Illness insight in schizophrenia patients and their caregivers linked
MedWire News: Schizophrenia patient's insight into their illness is closely correlated with the insight of their caregivers, study results have shown.
The findings provide "support for the incorporation of family psychoeducation in early psychosis," according to researchers Benjamin Brent (Massachusetts Mental Health Center, Boston, USA) and colleagues.
Poor insight into illness often complicates the course of treatment in early psychosis. Indeed, research over the past two decades has linked impaired insight to longer duration of untreated psychosis, medication non-adherence , greater symptom severity, and poor functional outcomes.
After the onset of psychosis, caregivers commonly play a critical role in supporting medication adherence, treatment engagement, and encouraging improved social functioning.
However, the relationship between caregivers' knowledge about psychosis and patients' insight into illness has not been addressed.
In the current study the researchers recruited 14 patients with schizophrenia or schizoaffective disorder diagnosed within 5 years of psychosis onset and 14 caregivers of the patients' choosing, all of whom were first-degree relatives.
Insight into illness was assessed in patients using the Scale to assess Unawareness of Mental Disorder (SUMD). The SUMD assesses several dimensions of insight into illness: awareness of having a mental disorder; awareness of the effects of and need for treatment with medication; awareness of the psychosocial consequences of having a mental illness; and awareness and attributions related to specific symptoms of serious mental disorder.
Scores for each item range from 1 (full awareness) to 5 (severe/complete unawareness) with scores of 2, 3, and 4 reflecting degrees of partial awareness.
Caregiver insight into illness was assessed using a modified version of the SUMD in which questions were rephrased to probe caregiver insight into a patient's illness, eg, "do you think that your son needs to take medication?"
In patients, levels of full awareness ranged from 21-57% across the SUMD insight items, compared with 64-92% among caregivers.
Analysis revealed that there was a significant correlation between patients' and caregivers' awareness of symptoms and need for treatment.
"Developing caregiver insight into illness may not only promote increased insight into illness in patients, but also help mitigate the risks of depression and suicide associated with the emergence of greater insight into illness in patients with early psychosis," Brent and colleagues comment in the journal Schizophrenia Research.
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By Andrew Czyzewski