Amador X F, Flaum M, Andreasen N C, Strauss D H, Yale S A, Clark S C, Gorman J M
Department of Clinical Psychobiology, New York State Psychiatric Institute.
Arch Gen Psychiatry. 1994 Oct;51(10):826-36. doi: 10.1001/archpsyc.1994.03950100074007.
The literature on insight, or self-awareness, in schizophrenia suggests that this cognitive dimension may be of nosological value. Poor insight has descriptive validity at the phenomenological and neuropsychological levels of schizophrenia and has prognostic validity in terms of the prediction of the course of illness. The lack of empirical data on the diagnostic specificity of poor insight to schizophrenia and the previous use of insight measures with questionable reliability and validity have limited this interpretation.
In the present study, we assessed insight into multiple aspects of mental disorder using a measure with demonstrated reliability and validity. A sample of 412 patients with psychotic and mood disorders coming from geographically diverse regions of the United States and one international site was studied. The main aims were to determine the prevalence of self-awareness deficits in patients in whom schizophrenia was diagnosed, to examine the relative severity of self-awareness deficits associated with schizophrenia compared with that of schizoaffective and mood disorders with and without psychosis, and to evaluate the clinical correlates of self-awareness in patients with schizophrenia.
The results indicated that poor insight is a prevalent feature of schizophrenia. A variety of self-awareness deficits are more severe and pervasive in patients with schizophrenia than in patients with schizoaffective or major depressive disorders with or without psychosis and are associated with poorer psychosocial functioning.
The results suggest that severe self-awareness deficits are a prevalent feature of schizophrenia, perhaps stemming from the neuropsychological dysfunction associated with the disorder, and are more common in schizophrenia than in other psychotic disorders.
关于精神分裂症中自知力或自我意识的文献表明，这一认知维度可能具有疾病分类学价值。自知力缺乏在精神分裂症的现象学和神经心理学层面具有描述效度，且在疾病进程预测方面具有预后效度。然而，自知力缺乏对精神分裂症诊断特异性的实证数据不足，以及既往使用的自知力测量方法的信效度存疑，限制了这一解释。
在本研究中，我们使用一种已证明具有信效度的测量方法评估对精神障碍多个方面的自知力。对来自美国不同地理区域和一个国际地点的412例患有精神病性和心境障碍的患者样本进行了研究。主要目的是确定精神分裂症诊断患者中自我意识缺陷的患病率，检查与精神分裂症相关的自我意识缺陷与伴有或不伴有精神病性症状的分裂情感性障碍和心境障碍相比的相对严重程度，并评估精神分裂症患者自我意识的临床相关性。
结果表明自知力缺乏是精神分裂症的一个普遍特征。与伴有或不伴有精神病性症状的分裂情感性障碍或重度抑郁症患者相比，精神分裂症患者的各种自我意识缺陷更为严重和普遍，且与较差的社会心理功能相关。
结果表明严重的自我意识缺陷是精神分裂症的一个普遍特征，可能源于与该疾病相关的神经心理功能障碍，且在精神分裂症中比在其他精神病性障碍中更常见。
