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David Baxter

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Insight linked to prognosis in first-episode psychosis patients
17 January 2007
Schizophr Res 2007; 89: 123?128

Researchers have found that a significant proportion of patients with first-episode schizophrenia have good insight at the initial assessment and that it improves over subsequent years.

"It seems as if at least for the first 3 years good insight remains stable," they report in the journal Schizophrenia Research.

These findings are "encouraging," the investigators note, and suggest that patients may accept pharmacological and psychological treatment during the early stages of their condition.

Huma Saeedi (Centre for Addiction and Mental Health, Toronto, Canada) and colleagues investigated insight in 278 individuals admitted to a comprehensive early psychosis treatment program. Insight, symptoms, and cognition were assessed on admission and after 1, 2, and 3 years.

At baseline, 60% of patients exhibited good insight, defined as a score below 4 on G12 of the Positive and Negative Syndrome Scale (PANSS).

The proportion of patients with good insight increased to 83% by the third year of follow-up, with intermediate rates of 80% at 1 year and 79% at 2 years.

Comparing patients with good and poor insight revealed that, at each assessment point, poor insight was associated with higher ratings for positive, negative, and general psychopathology symptoms.

Patients with good insight had higher overall cognitive scores at the 1-year assessment, and they also performed significantly better than those with poor insight on several individual cognitive tests. Notably, this occurred using the Wisconsin Card Sorting Test, a measure that is thought to be related to insight.

"Since the poor insight group demonstrates poor cognitive functioning and consistent poor ratings on all PANSS ratings, this may also reflect that a lack of insight is just one more deficit that marks a poor prognosis subgroup," Saeedi and team propose.

Baseline levels of depression were higher among patients with good insight than those with poor insight, which the researchers say supports the theory that "self-awareness deficits in psychosis may result from a form of psychological defense."

However, at subsequent assessments, depression levels did not differ significantly between those with good and poor insight.

"In terms of clinical implications, early psychosis treatment programs should capitalize on the fact that the majority of first-episode subjects may actually present with intact insight and work to engage them in the range of pharmacological and psychological treatments that are becoming standard practice in early psychosis," the investigators conclude.

abstract
 

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