Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Depatment of Psychiatry, Bejing Changping Hospital of Integrated Chinese and Western Medicine, Beijing, China.
Psychiatry Res. 2022 Jul;313:114613. doi: 10.1016/j.psychres.2022.114613. Epub 2022 May 10.
Poor cognitive insight, including low self-reflectiveness and high self-certainty, contributes to poor clinical insight, which includes awareness of illness, relabelling of specific symptoms, and treatment compliance. However, inconsistent results regarding cognitive insight among individuals at clinical high risk of psychosis (CHR) have been reported. This study investigated the difference in cognitive insight among groups with different severity of positive symptoms and analysed the effect of cognitive insight on clinical insight in each group. All participants, including CHR individuals with 3 or 4 points (L-P, n = 85) and 5 points (H-P, n = 37) on any positive-symptom item of the Scale of Prodromal Syndromes, and patients with first-episode psychosis (FEP, n = 59), were measured cognitive and clinical insight using the Beck Cognitive Insight Scale and the Schedule of Assessment of Insight, respectively. The self-reflectiveness of cognitive insight was highest in the L-P group and lowest in the FEP group. Self-reflectiveness was positively associated with awareness of illness in the L-P and FEP groups; both self-reflectiveness and self-certainty was positively associated with treatment compliance in the L-P group. Improving self-reflectiveness of cognitive insight may conduce to good clinical insight. Self-certainty may have different implication to individuals with mild prodromal symptoms.
认知洞察力差，包括自我反思能力低和自我确信度高，会导致临床洞察力差，包括对疾病的认识、对特定症状的重新标记以及治疗依从性。然而，在精神病高危人群（CHR）中，个体的认知洞察力存在不一致的结果。本研究调查了不同阳性症状严重程度的个体之间认知洞察力的差异，并分析了认知洞察力对每个组临床洞察力的影响。所有参与者，包括阳性症状项目中任何一项得 3 分或 4 分（L-P，n=85）和 5 分（H-P，n=37）的 CHR 个体，以及首发精神病患者（FEP，n=59），分别使用贝克认知洞察力量表和评估洞察力时间表来测量认知和临床洞察力。认知洞察力的自我反思在 L-P 组中最高，在 FEP 组中最低。自我反思与 L-P 和 FEP 组的疾病意识呈正相关；在 L-P 组中，自我反思和自我确信与治疗依从性呈正相关。提高认知洞察力的自我反思能力可能有助于获得良好的临床洞察力。自我确信对轻度前驱症状的个体可能有不同的影响。
