Insight, Global Functioning and Psychopathology Amongst In-patient Clients with Schizophrenia

Abstract

To explore whether cognitive impairment and global functioning can predict the degree of insight into illness as well as whether insight is mediated by specific symptom dimensions of psychopathology in schizophrenia. A dimensional/cross sectional approach was used. A mixed group of clients (n = 36) were assessed as part of a routine clinical evaluation. The Wechsler Adult Intelligence Scale (WAIS) was used as a measure of intellectual performance, the Brief Symptom Inventory (BSI) was used as a measure of general psychopathology while the Global Assessment of Functioning (GAF) scale assessed clients' psychosocial functioning; insight was assessed with the Insight and Treatment Attitudes Questionnaire (ITAQ). The correlation matrix of all outcome variables was examined; confounding effects of illness duration were tested by partial correlation analyses. GAF correlated with insight (rho = 0.41, P = 0.01) and the interpersonal sensitivity dimension of BSI (rho = -0.38, P = 0.03. Insight correlated positively with the anxiety (rho = 0.38, P = 0.03) and psychoticism (rho = 0.36, P = 0.04) dimensions of BSI. Our results suggest that insight is part of the phenomenology in schizophrenia, not being determined by neurocognitive disturbances. Improved insight was associated with more frequent psychotic symptoms endorsement, higher levels of anxiety and less severe psychopathological symptoms and difficulties in psychosocial functioning; clients with more pronounced difficulties in their personal and social interactions exhibited worse psychosocial functioning and more severe psychopathological symptoms.

Associations of psychiatric symptoms and neurocognition with clinical insight in schizophrenia

“…This study, which does not find a significant relationship between insight and neurocognitive functions, is consistent with other larger studies that have not established a relationship between insight and executive functions, memory, and attention (10,17,18). However, in a recent meta-analysis, a significant but small relation was found between neurocognitive functions and clinical insight (19).…”

“…Past research regarding this model revealed inconsistent findings. In some studies, there was a relationship between poor insight, executive functions (14,15) and memory impairment (16), whereas no relation was found in other studies (17,18). In a recent meta-analysis, neurocognitive impairment has been shown to have a significant but small effect on clinical insight (19).…”

Predictors of Real-World Functioning Improvement in a Sample of Psychiatric Outpatients

“…This finding is expected and intuitive as individuals with a higher level of symptoms producing a significant functional impairment have fewer resources to achieve and maintain the real-word milestones. Literature confirmed our results reporting significant relationships between severity of symptom domains and functional outcome in schizophrenia and mood disorders [49][50][51][52][53][54][55][56][57]. The lack of significant relationships between PSP change and severity of global symptoms in BPD patients might depend on the considerable heterogeneity of BPD symptomatology that would produce unstable and unpredictable effects on the real-world functioning.…”

An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments

“…Impaired insight is linked to important outcome variables such as treatment non-adherence [7][8][9], higher rates of re-hospitalization [10], poorer social skills [11], reduced social relationships [12,13], compromised work performance [14,15], and a longer duration of untreated psychosis [16,17]. Impaired insight has also been linked to concurrent and prospective assessments of quality of life [18], poorer personal recovery [19], and poor global functioning [20,21]. In line with this, other investigations have shown that individuals with higher levels of insight are better able to appraise their level of psychosocial functioning [22] and tend to have more self-efficacy when compared to individuals with poorer insight [23].…”