Vlachos Ilias I, Selakovic Mirjana, Ralli Irene, Hatzimanolis Alexandros, Xenaki Lida-Alkisti, Dimitrakopoulos Stefanos, Soldatos Rigas-Filippos, Foteli Stefania, Nianiakas Nikos, Kosteletos Ioannis, Stefanatou Pentagiotissa, Ntigrintaki Angeliki-Aikaterini, Triantafyllou Theoni-Fani, Voulgaraki Marina, Ermiliou Vassiliki, Mantonakis Leonidas, Kollias Konstantinos, Stefanis Nikos C
1st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece.
Department of Psychiatry, Sismanoglion General Hospital, 15126 Attica, Greece.
J Clin Med. 2023 Jun 25;12(13):4261. doi: 10.3390/jcm12134261.
Clinical insight constitutes a useful marker of the progress and outcome of the First Episode of Psychosis (FEP), and lack of insight has been associated with more severe psychopathology, treatment non-adherence, and rehospitalization/relapse. In this study, we aimed to further investigate the possible role of insight as a predictor of relapse, its relation to diagnosis, and other parameters of positive psychotic symptomatology (delusions, hallucinations, and suspiciousness).
The Athens FEP study employed a prospective, longitudinal cohort design in which consecutive newly diagnosed patients with psychosis were interviewed and asked to voluntarily participate after completing informed consent. A total of 88/225 patients were examined at three different time points (baseline, month, and year). Their scores in the relevant items of the Positive and Negative Syndrome Scale (PANSS) were compared (G12 for insight, P1 for delusions, P3 for hallucinations, and P6 for suspiciousness), and they were further associated to diagnosis and the outcome at the end of the year (remission/relapse).
In total, 22/88 patients with relapse at the year had greater scores in G12 for both the month and the year, and this finding was corroborated after adjusting the statistical analysis for demographics, diagnosis, social environment, and depression via multiple logistic regression analysis. Moreover, delusions and suspiciousness were significantly higher in patients diagnosed with non-affective psychosis compared to those diagnosed with affective psychosis ( < 0.001) at the first month.
Lack of insight at the first month may serve as a predictor of relapse at the year.
临床洞察力是首发精神病（FEP）进展和预后的一个有用指标，缺乏洞察力与更严重的精神病理学、治疗依从性差以及再次住院/复发有关。在本研究中，我们旨在进一步探讨洞察力作为复发预测指标的可能作用、其与诊断的关系以及阳性精神病性症状（妄想、幻觉和猜疑）的其他参数。
雅典首发精神病研究采用前瞻性纵向队列设计，对连续新诊断的精神病患者进行访谈，并在他们签署知情同意书后邀请其自愿参与。共有88/225名患者在三个不同时间点（基线、1个月和1年）接受检查。比较他们在阳性和阴性症状量表（PANSS）相关项目中的得分（G12为洞察力，P1为妄想，P3为幻觉，P6为猜疑），并进一步将这些得分与诊断以及1年末的预后（缓解/复发）相关联。
在这一年复发的22/88名患者中，有22名在1个月和1年时G12得分更高，在通过多元逻辑回归分析对人口统计学、诊断、社会环境和抑郁进行统计分析调整后，这一发现得到了证实。此外，在第1个月时，与诊断为情感性精神病的患者相比，诊断为非情感性精神病的患者的妄想和猜疑明显更高（<0.）。
第1个月时缺乏洞察力可能是1年时复发的预测指标。 （原文此处P值未完整给出，翻译时保留原文格式）
