Smith Thomas E, Hull James W, Huppert Jonathan D, Silverstein Steven M, Anthony Donna T, McClough Joel F
Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA.
J Psychiatr Res. 2004 Mar-Apr;38(2):169-76. doi: 10.1016/s0022-3956(03)00091-8.
Impaired insight is an important contributing factor to poor treatment response and outcome in schizophrenia. Prior studies have attempted to identify the illness characteristics that underlie these deficits, with conflicting results regarding associations with symptoms and neurocognitive deficits. These inconsistencies may be a function of a number of methodological issues, which were addressed in this study. In a prospective, longitudinal study, 50 individuals with schizophrenia or schizoaffective disorder underwent baseline assessments upon discharge from an acute inpatient unit, and again at a 6-month follow-up. Unawareness of positive and negative symptoms were studied separately, with analyses focusing on changes in insight over time as well as associations with disorganized symptoms, depression, and card sorting deficits. Subjects showed greater insight for negative symptoms than for positive symptoms. Insight for positive symptoms improved only slightly over the follow-up period, while negative symptom awareness did not change. Insight for negative symptoms showed modest associations with card sorting deficits, while awareness for positive symptoms showed stronger associations with thought disorder, depression, and card sorting deficits. Awareness for positive symptoms in schizophrenia may be distinct from awareness of negative symptoms. Clinicians should also be aware of the multidetermined nature of impaired insight, and future research should aim to isolate distinct mechanisms that give rise to these deficits.
自知力受损是精神分裂症治疗反应不佳和预后不良的一个重要促成因素。先前的研究试图确定这些缺陷背后的疾病特征，但关于与症状和神经认知缺陷的关联，结果相互矛盾。这些不一致可能是由一些方法学问题导致的，本研究对这些问题进行了探讨。在一项前瞻性纵向研究中，50名精神分裂症或分裂情感性障碍患者在急性住院单元出院时接受了基线评估，并在6个月随访时再次进行评估。分别研究了对阳性和阴性症状的自知力，分析重点是自知力随时间的变化以及与紊乱症状、抑郁和卡片分类缺陷的关联。受试者对阴性症状的自知力比对阳性症状的自知力更强。在随访期间，对阳性症状的自知力仅略有改善，而对阴性症状的自知力则没有变化。对阴性症状的自知力与卡片分类缺陷有适度关联，而对阳性症状的自知力与思维紊乱、抑郁和卡片分类缺陷有更强关联。精神分裂症中对阳性症状的自知力可能与对阴性症状的自知力不同。临床医生还应意识到自知力受损的多因素性质，未来的研究应旨在分离导致这些缺陷的不同机制。
