.P., Huang, C.F., Ko, C.H., Yen, J.Y., Chang, Y.P.et al.Relationship between psychosocial adjustment and executive function in patients with bipolar disorder and schizophrenia in remission: the mediating and moderating effects of insight. Bipolar Disord. 2009; 11 2: 190–197.CrossRefGoogle ScholarPubMed
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