Lysaker Paul H, Pattison Michelle L, Leonhardt Bethany L, Phelps Scott, Vohs Jenifer L
Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA.
College of Applied Behavioral Sciences, University of Indianapolis, Indianapolis, IN, USA.
World Psychiatry. 2018 Feb;17(1):12-23. doi: 10.1002/wps.20508.
Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.
精神分裂症患者自知力缺乏在不同文化和疾病阶段均普遍存在。在本综述中，我们审视了近期关于自知力与行为、情绪及感知生活质量之间关系的研究，探讨了自知力缺乏的复杂根源，以及现有和新兴治疗方法的效果。这项研究表明，自知力缺乏预示着较差的治疗依从性和治疗联盟、更高的症状严重程度以及更受损的社区功能，而自知力良好则预示着更高的抑郁和士气低落发生率，尤其是在伴有耻辱感和社会劣势时。该研究还表明，自知力缺乏可能是对生物、经验、神经心理学、社会认知、元认知及社会政治因素的反应。对现有和正在研发的治疗方法效果的研究表明，它们可能会影响自知力。结合早期研究和历史模型来看，这些发现支持了自知力缺乏的综合模型。该模型表明，自知力需要整合有关内部状态变化、外部环境、他人观点和生活轨迹的信息，以及这些变化中每一个的多方面后果和原因。这意味着治疗除了提供教育外，还应设法帮助精神分裂症患者将与精神疾病相关的广泛复杂且可能极其痛苦的经历整合到他们自己有个人意义、连贯且适应良好的认知图景中。
