Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710, United States.
Psychiatry and Behavioral Sciences, Duke University School of Medicine, United States.
Schizophr Res. 2018 Mar;193:83-90. doi: 10.1016/j.schres.2017.07.002. Epub 2017 Jul 8.
Insight in schizophrenia is long known to have a complex relationship with psychopathology symptoms and cognition. However, very few studies have examined models that explain these interrelationships.
In a large sample derived from the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial (N=1391), we interrogated these interrelationships for potential causal pathways using structural equation modeling. Using the NIMH consensus model, latent variables were constructed for psychopathology symptom dimensions, including positive, negative, disorganized, excited and depressed from the Positive and Negative Syndrome Scale (PANSS) items. Neurocognitive variables were created from five predefined domains of working memory, verbal memory, reasoning, vigilance and processing speed. Illness insight and treatment insight were tested using latent variables constructed from the Illness and Treatment Attitude Questionnaire (ITAQ).
Disorganized symptoms had the strongest effect on insight. Illness insight mediated the relationship of positive, depressed, and disorganized symptoms with treatment insight. Neurocognition mediated the relationship between disorganized and treatment insight and depressed symptoms and treatment insight. There was no effect of negative symptoms on either illness insight or treatment insight. Taken together, our results indicate overlapping and unique relational paths for illness and treatment insight dimensions, which could suggest differences in causal mechanisms and potential interventions to improve insight.
精神分裂症的洞察力长期以来一直被认为与精神病理学症状和认知有复杂的关系。然而，很少有研究探讨过可以解释这些相互关系的模型。
在一项源自美国国立卫生研究院精神分裂症临床试验干预效果（CATIE）的大型样本中（N=1391），我们使用结构方程模型来探究这些相互关系中的潜在因果途径。使用 NIMH 共识模型，从阳性和阴性综合征量表（PANSS）项目中构建了用于精神病理学症状维度的潜在变量，包括阳性、阴性、紊乱、兴奋和抑郁。使用五个预先定义的工作记忆、言语记忆、推理、警惕和处理速度领域创建了神经认知变量。使用从疾病和治疗态度问卷（ITAQ）构建的潜在变量测试了疾病洞察力和治疗洞察力。
紊乱症状对洞察力的影响最大。疾病洞察力中介了阳性、抑郁和紊乱症状与治疗洞察力之间的关系。神经认知中介了紊乱和治疗洞察力以及抑郁症状与治疗洞察力之间的关系。阴性症状对疾病洞察力或治疗洞察力没有影响。总的来说，我们的结果表明，疾病和治疗洞察力维度存在重叠和独特的关系路径，这可能表明在因果机制和改善洞察力的潜在干预措施方面存在差异。
