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Insight correlates in child- and adolescent-onset first episodes of psychosis: results from the CAFEPS study

Published online by Cambridge University Press:  18 December 2008

M. Parellada ,
D. Fraguas ,
I. Bombín ,
S. Otero ,
J. Castro-Fornieles ,
I. Baeza ,
A. Gonzalez-Pinto ,
M. Graell ,
C. Soutullo  and
B. Paya
...Show all authors
M. Parellada*
Affiliation:
Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM
D. Fraguas
Affiliation:
Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM
I. Bombín
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM Reintegra: Neurological Rehabilitation Centre, Oviedo, Spain
S. Otero
Affiliation:
Child and Adolescent Mental Health Unit, Department of Psychiatry and Psychology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
J. Castro-Fornieles
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona, Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, Spain
I. Baeza
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona, Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, Spain
A. Gonzalez-Pinto
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM Stanley Institute International Mood-Disorders Research Centre, Hospital Santiago Apóstol, Vitoria, Spain
M. Graell
Affiliation:
Section of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
C. Soutullo
Affiliation:
Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, University Clinic, College of Medicine, University of Navarra, Pamplona, Spain
B. Paya
Affiliation:
Child and Adolescent Mental Health Unit, Department of Psychiatry and Psychology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
C. Arango
Affiliation:
Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM
*
*Address for correspondence: Dr M. Parellada, Adolescent Unit, Department of Psychiatry, Hospital Gregorio Marañón, Ibiza 43, Madrid 28009, Spain. (Email: [email protected])
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Abstract

Background

The correlates of insight in early-onset psychosis have received little previous attention.

Method

We studied clinical correlates of insight in a sample of 110 adolescent recent-onset psychosis patients (mean age 15.53 years; psychotic symptoms present for <6 months). Insight was measured with the Scale to Assess Unawareness of Mental Disorder (SUMD) at baseline, 6 months and 12 months follow-up.

Results

Insight improved over the early phases of the illness, in parallel with psychopathological improvement. Poor insight at baseline and 6 months correlated with poor functioning at 6 and 12 months respectively. Schizophrenia patients had poorer insight than patients with bipolar disorder at 6 and 12 months but not at baseline. Logistic and linear regressions were used to predict 12-month diagnoses and functioning based on insight measurements. Baseline awareness of illness was a significant predictor for diagnosis [odds ratio (OR) 1.4, 95% confidence interval (CI) 1.05–1.97]. Treatment compliance at 6 months did not correlate with baseline SUMD subscores, but correlated with insight into having a disorder (Spearman's ρ=0.21, p=0.039), its consequences (Spearman's ρ=0.28, p=0.006) and the need for treatment (Spearman's ρ=0.26, p=0.012) at 6 months. The ‘attribution of symptoms’ dimension of insight is poorly correlated with other insight dimensions and with other clinical variables.

Conclusions

Poor insight correlates with symptom severity and global functioning but also has some trait value for schizophrenia, which is apparent once acute psychotic symptomatology is not prominent. A multi-dimensional approach to the assessment of insight is necessary, as different dimensions are influenced by different factors.

Keywords

Adolescencefirst-episode psychosisinsight
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 9 , September 2009 , pp. 1433 - 1445
Copyright
Copyright © 2008 Cambridge University Press

