Improvements in insight predict favorable schizophrenia outcomes
MedWire News: Schizophrenia patients whose insight into their illness improves in the early stages of the disease are likely to have good outcomes, research from India shows.
Anthony David, from King’s College London in the UK, and colleagues also point out that insight often continues to improve beyond the first 6 months, despite improvements in psychopathologic symptoms tending to plateau after this time.
The researchers investigated the relationship between insight and psychopathology and their effects on outcome in 131 first-episode schizophrenia patients from Tamil Nadu, one of the most industrialized states in India.
Of the 131 patients enrolled, data on 115 were available at the 1-year follow-up. The outcome for these patients, based on Global Assessment of Functioning score, was favorable, with half achieving full remission of symptoms over the course of the follow-up. The remaining patients achieved remission but with residual symptoms, and the overall relapse rate during the entire 12-month study was just 13%.
Linear and logistic regression analyses identified improvements in insight on the Scale for Assessment of Insight–Expanded version (SAI–E) and psychopathology on the Brief Psychiatric Rating Scale (BPRS) during the first 6 months as significant predictors of good outcome. By contrast, insight and psychopathology at baseline were not associated with remission, and nor were improvements in these two variables after 6 months.
Insight and psychopathology were not related to one another at baseline, but at the 6-month assessment, lower BPRS scores were significantly associated with an increase in awareness and treatment adherence and at 1-year lower BPRS scores were significantly associated with all three dimensions of the SAI-E – awareness, treatment adherence, and relabeling.
Although insight and psychopathology were significant predictors of outcome, duration of untreated psychosis (DUP) had the greatest impact on outcome. Patients with longer DUP were significantly less likely to achieve full remission, even after controlling for changes in insight and psychopathology, the team reports. The difference in DUP between patients who did and did not achieve full remission was an average of 55.4 weeks.
David and colleagues suggest in The British Journal of Psychiatry that “early change in insight or remaining within the existing ‘collaborative social world’ may have benefits.”
They conclude: “Efforts to improve insight taking account of local cultural factors could yield benefits in outcomes and might relate to the supposedly superior prognosis of psychosis in settings such as this in south India.”
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By Lucy Piper