Park Sang Won, Lee Nam Young, Jeong Hee Yeon, Chung In Won, Kim Yong Sik, Jeong Seong Hoon
Inarae Psychiatry Clinic, Cheongju, Republic of Korea.
Department of Psychiatry, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, Republic of Korea.
Psychiatry Investig. 2024 Apr;21(4):403-414. doi: 10.30773/pi.2023.0396. Epub 2024 Apr 23.
Auditory verbal hallucination (AVH) is a prominent symptom of schizophrenia causing profound distress. The influence of AVHs on insight appears to be intricate and contingent on other accompanying symptoms. This study investigated the relationship and possible mediators between AVHs and the degree of insight.
One hundred patients with schizophrenia participated in the study. Scales were used to evaluate the hallucinatory experience, the level of insight and other psychopathology. Complex relationships between variables were envisaged as a path model, whose initial structure was constructed via Gaussian Graphical Model. The validity of the final model was verified by Structural Equation Modeling. Separate analyses were performed for self-reported and clinician-rated data to enhance the model's robustness.
The greater the severity of the physical aspects of AVHs, the lower the level of insight observed. Conversely, higher emotional distress was associated with increased insight. These relationships were only evident in the self-reported results and were not reflected in the clinician-rated results. The path model suggested that the Positive and Negative Syndrome Scale (PANSS) anxiety/depression factor was an important mediator that linked the found association. Notably, the PANSS negative symptom had the opposite effect on the PANSS anxiety/depression factor and insight, making it difficult to define its overall effect.
The findings of this study provided one possible route for the positive influence of AVH experience in gaining insight. The mediating role of anxiety/depression modified by negative symptoms emerged as a valuable concept for clarifying this intricate relationship.
幻听是精神分裂症的一个突出症状，会造成极大痛苦。幻听对自知力的影响似乎很复杂，且取决于其他伴随症状。本研究调查了幻听与自知力程度之间的关系及可能的中介因素。
100名精神分裂症患者参与了本研究。使用量表评估幻觉体验、自知力水平及其他精神病理学表现。将变量之间的复杂关系设想为一个路径模型，其初始结构通过高斯图形模型构建。最终模型的有效性通过结构方程模型进行验证。对自我报告数据和临床医生评定数据进行单独分析，以增强模型的稳健性。
幻听身体方面的严重程度越高，观察到的自知力水平越低。相反，更高的情绪困扰与自知力增加有关。这些关系仅在自我报告结果中明显，未在临床医生评定结果中体现。路径模型表明，阳性和阴性症状量表（PANSS）焦虑/抑郁因子是连接所发现关联的重要中介因素。值得注意的是，PANSS阴性症状对PANSS焦虑/抑郁因子和自知力有相反的影响，因此难以确定其总体效应。
本研究结果为幻听体验在获得自知力方面的积极影响提供了一种可能途径。由阴性症状调节的焦虑/抑郁的中介作用成为阐明这种复杂关系的一个有价值的概念。
