University of Nevada, Las Vegas, Las Vegas, NV, USA.
, Martinez, USA.
Psychiatr Q. 2019 Jun;90(2):339-350. doi: 10.1007/s11126-019-09631-6.
Individuals with a severe mental illness, particularly a psychotic disorder, often lack insight into having a mental illness. This study sought to examine the differences in insight and symptom severity between individuals with psychotic, bipolar, and depressive disorders in an inpatient psychiatric sample. 199 participants were interviewed and medical records were consulted. Results show that participants with a psychotic disorder had significantly less insight into their illness, more debilitating symptoms, and reported less depression symptoms after controlling for education, race, marital status, homelessness, age, gender, and history of incarceration. Insight was shown to be a mediator between having a psychotic disorder and symptom severity. Subjective quality of life did not differ by diagnosis. Substance use was not associated with insight or overall symptom severity, while homelessness was associated with having a psychotic disorder and more severe symptoms. Fostering insight during an inpatient stay may be an important part of reducing symptom severity and preventing patient relapse. However, greater insight may increase depression and suicidality, indicating a need for mood management and safety planning along with psychoeducation of symptoms.
患有严重精神疾病的个体，特别是精神病患者，往往无法正确认识自身的精神疾病。本研究旨在比较精神病、双相情感障碍和抑郁症患者在住院精神病患者样本中的洞察力和症状严重程度的差异。对 199 名参与者进行了访谈，并查阅了病历记录。结果表明，在控制了教育程度、种族、婚姻状况、无家可归、年龄、性别和监禁史等因素后，患有精神病的参与者对自身疾病的认识明显不足，症状更为严重，抑郁症状也较少。洞察力被证明是精神病和症状严重程度之间的中介因素。主观生活质量不因诊断而异。物质使用与洞察力或整体症状严重程度无关，而无家可归与患有精神病和更严重的症状有关。在住院期间培养洞察力可能是减轻症状严重程度和预防患者复发的重要组成部分。然而，更深入的洞察力可能会增加抑郁和自杀倾向，这表明需要进行情绪管理和安全计划，以及对症状进行心理教育。
