Sportel Bouwina Esther, van Enthoven Mirjam, van Donkersgoed Rozanne J M, Kuis Daan Jan, van de Giessen Tara, Lysaker Paul H, Hasson-Ohayon Ilanit, de Jong Steven, Boonstra Nynke, Pijnenborg Gerdina H M
Department of Psychotic Disorders, GGZ Drenthe Mental Health Institute, Assen, Netherlands.
Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands.
Front Psychiatry. 2023 Apr 13;14:1154284. doi: 10.3389/fpsyt.2023.1154284. eCollection 2023.
Impaired cognitive insight and increased self-stigma have been consistently reported in individuals diagnosed with schizophrenia spectrum disorders, but little is known about its presence in individuals at ultra-high risk of developing a psychosis, although self-stigma is associated with transition.to psychosis. The current study examined whether self-stigma is already present in individuals at ultra-high risk of psychosis, and whether this is associated with impaired cognitive insight.
184 participants were recruited divided over three groups, namely individuals diagnosed with a schizophrenia spectrum disorder (SSD; n = 92, 34% females), individuals at ultra-high risk for psychosis (UHR; n = 43, 59% females) and general population controls (GPC; n = 49, 27% females). All participants completed assessments on demographic information (gender, age, education), and cognitive insight. In addition, participants with SSD and individuals at UHR completed a questionnaire on self-stigma.
The level of self-stigma did not differ between individuals at UHR and individuals diagnosed with SSD. Cognitive insight also did not differ significantly between the three groups, but the subscale self-reflection differed between the three groups [(2,184) = 4.20, = 0.02], with the UHR and SSD groups showing more self-reflection. Pearson's correlation analyses showed that in individuals at UHR total cognitive insight and its self-reflection subscale were significantly associated with the alienation subscale of self-stigma, and in individuals with SSD self-certainty subscale of cognitive insight was significantly associated with stereotype endorsement.
Findings show that self-stigma was already present in the UHR phase, to a similar degree as in individuals with a diagnosis of a SSD, and is thus not dependent of previous experience of having a label of SSD. Cognitive insight in individuals at UHR of psychosis appears to be intact, but individuals at UHR showed more self-reflectiveness, and individuals at risk with high cognitive insight also experience high levels of self-stigma. Overall findings from our study suggest that pre-emptive interventions targeting self-stigma, while considering cognitive insight, are needed early on in manifestation of psychotic illness, preferably already in the UHR phase.
在被诊断为精神分裂症谱系障碍的个体中，认知洞察力受损和自我污名化增加的情况一直有报道，但对于处于精神病超高风险的个体中是否存在这种情况却知之甚少，尽管自我污名化与向精神病的转变有关。本研究调查了自我污名化是否已经存在于处于精神病超高风险的个体中，以及这是否与认知洞察力受损有关。
招募了184名参与者，分为三组，即被诊断为精神分裂症谱系障碍的个体（SSD；n = 92，34%为女性）、处于精神病超高风险的个体（UHR；n = 43，59%为女性）和普通人群对照组（GPC；n = 49，27%为女性）。所有参与者都完成了关于人口统计学信息（性别、年龄、教育程度）和认知洞察力的评估。此外，患有SSD的参与者和处于UHR的个体完成了一份关于自我污名化的问卷。
UHR个体和被诊断为SSD的个体之间的自我污名化水平没有差异。三组之间的认知洞察力也没有显著差异，但三组之间的自我反思子量表存在差异[(2,184) = 4.20， = 0.02]，UHR组和SSD组表现出更多的自我反思。Pearson相关分析表明，在UHR个体中，总的认知洞察力及其自我反思子量表与自我污名化的疏离子量表显著相关，而在患有SSD的个体中，认知洞察力的自我确定性子量表与刻板印象认同显著相关。
研究结果表明，自我污名化在UHR阶段就已经存在，程度与被诊断为SSD的个体相似，因此不依赖于先前有SSD标签的经历。处于精神病UHR阶段的个体的认知洞察力似乎是完整的，但UHR个体表现出更多的自我反思，并且认知洞察力高的风险个体也经历高水平的自我污名化。我们研究的总体结果表明，在精神病性疾病表现的早期阶段，最好在UHR阶段就需要针对自我污名化并考虑认知洞察力的预防性干预措施。
