Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-14T01:31:27.140Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of the association between insight and symptoms in a large sample of patients with schizophrenia

Published online by Cambridge University Press:  16 April 2020

M.A.F. De Hert ,
V. Simon ,
D. Vidovic ,
T. Franic ,
M. Wampers ,
J. Peuskens  and
R. van Winkel
M.A.F. De Hert*
Affiliation:
University Psychiatric Centre Catholic University Leuven campus Kortenberg, Leuvense Steenweg 517 3070Kortenberg, Belgium
V. Simon
Affiliation:
Department of Psychiatry and Psychotherapy, Semmelweis University Budapest, Balassa u. 6.1083Budapest, Hungary
D. Vidovic
Affiliation:
Psychiatric Hospital Vrapce, Bolnicka cesta 32 10 000Zagreb, Croatia
T. Franic
Affiliation:
Department of Psychiatry, University of Split School of Medicine, Spinciceva 1, 21 000 Split Croatia
M. Wampers
Affiliation:
University Psychiatric Centre Catholic University Leuven campus Kortenberg, Leuvense Steenweg 517 3070Kortenberg, Belgium
J. Peuskens
Affiliation:
University Psychiatric Centre Catholic University Leuven campus Kortenberg, Leuvense Steenweg 517 3070Kortenberg, Belgium
R. van Winkel
Affiliation:
University Psychiatric Centre Catholic University Leuven campus Kortenberg, Leuvense Steenweg 517 3070Kortenberg, Belgium Department of Psychiatry and Neuropsychology, EURON, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, PO box 616 6200MD Maastricht, The Netherlands
*
*Corresponding author. Tel.: +32 2 758 05 11; fax: +32 2 759 98 78. E-mail address:[email protected] (M.A.F. De Hert).
Get access

Abstract

Background

The objective of the present study was to examine the association of insight into the illness with demographic variables and symptomatology in a sample of 1213 patients with schizophrenia.

Method

Data were collected with the Psychosis Evaluation tool for Common use by Caregivers (PECC), a semi-structured interview evaluating five symptom domains of schizophrenia and the insight items ‘awareness of having a mental disorder’ and ‘attributing symptoms to a mental disorder’.

Results

Insight was positively associated with educational level and inversely with overall symptom severity, and the positive, negative, excitatory and cognitive symptom domains. At symptom level, the items ‘delusions’, ‘grandiosity’, ‘poor rapport’, ‘social withdrawal’ and ‘guilt feelings’ showed the strongest associations with both insight items. Overall, correlations between insight and symptomatology were modest, explaining less than 30% of the variance in insight.

Conclusion

Lack of insight in schizophrenia is partially explained by clinical symptoms and demographic measures.

