Insight has ‘trait-like properties’ in psychosis

Poor insight persists in many patients after their first episode of psychosis and is predicted by insight at baseline, report researchers.

“Our study seems to underline the point that, to some extent, insight has trait-like properties even when determined at the first presentation of psychosis”, say Rosa Ayesa-Arriola (University of Cantabria, Santander, Spain) and colleagues.

“Thus, insight in schizophrenia may not be related to psychosis per se, but rather may be a feature of the personality of patients with schizophrenia.”

The study involved 202 patients who were followed up 3 years after being seen with first-episode psychosis. At the time of follow-up, results on the Scale to Assess Unawareness of Mental Disorder indicated that 45% of the patients had poor insight into having a mental illness, 36% had poor insight into their need for treatment and 33% were unaware of the social consequences of having psychosis.

The only baseline variable that significantly predicted poor insight into having a mental illness was being diagnosed with schizophrenia, rather than a milder form of psychosis. Conversely, having insight into the social consequences of psychosis at baseline protected against poor insight into having a mental illness at follow-up.

“Interestingly, a substantial percentage of patients, despite not admitting to having a mental illness, are aware of having social dysfunctions and agree to take medication”, note the researchers in Schizophrenia Research. “This finding lends support to the multidimensional approach that we have pursued to study this phenomenon.”

Poor insight into the need for treatment was associated with a poor score on the Premorbid Adjustment Scale in early and late adolescence and with having depression. When the team accounted for insight at baseline, only depression remained significantly associated with poor insight into the need for treatment.

Lack of insight into the social consequences of psychosis was also predicted by poor premorbid adjustment, specifically in late adolescence. Insight into having a mental illness at baseline was protective, however.

The fact that insight into mental illness predicted insight into the social consequences and vice versa underscores a trait-like element to these aspects of insight, say the researchers. By contrast, these factors did not seem to affect whether patients realised their need for treatment, implying room for intervention.

“[E]ducational interventions targeted at modifying these subjective attitudes and personal beliefs may play an important role in early intervention programs and psychosocial rehabilitation and/or recovery-oriented services”, says the team.

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