Mervis Joshua E, Fischer Jamie, Cooper Samuel E, Deckert Andrew C, Lysaker Paul H, MacDonald Angus W, Meyer-Kalos Piper
University of Minnesota, Department of Psychology, United States of America.
University of Minnesota, School of Social Work, United States of America.
Schizophr Res Cogn. 2021 May 27;26:100200. doi: 10.1016/j.scog.2021.100200. eCollection 2021 Dec.
Substance use exacerbates psychosis, mania, depression, and poor functioning in people with first episodes of psychosis (FEP) and is associated with poor treatment outcomes, even when it does not reach the level of a formal disorder. Impaired insight and substance use are common issues that may interfere with treatment outcomes among people experiencing FEP, yet both are treatable. Improvements in these domains are associated with better outcomes. Low insight could increase risk for substance use by impairing the ability to self-appraise and assess consequences. Introspective accuracy (IA) is understudied in this area and is one way of considering self-appraisal. This study is an archival review using data collected from NAVIGATE, a coordinated specialty care program treating people with FEP. IA was operationalized as the difference between clinician and client ratings of substance use. We tested whether IA changed over one year of treatment and whether those changes occurred alongside changes in symptoms and illness self-management. No changes in IA were detected in relation to illness self-management. Changes in IA for substance use occurred midway through treatment-individuals with greater symptom remission had more overconfident IA. Prior research on insight has shown a paradox where greater insight accompanies more symptoms. However, past research has also shown a relationship between IA and functional outcomes, like illness self-management, and that overconfidence in one domain can positively bias clinician ratings in another. Our findings suggest either a positive bias for ratings associated with overconfident IA or an insight paradox type effect.
物质使用会加剧首次发作精神病（FEP）患者的精神病性症状、躁狂、抑郁及功能障碍，即便未达到正式疾病的程度，也与治疗效果不佳相关。洞察力受损和物质使用是可能干扰FEP患者治疗效果的常见问题，但两者均可治疗。这些方面的改善与更好的治疗结果相关。低洞察力可能会通过损害自我评估和评估后果的能力而增加物质使用的风险。内省准确性（IA）在该领域研究较少，是考量自我评估的一种方式。本研究是一项档案回顾，使用了从NAVIGATE收集的数据，NAVIGATE是一个治疗FEP患者的协调专科护理项目。IA被定义为临床医生和患者对物质使用评分的差异。我们测试了IA在一年治疗期间是否发生变化，以及这些变化是否与症状和疾病自我管理的变化同时出现。未发现IA在疾病自我管理方面有变化。物质使用的IA变化发生在治疗中期，症状缓解程度较高的个体IA过度自信程度更高。先前关于洞察力的研究显示了一种悖论，即洞察力越强伴随的症状越多。然而，过去的研究也表明IA与功能结果（如疾病自我管理）之间存在关联，并且在一个领域的过度自信会对另一个领域的临床医生评分产生积极偏差。我们的研究结果表明，要么存在与过度自信的IA相关的评分积极偏差，要么存在洞察力悖论类型的效应。