Keywords

InsightSchizophreniaPsychosisClinical correlates
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 8 , December 2009 , pp. 507 - 512
Copyright
Copyright © Elsevier Masson SAS 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amador, XFDavid, ASInsight and psychosis New YorkOxford University Press 1998Google Scholar
Amador, XFFlaum, MAndreasen, NCStrauss, DHYale, SAClark, SCet al.Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry 1994;51:826–836CrossRefGoogle ScholarPubMed
Amador, XFGorman, JMPsychopathologic domains and insight in schizophrenia. Psychiatr Clin North Am 1998;21:27–42CrossRefGoogle Scholar
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth EditionWashington, DCAmerican Psychiatric Association 1994Google Scholar
Bora, ESehitoglu, GAslier, MAtabay, IVeznedaroglu, BTheory of mind and unawareness of illness in schizophrenia. Is poor insight a mentalizing deficit?. Eur Arch Psychiatry Clin Neurosci 2007;257:104–111CrossRefGoogle ScholarPubMed
Buckley, PFWirshing, DABhushan, PPierre, JMResnick, SAWirshing, WCLack of insight in schizophrenia. Impact on treatment adherence. CNS Drugs 2007;21:129–141CrossRefGoogle ScholarPubMed
Carpenter, WT Jr.Strauss, JSBartko, JJFlexible system for the diagnosis of schizophrenia: report from the WHO International Pilot Study of Schizophrenia. Science 1973;182:1275–1278CrossRefGoogle Scholar
Collins, AARemington, GJCoulter, KBirkett, KInsight, neurocognitive function and symptom clusters in chronic schizophrenia. Schizophr Res 1997;27:37–44CrossRefGoogle ScholarPubMed
Cooke, MAPeters, ERKuipers, EKumari, VDisease, deficit or denial? Models of poor insight in psychosis. Acta Psychiatr Scand 2005;112:4–17CrossRefGoogle ScholarPubMed
Cuffel, BJAlford, JFischer, EPOwen, RRAwareness of illness in schizophrenia and outpatient treatment adherence. J Nerv Ment Dis 1996;184:653–659CrossRefGoogle ScholarPubMed
David, AVan, OJJones, PHarvey, IFoerster, AFahy, TInsight and psychotic illness. Cross-sectional and longitudinal associations. Br J Psychiatry 1995;167:621–628CrossRefGoogle ScholarPubMed
De Hert, MWampers, MMannaert, GPECC, psychosis evaluation tool for common use by caregivers. Psychiatrie en Verpleging 2001;77:5–14Google Scholar
De Hert, MWampers, MThys, Eet al.Validation of PECC, interscale validity and interrater reliability. Int J Psychiatr Clin Pract 2002;6:135–140Google Scholar
De Hert, Mvan, WRWampers, MKane, Jvan, OJPeuskens, JRemission criteria for schizophrenia: evaluation in a large naturalistic cohort. Schizophr Res 2007;92:68–73CrossRefGoogle Scholar
Drake, RJLewis, SWInsight and neurocognition in schizophrenia. Schizophr Res 2003;62:165–173CrossRefGoogle Scholar
Drake, RJPickles, ABentall, RPKinderman, PHaddock, GTarrier, Net al.The evolution of insight, paranoia and depression during early schizophrenia. Psychol Med 2004;34:285–292CrossRefGoogle ScholarPubMed
Frith, CDThe cognitive neuropsychology of schipzophrenia HoveLawrence Erbaum Associates 1992Google Scholar
Goldberg, RWGreen-Paden, LDLehman, AFGold, JMCorrelates of insight in serious mental illness. J Nerv Ment Dis 2001;189:137–145CrossRefGoogle ScholarPubMed
Guy, WClinical global impression (CGI)ECDEU Assessment Manual for Psychopharmacology. US Department of Health and Human Services, Public Health Service, Alcohol Drug Abuse and Mental Health Administration, NIMH Psychopharmacology Research branch. Rockville, MDNational Institute of Mental Health 1976 218–221Google Scholar
Jones, SHThornicroft, GCoffey, MDunn, GA brief mental health outcome scale: reliability and validity of the Global Assessment of Functioning (GAF). Br J Psychiatry 1995;166:654–659CrossRefGoogle Scholar
Kaiser, SLSnyder, JACorcoran, RDrake, RJThe relationships among insight, social support, and depression in psychosis. J Nerv Ment Dis 2006;194:905–908CrossRefGoogle ScholarPubMed
Kemp, RDavid, APsychological predictors of insight and compliance in psychotic patients. Br J Psychiatry 1996;169:444–450CrossRefGoogle ScholarPubMed
Keshavan, MSRabinowitz, JDeSmedt, GHarvey, PDSchooler, NCorrelates of insight in first episode psychosis. Schizophr Res 2004;70:187–194CrossRefGoogle ScholarPubMed
Koren, DSeiman, LPoyurovsky, MGoldsmith, MViksman, PZichel, Set al.The neuropsychological basis of insight in first episode schizophrenia: a pilot metacognitive study. Schizophr Res 2004;70:195–202CrossRefGoogle ScholarPubMed
