Knowledge and insight in relation to functional remission in patients with long-term psychotic disorders

Alenius, Malin; Hammarlund‐Udenaes, Margareta; Hartvig, Per; Lindström, Leif

doi:10.1007/s00127-009-0096-3

Cited by 11 publications

(5 citation statements)

References 35 publications

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“…This metacognitive model propose a ‘social’ aspect of insight relied upon the ability of the patient to accept and incorporate others' opinion (e.g., professionals, friends, family) about psychosis into one's own insight. We thus hypothesize that neurocognitive and metacognitive conceptions of insight may represent a continuous process necessary to have an impact on nonadherence [43], in which patients with schizophrenia gain knowledge about the illness (awareness of symptoms) and then subsume their ‘awareness of symptoms’ into the ‘awareness of having mental disorder’ by accepting the other perspectives in a context of social situations. ‘Unawareness of positive symptoms’ and a possible psychological defense may be involved in this continuous process, which leads to nonadherence but to a lesser extent than neurocognition and metacognition.…”

Section: Discussionmentioning

confidence: 99%

Neurocognition, Insight and Medication Nonadherence in Schizophrenia: A Structural Equation Modeling Approach

et al. 2012

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ObjectiveThe aim of this study was to examine the complex relationships among neurocognition, insight and nonadherence in patients with schizophrenia.Methods Design: Cross-sectional study. Inclusion criteria: Diagnosis of schizophrenia according to the DSM-IV-TR criteria. Data collection: Neurocognition was assessed using a global approach that addressed memory, attention, and executive functions; insight was analyzed using the multidimensional ‘Scale to assess Unawareness of Mental Disorder;’ and nonadherence was measured using the multidimensional ‘Medication Adherence Rating Scale.’ Analysis: Structural equation modeling (SEM) was applied to examine the non-straightforward relationships among the following latent variables: neurocognition, ‘awareness of positive symptoms’ and ‘negative symptoms’, ‘awareness of mental disorder’ and nonadherence.ResultsOne hundred and sixty-nine patients were enrolled. The final testing model showed good fit, with normed χ2 = 1.67, RMSEA = 0.063, CFI = 0.94, and SRMR = 0.092. The SEM revealed significant associations between (1) neurocognition and ‘awareness of symptoms,’ (2) ‘awareness of symptoms’ and ‘awareness of mental disorder’ and (3) ‘awareness of mental disorder’ and nonadherence, mainly in the ‘attitude toward taking medication’ dimension. In contrast, there were no significant links between neurocognition and nonadherence, neurocognition and ‘awareness of mental disorder,’ and ‘awareness of symptoms’ and nonadherence.ConclusionsOur findings support the hypothesis that neurocognition influences ‘awareness of symptoms,’ which must be integrated into a higher level of insight (i.e., the ‘awareness of mental disorder’) to have an impact on nonadherence. These findings have important implications for the development of effective strategies to enhance medication adherence.

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Section: Discussionmentioning

confidence: 99%

Neurocognition, Insight and Medication Nonadherence in Schizophrenia: A Structural Equation Modeling Approach

et al. 2012

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“…This type of design has been utilized when there have been limits to verifying the time criterion of remission, when the time component was not considered in the design of the study, when patients were considered to have achieved symptomatic remission exclusively on the basis of their remission scores regardless of the time criterion, or when the study was not designed to follow changes in outcome over time. 4 , 23 , 28 , 70 – 75 …”

Section: Methodsmentioning

confidence: 99%

Predicting functional remission in patients with schizophrenia: a cross-sectional study of symptomatic remission, psychosocial remission, functioning, and clinical outcome

Valencia¹,

Fresán²,

Barak³

et al. 2015

NDT

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BackgroundNew approaches to assess outcome in schizophrenia include multidimensional measures such as remission, cognition, psychosocial functioning, and quality of life. Clinical and psychosocial measures have been recently introduced to assess functional outcome.ObjectiveThe study presented here was designed to examine the rates of symptomatic remission, psychosocial remission, global functioning, and clinical global impressions in a sample of schizophrenia outpatients in order to assess functional remission and to identify predictive factors for functional remission.MethodsA total of 168 consecutive Mexican outpatients receiving pharmacological treatment at the National Institute of Psychiatry in Mexico City were enrolled in a cross-sectional study. Symptomatic remission was assessed according to the definition and criteria proposed by the Remission in Schizophrenia Working Group using the Positive and Negative Symptom Scale. Psychosocial remission was assessed according to Barak criteria using the Psychosocial Remission in Schizophrenia scale. Functioning was measured with the Global Assessment of Functioning, and clinical outcome with the Clinical Global Impressions (CGI) Scale.ResultsFindings showed that 45.2% of patients fulfilled the symptomatic remission criteria, 32.1% achieved psychosocial remission, and 53% reported adequate functioning. However, the combination of these three outcome criteria – symptomatic, psychosocial remission, and functioning – indicated that 14.9% of the patients achieved our predefined functional remission outcome. The logistic regression model included five predictive variables for functional remission: (1) being employed, (2) use of atypical antipsychotics, (3) lower number of medications, (4) lower negative symptom severity, and (5) lower excitement symptom severity.ConclusionThe study demonstrated that symptomatic remission, psychosocial remission, and functioning could be achievable goals for a considerable number of patients. The outcome of functional remission was achieved by a minority of patients, less than 15%. New approaches should include multidimensional measures to assess functional outcome in schizophrenia research.

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“…Seminal viewpoint of Amador and Strauss (1993) has long suggested that poor insight of patients could stem from, among others potential deficits, a lack of general knowledge about the illness (Amador and Strauss, 1993). More recent studies have supported this assumption by demonstrating significant associations between levels of illness-related knowledge and insight in SZ individuals (Alenius et al, 2010;Chan et al, 2014). Studies investigating the effectiveness of the core psychoeducational component (i.e., conveying new knowledge) revealed significant improvements of illness knowledge questionnaires scores after psychoeducation (Jahn et al, 2011;Lincoln et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Well-informed but not aware: The P.A.C.T.® psychoeducation program for schizophrenia improves knowledge about, but not insight into, the illness

Dondé

Senn

Eche

et al. 2019

Asian Journal of Psychiatry

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Knowledge and insight in relation to functional remission in patients with long-term psychotic disorders

Abstract: Better treatment outcomes appear to be associated with better insight into illness, higher knowledge of warning signs and better coping strategies.

Cited by 11 publications

References 35 publications

Neurocognition, Insight and Medication Nonadherence in Schizophrenia: A Structural Equation Modeling Approach

Neurocognition, Insight and Medication Nonadherence in Schizophrenia: A Structural Equation Modeling Approach

Predicting functional remission in patients with schizophrenia: a cross-sectional study of symptomatic remission, psychosocial remission, functioning, and clinical outcome

Well-informed but not aware: The P.A.C.T.® psychoeducation program for schizophrenia improves knowledge about, but not insight into, the illness

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