First Department of Psychiatry, University of Athens, Eginition Hospital, Athens, Greece; Section of Cognitive Neuropsychiatry, Department of Psychosis Studies, Institute of Psychiatry, King's College, London, UK.
First Department of Psychiatry, University of Athens, Eginition Hospital, Athens, Greece.
Schizophr Res. 2014 Jan;152(1):217-22. doi: 10.1016/j.schres.2013.11.022. Epub 2013 Dec 8.
It has been proposed that theory of mind (ToM) deficits underlying difficulties in taking the perspective of others may substantially contribute to insight impairment in schizophrenia. The present study aimed to explore the effect of ToM deficits on insight impairment independently of co-existent neurocognitive deficits and symptom severity in chronic schizophrenia.
Fifty-eight chronic patients with schizophrenia and 56 matched healthy participants were assessed with the Schedule for the Assessment of Insight (SAI-E) along with a series of ToM tasks and a comprehensive battery of neuropsychological measures. Symptoms were measured with the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia.
ToM impairment explained a substantial proportion of variance in overall insight and its three major components: awareness of illness, relabelling of symptoms and treatment compliance. Moreover, the effect of ToM deficits on insight remained significant even after controlling for all neurocognitive factors and symptom ratings. Regression analysis showed that symptoms and cognitive deficits also contribute to impaired insight in schizophrenia. General intellectual ability was negatively associated with both overall insight and relabelling of symptoms. Executive functions were negatively associated with relabelling.
Our findings confirm that ToM deficits negatively affect insight independently of neurocognitive deficits and symptom severity in chronic schizophrenia. The effect of ToM deficits on insight should be further examined in the broader context of the failures in metacognition and their relationships with insight impairment in schizophrenia.
有人提出，理解他人观点的能力（ToM）缺陷可能是精神分裂症患者洞察力受损的主要原因。本研究旨在探讨精神分裂症慢性期患者的 ToM 缺陷对洞察力损害的影响，而不考虑并存的神经认知缺陷和症状严重程度。
58 名慢性精神分裂症患者和 56 名匹配的健康参与者接受了精神分裂症洞察力评估量表（SAI-E）以及一系列 ToM 任务和全面的神经心理测量。症状用阳性和阴性症状量表和精神分裂症的卡尔加里抑郁量表进行评估。
ToM 损伤解释了整体洞察力及其三个主要成分（对疾病的认识、症状重新标记和治疗依从性）的很大一部分方差。此外，即使在控制所有神经认知因素和症状评分后，ToM 缺陷对洞察力的影响仍然显著。回归分析表明，症状和认知缺陷也会导致精神分裂症洞察力受损。一般智力与整体洞察力和症状重新标记呈负相关。执行功能与症状重新标记呈负相关。
我们的发现证实，在慢性精神分裂症中，除了神经认知缺陷和症状严重程度外，ToM 缺陷也会对洞察力产生负面影响。应该在更广泛的元认知失败及其与精神分裂症洞察力损害的关系背景下，进一步研究 ToM 缺陷对洞察力的影响。
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