Xu Lihua, Cui Huiru, Wei Yanyan, Qian Zhenying, Tang Xiaochen, Hu Yegang, Wang Yingchan, Hu Hao, Guo Qian, Tang Yingying, Zhang Tianhong, Wang Jijun
Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Gen Psychiatr. 2022 May 31;35(3):e100696. doi: 10.1136/gpsych-2021-100696. eCollection 2022.
Self-reflectiveness, one dimension of cognitive insight, plays a protective role in an individual's mental state. Both high and low levels of self-reflectiveness have been reported in patients with schizophrenia and individuals at clinical high risk for the illness.
This study aimed to explore the relationship patterns between self-reflectiveness and clinical symptoms in individuals during the pre-morbid and early clinical stages of psychosis.
A total of 181 subjects, including individuals with attenuated positive symptoms (APS, n=122) and patients with first-episode psychosis (FEP, n=59), completed the Beck Cognitive Insight Scale and were evaluated using the Schedule of Assessment of Insight and Positive and Negative Syndrome Scale. All subjects were classified into three groups according to their level of self-reflectiveness: low level (LSR, n=59), medium level (MSR, n=67) and high level (HSR, n=55). Both linear and non-linear relationships between self-reflectiveness and clinical symptoms were explored.
More individuals with APS were classified into the MSR group, while more patients with FEP were classified into the LSR group. The LSR group demonstrated less awareness of illness than the MSR and HSR groups, more stereotyped thinking and poorer impulse control but less anxiety than the MSR group, and lower levels of blunted affect and guilt feelings than the HSR group. The MSR group demonstrated lower stereotyped thinking than the HSR group. Compared to the LSR group, the MSR group had increased self-reflectiveness, improved awareness of illness, decreased stereotyped thinking, and better impulse control, but increased feelings of guilt. The HSR group showed increased stereotyped thinking when compared to the MSR group, but the other variables did not change significantly between these two groups. Overall, self-reflectiveness demonstrated an approximately inverse S-shaped relationship with the awareness of illness, a U-shaped relationship with stereotyped thinking and poor impulse control, and an almost linear relationship with anxiety and guilt feelings.
Self-reflectiveness demonstrates complex relationships with clinical symptoms and fails to exert significant positive effects when reaching a certain high level.
自我反思是认知洞察力的一个维度，对个体的心理状态起保护作用。精神分裂症患者及临床高危个体中均有自我反思水平高和低的报道。
本研究旨在探讨精神病前和临床早期个体的自我反思与临床症状之间的关系模式。
共有181名受试者，包括症状轻微的阳性症状个体（APS，n = 122）和首发精神病患者（FEP，n = 59），完成了贝克认知洞察量表，并使用洞察评估量表以及阳性和阴性症状量表进行评估。所有受试者根据其自我反思水平分为三组：低水平（LSR，n = 59）、中等水平（MSR，n = 67）和高水平（HSR，n = 55）。探讨了自我反思与临床症状之间的线性和非线性关系。
更多的APS个体被归类到MSR组，而更多的FEP患者被归类到LSR组。LSR组比MSR组和HSR组表现出更低的疾病自知力，更多的刻板思维和更差的冲动控制，但比MSR组焦虑更少，比HSR组情感迟钝和内疚感水平更低。MSR组比HSR组表现出更低的刻板思维。与LSR组相比，MSR组自我反思增加，疾病自知力提高，刻板思维减少，冲动控制更好，但内疚感增加。与MSR组相比，HSR组表现出更多的刻板思维，但两组之间的其他变量没有显著变化。总体而言，自我反思与疾病自知力呈近似倒S形关系，与刻板思维和冲动控制差呈U形关系，与焦虑和内疚感呈近似线性关系。
自我反思与临床症状表现出复杂的关系，在达到一定高水平时未能发挥显著的积极作用。
