Lack of insight in schizophrenia partly explained by other factors
MedWire News: Clinical symptoms and demographic characteristics such as educational level partially account for the lack of insight in schizophrenia, the results of a European study indicate.
Poor insight is a common feature of schizophrenia and is associated with clinical outcome, treatment compliance, social function, and rehabilitation outcomes. However, it is generally agreed that insight in schizophrenia is a multidimensional construct that affects not only awareness of the mental illness, its signs and symptoms, and its consequences, but also the need for treatment.
To investigate factors associated with insight, Marc de Hert, from Catholic University Leuven in Kortenberg, Belgium, and colleagues administered the Psychosis Evaluation Tool for Common Use by Caregivers (PECC), the Clinical Global Impression scale, and the Global Assessment of Function to 1213 schizophrenia patients, and gathered demographic and clinical information.
Based on PECC insight scores, 41.5% of patients had no insight and 28.5% severely impaired insight into their illness, while 32.0% had no insight and 30.0% severely impaired insight into having symptoms attributed to a mental illness. The respective figures for good and moderately impaired insight were 11.0% and 19.6%, and 14.0% and 23.7%, respectively.
Female gender was significantly associated with more impaired insight, but not when symptomatology was taken into account. Educational level was significantly positively associated with insight on both measures.
While age was significantly associated with insight, the correlations were low. Lifetime admissions was associated with only impaired insight into the illness, but not with insight into symptoms.
Insight on both measures was significantly negatively correlated with positive, negative, cognitive, and excitatory symptoms, but only explained 18% of the insight into illness and 22% of the insight into symptoms.
On stepwise regression analysis, the symptoms of delusions, poor rapport, grandiosity, guilt feelings, and social withdrawal were most strongly associated with both insight items. A model including guilt feelings, lifetime admissions, age, and educational level explained just 24% of the insight into the illness and 28% of the insight into symptoms.
The team concludes in the journal European Psychiatry: “Taken together, the results of the present study suggest that impaired insight among patients with schizophrenia may in part be a direct effect of symptoms, with delusions, poor rapport, grandiosity, guilt feelings and social withdrawal showing the strongest influence on both insight items.”
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By Liam Davenport