Insight in schizophrenia tends to be assessed as the degree to which one possesses specific knowledge. It therefore often fails to account for the fact that awareness of illness is an inextricable part of a personal narrative and may be incoherent or incomplete for many different narrative reasons. Accordingly, we have developed a means of eliciting narratives of illness: the Indiana Psychiatric Illness Interview, and a method for rating the coherence of those narratives: the Narrative Coherence Rating Scale. In this article we describe these methods and present data on their reliability and validity in a study of the illness narratives of 33 outpatients with schizophrenia or schizoaffective disorder. Results suggest our measures possess sufficient internal consistency and good to excellent interrater reliability. Additionally, as predicted, our measures of narrative coherence were significantly correlated with traditional measures of insight and with measures of cognitive impairment and hopelessness gathered earlier.
It has been alternately theorized that poor insight in patients with schizophrenia results from deficits in executive function and a preference for denial as a coping strategy. One possibility is there are two distinct groups of persons with poor insight: those with impairments in executive function and those with a generally avoidant coping style. To examine this question, the authors performed a cluster analysis on 64 persons with schizophrenia spectrum disorders on the basis of the PANSS insight and judgment item and executive function assessed with the Wisconsin Card Sorting Test. As predicted, three groups were found: good insight-average executive function (N = 28), poor insight-average executive function (N = 13), and poor insight-poor executive function (N = 23). When self-reported coping styles were compared among groups, as predicted, the poor insight-average executive function group endorsed a significantly greater preference for denial as a coping strategy than the poor insight-poor executive function group, even after controlling for differences in executive function. The coping scores of the good insight group did not differ significantly from either poor insight group. Results suggest that denial may play a role in the unawareness of illness in some persons with schizophrenia who have average executive function.
While individual differences in personality exist among persons with schizophrenia and predate the onset of illness, less is known about their relationship to outcome. This study examined whether levels of three personality dimensions-neuroticism, extraversion, and agreeableness-are associated with symptomatology and coping in persons with schizophrenia. Symptom, personality, and coping measures were obtained for 59 participants with schizophrenia. Personality and coping measures were obtained for 17 persons in a community comparison group. Relative to the community comparison groups, participants with schizophrenia had higher levels of neuroticism, lower levels of extraversion and agreeableness, and tended to employ more avoidant styles of coping. Participants with schizophrenia who had higher levels of neuroticism had greater positive and emotional discomfort symptoms and greater preferences for avoidant coping strategies. Participants with schizophrenia who had higher levels of agreeableness had lower levels of positive and excitement symptoms. No links were found between extraversion and outcome measures. Implications for understanding how personality may affect outcome are discussed.
Persons with schizophrenia are widely recognized to experience potent feelings of hopelessness, helplessness, and a fragile sense of well-being. Although these subjective experiences have been linked to positive symptoms, little is known about their relationship to neurocognition. Accordingly, this study examined the relationship of self-reports of hope, self-efficacy, and well-being to measures of neurocognition, symptoms, and coping among 49 persons with schizophrenia or schizoaffective disorder. Results suggest that poorer executive function, verbal memory, and a greater reliance on escape avoidance as a coping mechanism predicted significantly higher levels of hope and well being with multiple regressions accounting for 34% and 20% of the variance (p < .0001), respectively. Self-efficacy predicted lower levels of positive symptoms and greater preference for escape avoidance as a coping mechanism with a multiple repression accounting for 9% of the variance (p < .05). Results may suggest that higher levels of neurocognitive impairment and an avoidant coping style may shield some with schizophrenia from painful subjective experiences. Theoretical and practical implications for rehabilitation are discussed.
While individual differences in personality exist among persons with schizophrenia and predate the onset of illness, less is known about their relationship to outcome. This study examined whether levels of three personality dimensions-neuroticism, extraversion, and agreeableness-are associated with symptomatology and coping in persons with schizophrenia. Symptom, personality, and coping measures were obtained for 59 participants with schizophrenia. Personality and coping measures were obtained for 17 persons in a community comparison group. Relative to the community comparison groups, participants with schizophrenia had higher levels of neuroticism, lower levels of extraversion and agreeableness, and tended to employ more avoidant styles of coping. Participants with schizophrenia who had higher levels of neuroticism had greater positive and emotional discomfort symptoms and greater preferences for avoidant coping strategies. Participants with schizophrenia who had higher levels of agreeableness had lower levels of positive and excitement symptoms. No links were found between extraversion and outcome measures. Implications for understanding how personality may affect outcome are discussed.
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