Yen Cheng-Fang, Chen Cheng-Sheng, Yen Ju-Yu, Ko Chih-Hung
Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Affect Disord. 2008 May;108(1-2):121-7. doi: 10.1016/j.jad.2007.10.004. Epub 2007 Nov 13.
Research has revealed that a lack of insight is associated with poorer clinical outcomes in schizophrenia; however, the predictive value of insight on adverse clinical outcomes among bipolar patients is quite understudied. The aim of this prospective study was to examine the impact of insight on adverse clinical outcomes among the patients with bipolar I disorder over a 2-year period. Sixty-five remitted bipolar I disorder patients received follow-up assessments at 3, 6, 9, 12, 18, and 24 months to detect the adverse clinical outcomes defined by the incidence of bipolar-related psychiatric hospitalization, emergency room visits, violent or suicidal behavior. The Schedule of Assessment of Insight was used to provide a baseline insight score. Cox regression analysis was used to examine the predictive value of insight on the adverse clinical outcomes. Impaired insight into treatment and a greater number of previous hospitalizations significantly increased the risk of adverse clinical outcomes with bipolar disorder in the 2-year period. However, insight into recognition of the illness and re-labeling of psychotic phenomena did not have any significant effect on adverse clinical outcomes. Bipolar patients' insight into treatment is an independent predictor of adverse clinical outcomes. Improving insight into treatment might be a promising target for a better outcome.
研究表明，自知力缺乏与精神分裂症较差的临床结局相关；然而，自知力对双相情感障碍患者不良临床结局的预测价值却鲜有研究。这项前瞻性研究的目的是在两年时间内，考察自知力对双相I型障碍患者不良临床结局的影响。65名缓解期双相I型障碍患者在3个月、6个月、9个月、12个月、18个月和24个月接受随访评估，以检测由双相情感障碍相关的精神科住院、急诊就诊、暴力或自杀行为发生率所定义的不良临床结局。使用自知力评估量表来提供基线自知力评分。采用Cox回归分析来考察自知力对不良临床结局的预测价值。对治疗的自知力受损以及既往住院次数较多显著增加了两年内双相情感障碍不良临床结局的风险。然而，对疾病的认识和对精神病性现象的重新认定的自知力对不良临床结局没有任何显著影响。双相情感障碍患者对治疗的自知力是不良临床结局的独立预测因素。提高对治疗的自知力可能是改善结局的一个有前景的目标。
