Psychiatric University Hospital of Basel.
J Clin Psychol. 2012 Apr;68(4):462-76. doi: 10.1002/jclp.20872. Epub 2012 Feb 13.
Low levels of insight are a risk factor for treatment nonadherence in schizophrenia, which can contribute to poor clinical outcome. On the other hand, high levels of insight have been associated with negative outcome, such as depression, hopelessness, and lowered quality of life. The present study investigates mechanisms underlying the association of insight and depressive symptoms and protective factors as potential therapeutic targets.
One hundred and forty-two outpatients with schizophrenia or schizoaffective disorder (35.2% women, mean age of 44.83 years) were studied using questionnaires and interviews to assess insight, depressive symptoms, recovery attitude, and illness appraisals with regard to course, functional impairments, and controllability. Psychotic and negative symptoms were assessed as control variables. The cross-sectional data were analyzed using structural equation models and multiple linear regression analyses with latent variables.
Higher levels of insight and psychotic symptoms were associated with more depressive symptoms. The association of negative symptoms with depressive symptoms was not significant. The relationship between insight and depressive symptoms was mediated by the participants' perception of their illness as being chronic and disabling, as well as suppressed by their expectation of symptom control due to treatment. Finally, the association of insight and depressive symptoms was less pronounced in the patients with a positive recovery attitude than in those without this protective factor.
To achieve recovery, which includes symptom reduction, functional improvement, and subjective well-being, it is necessary to prevent depressive symptoms as indicators of a demoralization process, which may arise as a consequence of growing insight. Possible treatment strategies focusing on changes of dysfunctional beliefs about the illness and the self and inducing a positive recovery attitude are discussed.
自知力低下是精神分裂症治疗不依从的危险因素，可导致临床结局较差。另一方面，高自知力与抑郁、绝望和生活质量下降等负面结果相关。本研究旨在探讨自知力与抑郁症状的关联机制以及保护性因素，将其作为潜在的治疗靶点。
对 142 名精神分裂症或分裂情感障碍门诊患者（35.2%为女性，平均年龄为 44.83 岁）进行问卷调查和访谈，以评估其自知力、抑郁症状、康复态度以及对疾病过程、功能障碍和可控制性的看法。将精神病性和阴性症状作为控制变量。采用结构方程模型和潜变量的多元线性回归分析对横断面数据进行分析。
较高的自知力和精神病性症状与更多的抑郁症状相关。阴性症状与抑郁症状的相关性不显著。自知力与抑郁症状之间的关系是由参与者对自身疾病的认知所决定的，他们认为自己的疾病是慢性的和致残的，同时也受到治疗带来的症状控制期望的抑制。最后，与没有这种保护因素的患者相比，具有积极康复态度的患者其自知力与抑郁症状的相关性较弱。
为了实现康复，包括症状减轻、功能改善和主观幸福感，有必要预防抑郁症状，因为它可能是由于自知力增强而导致的士气低落过程的指标。讨论了可能的治疗策略，这些策略侧重于改变对疾病和自我的功能失调信念，并诱导积极的康复态度。