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References

Addington, D, Addington, J, Patten, S (1998). Depression in people with first-episode schizophrenia. British Journal of Psychiatry (Suppl.) 172, 90–92.CrossRefGoogle ScholarPubMed
Addington, J, Addington, D (2005). Patterns of premorbid functioning in first-episode psychosis: relationship to 2-year outcome. Acta Psychiatrica Scandinavica 112, 40–46.CrossRefGoogle ScholarPubMed
Amador, XF, Flaum, M, Andreasen, NC, Strauss, DH, Yale, SA, Clark, SC, Gorman, JM (1994). Awareness of illness in schizophrenia and schizoaffective and mood disorders. Archives of General Psychiatry 51, 826–836.Google ScholarPubMed
Amador, XF, Gorman, JM (1998). Psychopathologic domains and insight in schizophrenia. Psychiatric Clinics of North America 21, 27–42.CrossRefGoogle ScholarPubMed
Amador, XF, Strauss, DH, Yale, SA, Flaum, MM, Endicott, J, Gorman, JM (1993). Assessment of insight in psychosis. American Journal of Psychiatry 150, 873–879.Google ScholarPubMed
Amador, XF, Strauss, DH, Yale, SA, Gorman, JM (1991). Awareness of illness in schizophrenia. Schizophrenia Bulletin 17, 113–132.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (text revision). Washington, DC: American Psychiatric Association.Google Scholar
Arango, C, Adami, H, Sherr, JD, Thaker, GK, Carpenter, WT Jr. (1999 a). Relationship of awareness of dyskinesia in schizophrenia to insight into mental illness. American Journal of Psychiatry 156, 1097–1099.CrossRefGoogle ScholarPubMed
Arango, C, Calcedo Barba, A, Gonzalez, S, Calcedo Ordonez, A (1999 b). Violence in inpatients with schizophrenia: a prospective study. Schizophrenia Bulletin 25, 493–503.CrossRefGoogle ScholarPubMed
Birchwood, M, Iqbal, Z, Chadwick, P, Trower, P (2000). Cognitive approach to depression and suicidal thinking in psychosis. 1. Ontogeny of post-psychotic depression. British Journal of Psychiatry 177, 516–521.CrossRefGoogle ScholarPubMed
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.CrossRefGoogle ScholarPubMed
Carpenter, WT Jr., Strauss, JS, Bartko, JJ (1973). Flexible system for the diagnosis of schizophrenia: report from the WHO International Pilot Study of Schizophrenia. Science 182, 1275–1278.CrossRefGoogle ScholarPubMed
Castro-Fornieles, J, Parellada, M, Gonzalez-Pinto, A, Moreno, D, Graell, M, Baeza, I, Otero, S, Soutullo, CA, Crespo-Facorro, B, Ruiz-Sancho, A, Desco, M, Rojas-Corrales, O, Patino, A, Carrasco-Marin, E, Arango, C (2007). The child- and adolescent first-episode psychosis study (CAFEPS): design and baseline results. Schizophrenia Research 91, 226–237.CrossRefGoogle ScholarPubMed
Cuesta, MJ, Peralta, V (1994). Lack of insight in schizophrenia. Schizophrenia Bulletin 20, 359–366.CrossRefGoogle ScholarPubMed
Cuesta, MJ, Peralta, V, Zarzuela, A, Zandio, M (2006). Insight dimensions and cognitive function in psychosis: a longitudinal study. BMC Psychiatry 6, 26.CrossRefGoogle ScholarPubMed
David, A, Buchanan, A, Reed, A, Almeida, O (1992). The assessment of insight in psychosis. British Journal of Psychiatry 161, 599–602.CrossRefGoogle ScholarPubMed
David, AS (1992). Illness and insight. British Journal of Hospital Medicine 48, 652–654.Google ScholarPubMed
Debowska, G, Grzywa, A, Kucharska-Pietura, K (1998). Insight in paranoid schizophrenia: its relationship to psychopathology and premorbid adjustment. Comprehensive Psychiatry 39, 255–260.CrossRefGoogle ScholarPubMed
Fennig, S, Everett, E, Bromet, EJ, Jandorf, L, Fennig, SR, Tanenberg-Karant, M, Craig, TJ (1996). Insight in first-admission psychotic patients. Schizophrenia Research 22, 257–263.CrossRefGoogle ScholarPubMed
Guy, W (1976). ECDEU Assessment Manual for Psychopharmacology, Revised. US Department of Health, Education and Welfare: Rockville, MD.Google Scholar
Hollingshead, A, Redlich, F (1958). Social Class and Mental Illness. Wiley: New York.CrossRefGoogle Scholar
Hollis, C (2000). Adult outcomes of child- and adolescent-onset schizophrenia: diagnostic stability and predictive validity. American Journal of Psychiatry 157, 1652–1659.CrossRefGoogle ScholarPubMed
Howard, R, Castle, D, Wessely, S, Murray, R (1993). A comparative study of 470 cases of early-onset and late-onset schizophrenia. British Journal of Psychiatry 163, 352–357.CrossRefGoogle ScholarPubMed
Kaufman, J, Birmaher, B, Brent, D, Rao, U, Flynn, C, Moreci, P, Williamson, D, Ryan, N (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children: Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry 36, 980–988.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Keshavan, MS, Rabinowitz, J, DeSmedt, G, Harvey, PD, Schooler, N (2004). Correlates of insight in first-episode psychosis. Schizophrenia Research 70, 187–194.CrossRefGoogle ScholarPubMed
Kim, Y, Sakamoto, K, Kamo, T, Sakamura, Y, Miyaoka, H (1997). Insight and clinical correlates in schizophrenia. Comprehensive Psychiatry 38, 117–123.Google ScholarPubMed