Lincoln, TMLullmann, ERief, WCorrelates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophr Bull 2007;33:1324–1342CrossRefGoogle ScholarPubMed
Lysaker, PBell, MWork rehabilitation and improvements in insight in schizophrenia. J Nerv Ment Dis 1995;183:103–106CrossRefGoogle Scholar
Lysaker, PHBell, MDBryson, GJKaplan, EInsight and interpersonal function in schizophrenia. J Nerv Ment Dis 1998;186:432–436CrossRefGoogle Scholar
Lysaker, PBuck, KTaylor, ARoe, DAssociation of metacognition and internalized stigma with quantitative assessment of self-experience in narratives of schizophrenia. Psychiatry Res 2008;157:31–38CrossRefGoogle Scholar
Lysaker, PHDaroyanni, PRinger, JMBeattie, NLStrasburger, AMDavis, LWAssociations of awareness of illness in schizophrenia spectrum disorder with social cognition and cognitive perceptual organization. J Nerv Ment Dis 2007;195:618–621CrossRefGoogle ScholarPubMed
Macpherson, RJerrom, BHughes, ARelationship between insight, educational background and cognition in schizophrenia. Br J Psychiatry 1996;168:718–722CrossRefGoogle ScholarPubMed
Matton, CWampers, MDe Hert, MPeuskens, JZiekte-inzicht bij patiënten met schizofrenie. Tijdschr Psychiatr 2004;46:589–599Google Scholar
McEvoy, JPApperson, LJAppelbaum, PSOrtlip, PBrecosky, JHammill, Ket al.Insight in schizophrenia. Its relationship to acute psychopathology. J Nerv Ment Dis 1989;177:43–47CrossRefGoogle ScholarPubMed
Mintz, ARDobson, KSRomney, DMInsight in schizophrenia: a meta-analysis. Schizophr Res 2003;61:75–88CrossRefGoogle ScholarPubMed
Moore, OCassidy, ECarr, ACallaghan, EOUnawareness of illness and its relationship with depression and self-deception in schizophrenia. Eur Psychiatry 1999;14:264–269CrossRefGoogle Scholar
Mutsatsa, SHJoyce, EMHutton, SBBarnes, TRRelationship between insight, cognitive function, social function and symptomatology in schizophrenia: the West London first episode study. Eur Arch Psychiatry Clin Neurosci 2006;256:356–363CrossRefGoogle ScholarPubMed
Ritsner, MSBlumenkrantz, HPredicting domain-specific insight of schizophrenia patients from symptomatology, multiple neurocognitive functions, and personality related traits. Psychiatry Res 2007;149:59–69CrossRefGoogle ScholarPubMed
Rossell, SLCoakes, JShapleske, JWoodruff, PWDavid, ASInsight: its relationship with cognitive function, brain volume and symptoms in schizophrenia. Psychol Med 2003;33:111–119CrossRefGoogle Scholar
Saeedi, HAddington, JAddington, DThe association of insight with psychotic symptoms, depression, and cognition in early psychosis: a 3-year follow-up. Schizophr Res 2007;89:123–128CrossRefGoogle ScholarPubMed
Schwartz, RCCohen, BNGrubaugh, ADoes insight affect long-term impatient treatment outcome in chronic schizophrenia?. Compr Psychiatry 1997;38:283–288CrossRefGoogle ScholarPubMed
Sevy, SNathanson, KVisweswaraiah, HAmador, XThe relationship between insight and symptoms in schizophrenia. Compr Psychiatry 2004;45:16–19CrossRefGoogle Scholar
Shad, MUMuddasani, SPrasad, KSweeney, JAKeshavan, MSInsight and prefrontal cortex in first-episode schizophrenia. Neuroimage 2004;22:1315–1320CrossRefGoogle ScholarPubMed
Simon, AEBerger, GEGiacomini, VFerrero, FMohr, SInsight, symptoms and executive functions in schizophrenia. Cognit Neuropsychiatry 2006;11:437–451CrossRefGoogle Scholar
Simon, VDe Hert, MWampers, MPeuskens, Jvan Winkel, RThe relation between neurocognitive dysfunction and impaired insight in patients with schizophrenia. Eur Psychiatry 2009;24:239–243 doi: 10.1016/j.eurpsy.2008.10.004.CrossRefGoogle ScholarPubMed
Smith, TEHull, JWIsrael, LMWillson, DFInsight, symptoms, and neurocognition in schizophrenia and schizoaffective disorder. Schizophr Bull 2000;26:193–200CrossRefGoogle ScholarPubMed
Startup, MInsight and cognitive deficits in schizophrenia: evidence for a curvilinear relationship. Psychol Med 1996;26:1277–1281CrossRefGoogle ScholarPubMed
Subotnik, KLNuechterlein, KHIrzhevsky, VKitchen, CMWoo, SMMintz, JIs unawareness of psychotic disorder a neurocognitive or psychological defensiveness problem?. Schizophr Res 2005;75:147–157CrossRefGoogle ScholarPubMed
Thompson, KNMcGorry, PDHarrigan, SMReduced awareness of illness in first-episode psychosis. Compr Psychiatry 2001;42:498–503CrossRefGoogle ScholarPubMed
Vaz, FJBejar, ACasado, MInsight, psychopathology, and interpersonal relationships in schizophrenia. Schizophr Bull 2002;28:311–317CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.