Lu Ying, Wang Xiaoping
Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China ; Forensic Psychiatry Department of Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.
Shanghai Arch Psychiatry. 2012 Apr;24(2):91-8. doi: 10.3969/j.issn.1002-0829.2012.02.004.
The relationship between insight and internalized stigma in patients with schizophrenia is important both for theoretical and practical reasons because of its close association with patients' willingness to seek (or accept) care for their mental illness.
To investigate the relationship between insight and internalized stigma in patients with schizophrenia in mainland China.
65 inpatients and 27 outpatients with schizophrenia who had a median duration of four years of illness completed Chinese versions of two self-report questionnaires-the Internalized Stigma of Mental Illness (ISMI) scale and the Modified Consumer Experiences of Stigma Questionnaire (MCESQ). The patients were also assessed by senior psychiatrists using the Scale for Assessment of Positive Symptoms (SAPS) and the Scale for Assessment of Negative Symptoms (SANS). Patients were divided into those with and without insight into their illness based on the score of the insight item on the Chinese version of the Brief Psychiatric Rating Scale.
49 patients were classified as having insight and 43 classified as lacking insight. Compared to patients with insight, those without insight had a significantly shorter duration of illness, were more likely to be inpatients, and (at trend level only) had more prominent positive and negative symptoms. The 'alienation' subscale score of the ISMI was significantly higher in patients with insight but none of the remaining six subscales in the two instruments were different between the two groups and only 4 of the 48 separate items in the two scales were significantly different between the groups. Logistic regression analysis found no relationship between lack of insight and the scores of the two self-completion stigma scales or the scores of the two clinician-administered symptom scales.
This study among inpatients and outpatients with schizophrenia in China does not support findings of previous studies that report increased experience of stigma among patients who have better insight. The measures of stigma used in the study need further revision and validation for use in China and studies with a wider spectrum of patients that make more detailed assessments of insight and that follow fluctuations in insight and experiences of stigma over time are needed to clarify the complex relationship between these two phenomena in patients with schizophrenia.
精神分裂症患者的自知力与内化耻辱感之间的关系无论在理论上还是实践中都很重要，因为它与患者寻求（或接受）精神疾病治疗的意愿密切相关。
调查中国大陆精神分裂症患者自知力与内化耻辱感之间的关系。
65例住院精神分裂症患者和27例门诊精神分裂症患者，病程中位数为4年，完成了两个自填式问卷的中文版——精神疾病内化耻辱感（ISMI）量表和修订后的耻辱感消费者体验问卷（MCESQ）。这些患者还由资深精神科医生使用阳性症状评定量表（SAPS）和阴性症状评定量表（SANS）进行评估。根据中文版简明精神病评定量表自知力项目的得分，将患者分为有自知力和无自知力两组。
49例患者被归类为有自知力，43例被归类为无自知力。与有自知力的患者相比，无自知力的患者病程明显较短，更可能是住院患者，并且（仅在趋势水平上）有更明显的阳性和阴性症状。有自知力的患者ISMI的“疏离感”分量表得分显著更高，但两组在这两个工具的其余六个分量表上没有差异，且两个量表中48个单独项目中只有4个在两组之间有显著差异。逻辑回归分析发现，无自知力与两个自填式耻辱感量表的得分或两个由临床医生评定的症状量表的得分之间没有关系。
在中国住院和门诊精神分裂症患者中进行的这项研究不支持先前研究的结果，即报告显示自知力较好的患者耻辱感体验增加。本研究中使用的耻辱感测量方法需要在中国进一步修订和验证，需要开展针对更广泛患者群体的研究，对自知力进行更详细的评估，并跟踪自知力和耻辱感体验随时间的波动情况，以阐明精神分裂症患者这两种现象之间的复杂关系。
