Erasmus MC, Department of Psychiatry, Rotterdam, the Netherlands.
Compr Psychiatry. 2013 Oct;54(7):873-9. doi: 10.1016/j.comppsych.2013.03.016. Epub 2013 Apr 22.
Lack of insight in schizophrenia is associated with negative social outcomes mediated by symptom severity, but longitudinal studies show contradicting findings.
After commencement of court-ordered admission, adult patients were enrolled in a prospective study. A relatively homogeneous group of 133 patients with schizophrenia or related psychotic disorders was selected to evaluate the impact of illness insight and symptom severity on social outcomes. Interviews at baseline and after 6 and 12months included objective and subjective indicators of insight and social outcomes. Multilevel analyses were used to estimate the effect of insight and change in social outcomes controlling for symptom severity.
In 12-month follow-up, patients involuntarily hospitalized showed improvement in illness insight, symptom level, and social functioning, and had stable quality of life scores. Illness insight was associated with change in outcomes, independent from symptom severity. Results of the change analyses suggest that in time the association between insight and functioning becomes stronger. In contrast, insight scores were negatively associated with self-report quality of life ratings and markedly ill patients had a more negative perception of their quality of life.
Improvement in illness insight was associated with improvement in social functioning, but this was not reflected in improved self-perceived quality of life. Illness insight could result in worrying about relationships, living situation, health and finances. For severely mentally ill patients additional strategies must be found to improve social outcomes. Researchers should be more aware of varying effects for researcher-rated versus self-report indicators of insight and social outcome.
精神分裂症患者缺乏洞察力与症状严重程度相关，进而导致负面的社会后果，但纵向研究的结果却存在矛盾。
在被法院强制收治后，成年患者被纳入一项前瞻性研究。选择了一个相对同质的 133 例精神分裂症或相关精神病性障碍患者的队列，以评估疾病洞察力和症状严重程度对社会结果的影响。基线时以及 6 个月和 12 个月时进行访谈，包括洞察力和社会结果的客观和主观指标。采用多水平分析来估计洞察力和社会结果变化的影响，同时控制症状严重程度。
在 12 个月的随访中，非自愿住院的患者的疾病洞察力、症状水平和社会功能均有所改善，生活质量评分保持稳定。疾病洞察力与结果的变化相关，独立于症状严重程度。变化分析的结果表明，随着时间的推移，洞察力与功能之间的关联变得更强。相比之下，洞察力得分与自我报告的生活质量评分呈负相关，且病情严重的患者对自己的生活质量评价更差。
疾病洞察力的改善与社会功能的改善相关，但这并没有反映在自我感知的生活质量的改善上。疾病洞察力可能会导致对人际关系、生活状况、健康和经济状况的担忧。对于严重的精神疾病患者，必须寻找额外的策略来改善社会结果。研究人员应该更加意识到研究者评定的洞察力和社会结果指标与自我报告的洞察力和社会结果指标之间的不同影响。
