Varga Monica, Magnusson Andres, Flekkøy Kjell, David Anthony S, Opjordsmoen Stein
Department of Acute Psychiatric Emergency Ward, Aker University Hospital, N-0514 Oslo, Norway.
Compr Psychiatry. 2007 Nov-Dec;48(6):583-91. doi: 10.1016/j.comppsych.2007.06.003. Epub 2007 Aug 21.
Lack of insight is a well-recognized feature of schizophrenia and is associated with symptom severity and cognitive impairments. However, the diagnostic specificity of insight variables and their correlates is not known. To assess this specificity, we compared awareness of illness and neuropsychological function between patients with chronic schizophrenia and bipolar I disorder.
We assessed insight, level of psychopathology, and cognitive performance on a neuropsychological test battery in 37 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition bipolar I disorder, 32 patients with schizophrenia, and 31 healthy subjects for comparison.
There was no significant difference between the 2 diagnostic groups on general illness awareness. However, patients with bipolar disorder had better awareness of their symptoms and their pathologic nature compared to patients with schizophrenia. Similar patterns of association emerged between insight and clinical variables. General unawareness was associated with clinical severity, especially of the affective type, and working memory deficits (Wechsler Adult Intelligence Scale digit span) in both diagnostic groups. The contribution of other cognitive deficits to insight differed across the groups. Misattribution differed from the other aspects of insight in its relative independence of clinical and neurocognitive correlates. Both patient groups were neurocognitively impaired, with the schizophrenia group performing significantly worse on conceptual ability, verbal learning, visuospatial processing, and motor speed.
The results suggest that differences in general insight in major mental disorders may be explained by symptom severity and working memory function rather than the specific diagnosis. Subcomponents of insight are influenced by different factors emphasizing the need to consider insight as multidimensional.
自知力缺乏是精神分裂症一个公认的特征，且与症状严重程度和认知障碍相关。然而，自知力变量及其相关因素的诊断特异性尚不清楚。为评估这种特异性，我们比较了慢性精神分裂症患者和双相I型障碍患者对疾病的认识及神经心理功能。
我们对37例符合《精神障碍诊断与统计手册》第四版双相I型障碍的患者、32例精神分裂症患者以及31名健康对照者进行了自知力、精神病理学水平评估，并通过一套神经心理测试评估了认知表现。
两个诊断组在对疾病的总体认识上没有显著差异。然而，与精神分裂症患者相比，双相障碍患者对自身症状及其病理性质有更好的认识。自知力与临床变量之间也呈现出相似的关联模式。在两个诊断组中，总体无自知力均与临床严重程度相关，尤其是情感类型的严重程度，以及工作记忆缺陷（韦氏成人智力量表数字广度测试）。其他认知缺陷对自知力的影响在不同组之间存在差异。错误归因在其与临床和神经认知相关因素的相对独立性方面与自知力的其他方面不同。两组患者均存在神经认知损害，精神分裂症组在概念能力、言语学习、视觉空间处理和运动速度方面表现明显更差。
结果表明，主要精神障碍中总体自知力的差异可能由症状严重程度和工作记忆功能而非具体诊断来解释。自知力的子成分受不同因素影响，这强调了将自知力视为多维概念的必要性。
