Cavelti Marialuisa, Rüsch Nicolas, Vauth Roland
*University Hospital for Psychiatry and Psychotherapy, Bern, Switzerland; †Section of Public Mental Health, Department of Psychiatry II, University of Ulm, Ulm, Germany; and ‡University Hospital for Psychiatry, Department of Psychiatric Outpatient Treatment, Basel, Switzerland.
J Nerv Ment Dis. 2014 Jul;202(7):521-9. doi: 10.1097/NMD.0000000000000160.
Lack of insight is a major target in the treatment of schizophrenia. However, insight may have undesirable effects on self-concept and motivation that can hinder recovery. This study aimed to examine the link between insight, self-stigma, and demoralization as predictors of symptoms and functioning. Insight, self-stigma, depressive and psychotic symptoms, and functioning were assessed among 133 outpatients with schizophrenia at baseline and 12 months later. The data were analyzed by hierarchical multiple linear regressions. More insight at baseline and an increase in self-stigma over 12 months predicted more demoralization at follow-up. Insight at baseline was not associated with any outcome variable, but self-stigma at baseline was related to poorer functioning and more positive symptoms at follow-up. More demoralization at baseline predicted poorer functioning 12 months later. Demoralization did not mediate the relationship between self-stigma at baseline and functioning after 1 year. Given the decisive role of self-stigma regarding recovery from schizophrenia, dysfunctional beliefs related to illness and the self should be addressed in treatment. Different psychotherapeutical approaches are discussed.
自知力缺失是精神分裂症治疗的主要目标。然而，自知力可能会对自我概念和动机产生不良影响，进而阻碍康复。本研究旨在探讨自知力、自我污名化和士气低落之间的联系，将其作为症状和功能的预测因素。在基线时和12个月后，对133名精神分裂症门诊患者的自知力、自我污名化、抑郁和精神病性症状以及功能进行了评估。通过分层多元线性回归对数据进行分析。基线时自知力更强以及12个月内自我污名化增加，预测随访时士气低落更严重。基线时的自知力与任何结局变量均无关联，但基线时的自我污名化与随访时功能较差及更多阳性症状相关。基线时士气低落更严重预测12个月后功能更差。士气低落并未介导基线时自我污名化与1年后功能之间的关系。鉴于自我污名化在精神分裂症康复中的决定性作用，治疗中应解决与疾病和自我相关的功能失调信念。文中讨论了不同的心理治疗方法。
