Department of Psychiatry & Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands.
Schizophr Bull. 2011 Jan;37(1):29-37. doi: 10.1093/schbul/sbq133. Epub 2010 Nov 22.
Reduced insight has been reported in a majority of patients with a psychotic disorder. Most studies have focused on associations with neurocognition, neglecting relations with social cognition. Two hundred seventy patients with nonaffective psychosis participated in this study, which was part of the GROUP (Genetic Risk and OUtcome of Psychosis)-project. Linear regression analyses were performed to investigate the predictive value of composite measures of neurocognition, social cognition, and clinical symptoms. The moderating effect of phase of illness was also investigated. Insight was measured with a composite measure, based on the insight item on the Positive And Negative Syndrome Scale (PANSS) and the Birchwood Insight Scale (BIS). Insight on the BIS and the PANSS correlated significantly (r = .406). All independent variables correlated with the insight composite measure. The additional effect of social cognition and clinical symptoms were both significant. Phase of illness was a moderating variable: In patients with recent-onset psychosis (ROP), none of the independent variables explained variance. In patients with multiple episode or chronic psychosis, both social cognition and clinical symptoms had additional effects and explained insight, along with neurocognition, together explaining 20% of the variance. These findings indicate that multiple factors are associated with insight in psychosis. Specifically, associations of insight with social cognitive and clinical symptom measures were observed, over and above a contribution of neurocognition. This supports theories that imply a role for deficient emotion recognition and mentalizing in reduced insight. Further studies need to investigate insight in ROP into more detail.
大多数精神病患者都存在洞察力下降的情况。大多数研究都集中在与神经认知的关联上，而忽略了与社会认知的关系。270 名非情感性精神病患者参与了这项研究，该研究是 GROUP（遗传风险和精神病的结果）项目的一部分。线性回归分析用于研究神经认知、社会认知和临床症状综合测量的预测价值。还研究了疾病阶段的调节作用。洞察力通过基于阳性和阴性症状量表（PANSS）和 Birchwood 洞察力量表（BIS）的洞察力项目的综合测量来衡量。BIS 和 PANSS 的洞察力显著相关（r =.406）。所有自变量都与洞察力综合测量值相关。社会认知和临床症状的额外效应均具有统计学意义。疾病阶段是一个调节变量：在首发精神病（ROP）患者中，没有一个自变量可以解释方差。在多次发作或慢性精神病患者中，社会认知和临床症状都有额外的作用，并且与神经认知一起解释了洞察力，共解释了 20%的方差。这些发现表明，多种因素与精神病中的洞察力有关。具体来说，洞察力与社会认知和临床症状测量之间的关联，超出了神经认知的贡献。这支持了暗示情绪识别和心理化缺陷在洞察力下降中的作用的理论。需要进一步的研究来更详细地研究 ROP 中的洞察力。
