Belvederi Murri Martino, Amore Mario, Calcagno Pietro, Respino Matteo, Marozzi Valentina, Masotti Mattia, Bugliani Michele, Innamorati Marco, Pompili Maurizio, Galderisi Silvana, Maj Mario
Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genova, Italy; Department of Psychological Medicine, King's College London, London, UK; These authors contributed equally to this work.
Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genova, Italy; These authors contributed equally to this work.
Schizophr Bull. 2016 Sep;42(5):1225-33. doi: 10.1093/schbul/sbw040. Epub 2016 Apr 11.
The so-called "insight paradox" posits that among patients with schizophrenia higher levels of insight are associated with increased levels of depression. Although different studies examined this issue, only few took in account potential confounders or factors that could influence this association. In a sample of clinically stable patients with schizophrenia, insight and depression were evaluated using the Scale to assess Unawareness of Mental Disorder and the Calgary Depression Scale for Schizophrenia. Other rating scales were used to assess the severity of psychotic symptoms, extrapyramidal symptoms, hopelessness, internalized stigma, self-esteem, and service engagement. Regression models were used to estimate the magnitude of the association between insight and depression while accounting for the role of confounders. Putative psychological and sociodemographic factors that could act as mediators and moderators were examined using the PROCESS macro. By accounting for the role of confounding factors, the strength of the association between insight into symptoms and depression increased from 13% to 25% explained covariance. Patients with lower socioeconomic status (F = 8.5, P = .04), more severe illness (F = 4.8, P = .03) and lower levels of service engagement (F = 4.7, P = .03) displayed the strongest association between insight and depression. Lastly, hopelessness, internalized stigma and perceived discrimination acted as significant mediators. The relationship between insight and depression should be considered a well established phenomenon among patients with schizophrenia: it seems stronger than previously reported especially among patients with lower socioeconomic status, severe illness and poor engagement with services. These findings may have relevant implications for the promotion of insight among patients with schizophrenia.
所谓的“领悟悖论”认为，在精神分裂症患者中，较高水平的领悟与抑郁水平的升高有关。尽管不同的研究探讨了这个问题，但只有少数研究考虑了可能影响这种关联的潜在混杂因素或因素。在一组临床稳定的精神分裂症患者样本中，使用精神障碍自知力评估量表和卡尔加里精神分裂症抑郁量表对领悟和抑郁进行了评估。使用其他评定量表评估精神病性症状、锥体外系症状、绝望感、内化耻辱感、自尊和服务参与度的严重程度。在考虑混杂因素作用的同时，使用回归模型估计领悟与抑郁之间关联的强度。使用PROCESS宏检验了可能作为中介和调节因素的假定心理和社会人口学因素。通过考虑混杂因素的作用，对症状的领悟与抑郁之间关联的强度从解释方差的13%增加到了25%。社会经济地位较低（F = 8.5，P = .04）、病情更严重（F = 4.8，P = .03）以及服务参与度较低（F = 4.7，P = .03）的患者在领悟与抑郁之间表现出最强的关联。最后，绝望感、内化耻辱感和感知到的歧视起到了显著的中介作用。领悟与抑郁之间的关系在精神分裂症患者中应被视为一种已被充分证实的现象：它似乎比之前报道的更强，尤其是在社会经济地位较低、病情严重且服务参与度差的患者中。这些发现可能对促进精神分裂症患者的领悟具有相关意义。
