Cooke M A, Peters E R, Kuipers E, Kumari V
Department of Psychology, Institute of Psychiatry, London, UK.
Acta Psychiatr Scand. 2005 Jul;112(1):4-17. doi: 10.1111/j.1600-0447.2005.00537.x.
To examine the evidence for the three kinds of aetiological model that dominate the current literature on poor insight in psychosis: clinical models, the neuropsychological model, and the psychological denial model.
Studies pertaining to one or more of these aetiological models were identified, reviewed and critically evaluated.
There is little support for clinical models, partly because they lack testable hypotheses. Several studies reveal a positive relationship between insight and executive function, which may be related to frontal lobe dysfunction. However, the extent to which this relationship is specific and independent of general cognitive impairment remains unclear. There is tentative evidence to support the psychological denial model. Recent data combining the latter two approaches suggest that multiple factors contribute to poor insight.
Integration of different aetiological models is necessary for a fuller understanding of insight in psychosis. Future research should assess multiple aetiological mechanisms in single investigations.
考察主导当前关于精神病性障碍自知力缺失文献的三种病因学模型的证据：临床模型、神经心理学模型和心理否认模型。
识别、回顾并批判性评估与这些病因学模型中的一种或多种相关的研究。
临床模型几乎没有得到支持，部分原因是它们缺乏可检验的假设。多项研究揭示了自知力与执行功能之间存在正相关，这可能与额叶功能障碍有关。然而，这种关系的特异性程度以及独立于一般认知损害的程度仍不清楚。有初步证据支持心理否认模型。最近结合后两种方法的数据表明，多种因素导致自知力缺失。
为了更全面地理解精神病性障碍的自知力，有必要整合不同的病因学模型。未来的研究应在单一研究中评估多种病因学机制。
