Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway.
J Nerv Ment Dis. 2022 Jul 1;210(7):532-540. doi: 10.1097/NMD.0000000000001475. Epub 2022 Jan 12.
Poor clinical insight is one of the most common features of schizophrenia spectrum disorders and plays a critical role in prognosis and treatment. Considering the biological and phenomenological overlap between schizophrenia and bipolar I disorder with psychotic features (BID) and increasing incidents of methamphetamine-induced psychotic disorder (MIPD) patients in Iran, it is necessary to have a clear picture of insight among these three groups. The aim of the present study was to compare clinical insight and other aspects of illness among three different disorders: schizophrenia, BID, and MIPD. In addition, we sought to examine the relationship of the severity of psychotic symptoms with clinical insight in each group. A total of 115 male inpatients, including 48 persons diagnosed with schizophrenia, 35 persons diagnosed with BID, and 32 persons diagnosed with MIPD, were selected. All participants completed the Scale to Assess Unawareness of Mental Disorder and the Positive and Negative Syndrome Scale. The results of analysis of variance indicated that schizophrenia patients reported higher rates of illness duration and number of hospital admissions in comparison to the MIPD and BID groups. In addition, persons diagnosed with BID reported more of these outcomes than MIPD groups. However, the three groups showed similar patterns in terms of age of onset and educational, marital, and occupational statuses. The results also revealed that awareness of the disorder was more impaired in schizophrenia patients compared with BID and MIPD patients and in MIPD compared with BID groups. However, the level of awareness of the effect of medication, the awareness of social consequences, and the total score of clinical insight were similar across the three diagnostic groups. As expected, poor clinical insight was correlated with high levels of positive, negative, and cognitive symptoms in the schizophrenia group; with high levels of positive, cognitive, and depressive symptoms in the BID group; and with high levels of positive and excitement symptoms in MIPD. In addition, hierarchical linear regression analyses revealed that only cognitive symptoms in the schizophrenia group and excitement symptoms in the MIPD group significantly predicted the overall score of clinical insight. In the BID group, both cognitive and depressive symptoms significantly predicted clinical insight. These findings suggest that there are differing levels of poor clinical insight in schizophrenia, MIPD, and BID and that poor clinical insight found within each group may have different antecedents.
临床洞察力差是精神分裂症谱系障碍的最常见特征之一，对预后和治疗起着至关重要的作用。考虑到精神分裂症和伴有精神病性特征的双相情感障碍 I 型（BID）以及在伊朗越来越多的甲基苯丙胺引起的精神病性障碍（MIPD）患者之间的生物学和现象学重叠，有必要清楚地了解这三组人群的洞察力。本研究的目的是比较三种不同疾病（精神分裂症、BID 和 MIPD）之间的临床洞察力和其他疾病方面。此外，我们还试图检查每组中精神病症状严重程度与临床洞察力之间的关系。共纳入 115 名男性住院患者，其中 48 名被诊断为精神分裂症，35 名被诊断为 BID，32 名被诊断为 MIPD。所有参与者都完成了精神障碍自知力评定量表和阳性与阴性症状量表。方差分析的结果表明，与 MIPD 和 BID 组相比，精神分裂症患者报告的疾病持续时间和住院次数更多。此外，被诊断为 BID 的患者比 MIPD 组报告的这些结果更多。然而，三组在发病年龄、教育程度、婚姻状况和职业状况方面表现出相似的模式。结果还表明，与 BID 和 MIPD 患者相比，精神分裂症患者对疾病的认识更差，与 BID 患者相比，MIPD 患者对疾病的认识更差。然而，三组在药物治疗效果、社会后果意识和临床洞察力总分方面的意识水平相似。不出所料，在精神分裂症组中，较差的临床洞察力与高水平的阳性、阴性和认知症状相关；在 BID 组中，较差的临床洞察力与高水平的阳性、认知和抑郁症状相关；在 MIPD 组中，较差的临床洞察力与高水平的阳性和兴奋症状相关。此外，分层线性回归分析表明，只有精神分裂症组的认知症状和 MIPD 组的兴奋症状显著预测了临床洞察力的总分。在 BID 组中，认知和抑郁症状都显著预测了临床洞察力。这些发现表明，精神分裂症、MIPD 和 BID 中存在不同程度的临床洞察力差，并且每组中发现的较差的临床洞察力可能有不同的前因。
