Dönmezler Süleyman, İskender Gizem, Fıstıkcı Nurhan, Altunkaynak Yavuz, Ulusoy Sevinç, Berkol Tonguç Demir
Department of Psychiatry, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.
Department of Psychiatry, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey.
Alpha Psychiatry. 2023 May 1;24(3):102-107. doi: 10.5152/alphapsychiatry.2023.221030. eCollection 2023 May.
There remains a lack of clarity as to the possible cross talk of insight into illness and depressive symptoms in treatment-resistant schizophrenia. We therefore set our primary aim to evaluate relationship between insight dimensions and depressive symptoms in patients with treatment-resistant schizophrenia receiving clozapine.
This was a cross-sectional, non-interventional study, conducted in daily clinical practice conditions. Patients in outpatient clinics between March 2020 and May 2020 with treatment-resistant schizophrenia (based on Treatment Response and Resistance in Psychosis), with no comorbid psychiatric disorder, and with no body mass index greater than 40.0 kg/m were included. We collected sociodemographic variables, scores of insight dimensions (treatment compliance, illness recognition, and symptom relabeling with the Schedule for Assessment of Insight), and depressive symptoms with Calgary Depression Score for Schizophrenia. Linear regression models were used to investigate variables associated with depressive symptoms as the outcome of interest.
The final analysis sample comprised 55 patients with treatment-resistant schizophrenia, with a mean age of 42.48 (SD = 9.18) years and a predominance of the male sex (n = 42, 76.9%). Model 1 [Calgary Depression Score for Schizophrenia ~ (Schedule for Assessment of Insight + Positive and Negative Syndrome Scale)] displayed that 48% of the variation in the Calgary Depression Score for Schizophrenia can be explained by Schedule for Assessment of Insight-composite and Positive and Negative Syndrome Scale-composite ( < .001). More effectively, model 2 [Calgary Depression Score for Schizophrenia ~ (Schedule for Assessment of Insight-illness recognition + Positive and Negative Syndrome Scale-general psychopathology)] revealed that 51% of the variation in the Calgary Depression Score for Schizophrenia can be explained by the sub-scales ( < .001). We further designed a new model in which Global Assessment of Functioning scores were the response variable to explore the link between awareness into illness and functionality (Global Assessment of Functioning ~ Schedule for Assessment of Insight-illness recognition). In this model, awareness of illness did not explain a significant proportion of variance in functionality scores ( = 0.045, (1,52) = 2.48, = 0.121).
The treatment compliance part of insight was not one of the significant explanatory variables of depressive symptoms, but it explained the variance in functioning, in contrast to the illness recognition dimension of insight. If our findings were replicated in treatment-resistant schizophrenia, they would suggest that promoting treatment compliance dimension of insight instead of recognition of illness could not increase depressive symptoms.
对于难治性精神分裂症中对疾病的洞察与抑郁症状之间可能存在的相互作用，目前仍缺乏清晰的认识。因此，我们将主要目标设定为评估接受氯氮平治疗的难治性精神分裂症患者的洞察维度与抑郁症状之间的关系。
这是一项在日常临床实践条件下进行的横断面、非干预性研究。纳入了2020年3月至2020年5月在门诊就诊的难治性精神分裂症患者（基于精神病治疗反应和耐药性），无合并精神障碍，体重指数不超过40.0kg/m 。我们收集了社会人口统计学变量、洞察维度得分（治疗依从性、疾病认识以及使用洞察评估量表进行症状重新标注），以及使用精神分裂症卡尔加里抑郁量表评估的抑郁症状。使用线性回归模型来研究与作为感兴趣结果的抑郁症状相关的变量。
最终分析样本包括55例难治性精神分裂症患者，平均年龄为42.48（标准差=9.18）岁，男性占多数（n = 42，76.9%）。模型1[精神分裂症卡尔加里抑郁量表（洞察评估量表+阳性和阴性症状量表）]显示，精神分裂症卡尔加里抑郁量表中48%的变异可由洞察评估量表综合得分和阳性和阴性症状量表综合得分解释（P<0.001）。更有效的是，模型2[精神分裂症卡尔加里抑郁量表（洞察评估量表-疾病认识+阳性和阴性症状量表-一般精神病理学）]显示，精神分裂症卡尔加里抑郁量表中51%的变异可由子量表解释（P<0.001）。我们进一步设计了一个新模型，其中功能总体评估得分作为反应变量，以探索对疾病的认识与功能之间的联系（功能总体评估~洞察评估量表-疾病认识）。在这个模型中，对疾病的认识并不能解释功能得分中很大比例的变异（F = 0.045，（1,52）= 2.48，P = 0.121）。
洞察的治疗依从性部分不是抑郁症状的重要解释变量之一，但与洞察的疾病认识维度相反，它解释了功能方面的变异。如果我们的研究结果在难治性精神分裂症中得到重复验证，这将表明促进洞察的治疗依从性维度而非疾病认识不会增加抑郁症状。