Laroi, F, Fannemel, M, Ronneberg, U, Flekkoy, K, Opjordsmoen, S, Dullerud, R, Haakonsen, M (2000). Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests. Psychiatry Research 100, 49–58.CrossRefGoogle ScholarPubMed
Lele, MV, Joglekar, AS (1998). Poor insight in schizophrenia: neurocognitive basis. Journal of Postgraduate Medicine 44, 50–55.Google ScholarPubMed
Lysaker, PH, Bryson, GJ, Lancaster, RS, Evans, JD, Bell, MD (2003). Insight in schizophrenia: associations with executive function and coping style. Schizophrenia Research 59, 41–47.CrossRefGoogle ScholarPubMed
Markova, IS, Berrios, GE (1992). The meaning of insight in clinical psychiatry. British Journal of Psychiatry 160, 850–860.Google ScholarPubMed
McEvoy, JP, Freter, S, Everett, G, Geller, JL, Appelbaum, P, Apperson, LJ, Roth, L (1989). Insight and the clinical outcome of schizophrenic patients. Journal of Nervous and Mental Diseases 177, 48–51.Google ScholarPubMed
McEvoy, JP, Hartman, M, Gottlieb, D, Godwin, S, Apperson, LJ, Wilson, W (1996). Common sense, insight, and neuropsychological test performance in schizophrenia patients. Schizophrenia Bulletin 22, 635–641.CrossRefGoogle ScholarPubMed
McEvoy, JP, Johnson, J, Perkins, D, Lieberman, JA, Hamer, RM, Keefe, RS, Tohen, M, Glick, ID, Sharma, T (2006). Insight in first-episode psychosis. Psychological Medicine 36, 1385–1393.CrossRefGoogle ScholarPubMed
Mintz, AR, Addington, J, Addington, D (2004). Insight in early psychosis: a 1-year follow-up. Schizophrenia Research 67, 213–217.CrossRefGoogle ScholarPubMed
Mintz, AR, Dobson, KS, Romney, DM (2003). Insight in schizophrenia: a meta-analysis. Schizophrenia Research 61, 75–88.CrossRefGoogle ScholarPubMed
Peralta, V, Cuesta, MJ (1994 a). Lack of insight: its status within schizophrenic psychopathology. Biological Psychiatry 36, 559–561.CrossRefGoogle ScholarPubMed
Peralta, V, Cuesta, MJ (1994 b). Psychometric properties of the positive and negative syndrome scale (PANSS) in schizophrenia. Psychiatry Research 53, 31–40.CrossRefGoogle ScholarPubMed
Perkins, DO (2002). Predictors of noncompliance in patients with schizophrenia. Journal of Clinical Psychiatry 63, 1121–1128.CrossRefGoogle ScholarPubMed
Perneger, TV (1998). What's wrong with Bonferroni adjustments. British Medical Journal 316, 1236–1238.CrossRefGoogle ScholarPubMed
Rosenbaum, B, Valbak, K, Harder, S, Knudsen, P, Koster, A, Lajer, M, Lindhardt, A, Winther, G, Petersen, L, Jorgensen, P, Nordentoft, M, Andreasen, AH (2006). Treatment of patients with first-episode psychosis: two-year outcome data from the Danish National Schizophrenia Project. World Psychiatry 5, 100–103.Google ScholarPubMed
Sartorius, N, Shapiro, R, Kimura, M, Barrett, K (1972). WHO international pilot study of schizophrenia. Psychological Medicine 2, 422–425.CrossRefGoogle ScholarPubMed
Schwartz, RC, Petersen, S (1999). The relationship between insight and suicidality among patients with schizophrenia. Journal of Nervous and Mental Diseases 187, 376–378.Google ScholarPubMed
Schwartz, RC, Skaggs, JL, Petersen, S (2000). Critique of recent empirical research on insight and symptomatology in schizophrenia. Psychological Reports 86, 471–474.CrossRefGoogle ScholarPubMed
Schwartz-Stav, O, Apter, A, Zalsman, G (2006). Depression, suicidal behavior and insight in adolescents with schizophrenia. European Child and Adolescent Psychiatry 15, 352–359.Google ScholarPubMed
Shaffer, D, Gould, MS, Brasic, J, Ambrosini, P, Fisher, P, Bird, H, Aluwahlia, S (1983). A children's global assessment scale (CGAS). Archives of General Psychiatry 40, 1228–1231.Google ScholarPubMed
Sim, K, Chua, TH, Chan, YH, Mahendran, R, Chong, SA (2006). Psychiatric comorbidity in first episode schizophrenia: a 2-year, longitudinal outcome study. Journal of Psychiatric Research 40, 656–663.CrossRefGoogle Scholar
Smith, TE, Hull, JW, Israel, LM, Willson, DF (2000). Insight, symptoms, and neurocognition in schizophrenia and schizoaffective disorder. Schizophrenia Bulletin 26, 193–200.CrossRefGoogle ScholarPubMed
Soutullo, C (1999). Kiddie-Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version. (Validated by Dr F. de la Peña, translated into Spanish by Dr M. Wolff, adapted to Spanish by Dr C. Soutullo).Google Scholar
Soyka, M, Graz, C, Bottlender, R, Dirschedl, P, Schoech, H (2007). Clinical correlates of later violence and criminal offences in schizophrenia. Schizophrenia Research 94, 89–98.CrossRefGoogle ScholarPubMed
Varga, M, Magnusson, A, Flekkoy, K, David, AS, Opjordsmoen, S (2007). Clinical and neuropsychological correlates of insight in schizophrenia and bipolar I disorder: does diagnosis matter? Comprehensive Psychiatry 48, 583–591.CrossRefGoogle ScholarPubMed
Young, DA, Davila, R, Scher, H (1993). Unawareness of illness and neuropsychological performance in chronic schizophrenia. Schizophrenia Research 10, 117–124.CrossRefGoogle ScholarPubMed