Gerretsen Philip, Voineskos Aristotle N, Graff-Guerrero Ariel, Menon Mahesh, Pollock Bruce G, Mamo David C, Mulsant Benoit H, Rajji Tarek K
FRCPC, Centre for Addiction and Mental Health, 80 Workman Way, 6th Floor, Toronto, ON M6J1H4, Canada.
Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
J Clin Psychiatry. 2017 Apr;78(4):e390-e397. doi: 10.4088/JCP.16m10741.
Impaired insight into illness in schizophrenia is associated with illness severity and deficits in premorbid intellectual function, executive function, and memory. A previous study of patients aged 60 years and older found that illness severity and premorbid intellectual function accounted for variance in insight impairment. As such, we aimed to test whether similar relationships would be observed in earlier life.
A retrospective analysis was performed on 1 large sample of participants (n = 171) with a DSM-IV-TR diagnosis of schizophrenia aged 19 to 79 years acquired from 2 studies: (1) a psychosocial intervention trial for older persons with schizophrenia (June 2008 to May 2014) and (2) a diffusion tensor imaging and genetics study of psychosis across the life span (February 2007 to December 2013). We assessed insight into illness using the Positive and Negative Syndrome Scale (PANSS) item G12 and explored its relationship to illness severity (PANSS total modified), premorbid intellectual function (Wechsler Test of Adult Reading [WTAR]), and cognition.
Insight impairment was more severe in later life (≥ 60 years) than in earlier years (t = -3.75, P < .001). Across the whole sample, the variance of impaired insight was explained by PANSS total modified (Exp[B] = 1.070, P < .001) and WTAR scores (Exp[B] = 0.970, P = .028). Although age and cognition were correlated with impaired insight, they did not independently contribute to its variance. However, the relationships between impaired insight and illness severity and between impaired insight and cognition, particularly working memory, were stronger in later life than in earlier life.
These results suggest an opportunity for intervention may exist with cognitive-enhancing neurostimulation or medications to improve insight into illness in schizophrenia across the life span.
Original study registered on ClinicalTrials.gov (identifier: NCT00832845).
精神分裂症患者自知力受损与疾病严重程度以及病前智力功能、执行功能和记忆缺陷有关。先前一项针对60岁及以上患者的研究发现，疾病严重程度和病前智力功能可解释自知力损害的差异。因此，我们旨在测试在生命早期是否也会观察到类似的关系。
对从两项研究中获取的171名年龄在19至79岁之间、符合《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）精神分裂症诊断标准的参与者大样本进行回顾性分析：（1）一项针对老年精神分裂症患者的社会心理干预试验（2008年6月至2014年5月）；（2）一项贯穿生命周期的精神病扩散张量成像和遗传学研究（2007年2月至2013年12月）。我们使用阳性和阴性症状量表（PANSS）的G12项评估自知力，并探讨其与疾病严重程度（PANSS总修订版）、病前智力功能（韦氏成人阅读测验[WTAR]）和认知的关系。
晚年（≥60岁）的自知力损害比早年更严重（t = -3.75，P <.001）。在整个样本中，PANSS总修订版（Exp[B] = 1.070，P <.001）和WTAR分数（Exp[B] = 0.970，P =.028）可解释自知力损害的差异。虽然年龄和认知与自知力损害相关，但它们并未独立影响其差异。然而，自知力损害与疾病严重程度之间以及自知力损害与认知（尤其是工作记忆）之间的关系在晚年比早年更强。
这些结果表明，使用认知增强神经刺激或药物进行干预可能有机会改善精神分裂症患者在整个生命周期内的自知力。
原始研究已在ClinicalTrials.gov上注册（标识符：NCT00832845）。
