Abstract
Awareness of illness (insight) has been found to have contradictory effects for different functional outcomes after the early course of psychosis. Whereas it is related to psychotic symptom reduction and medication adherence, it is also associated with increased depressive symptoms. In this line, the specific effects of insight on the evolution of functioning over time have not been identified, and social indicators, such as socio-occupational functioning have barely been considered. Drawing from social identity theory we investigated the impact of insight on the development of psychosocial outcomes and the interactions of these variables over time. The participants, 240 patients in early phase of psychosis from the Treatment and Early Intervention in Psychosis Program (TIPP) of the University Hospital of Lausanne, Switzerland, were assessed at eight time points over 3 years. Cross-lagged panel analyses and multilevel analyses were conducted on socio-occupational and general functioning [Social and Occupational Functioning Assessment Scale (SOFAS) and Global Assessment of Functioning (GAF)] with insight, time and depressive symptoms as independent variables. Results from multilevel analyses point to an overall positive impact of insight on psychosocial functioning, which increases over time. Yet the cross-lagged panel analysis did not reveal a systematic positive and causal effect of insight on SOFAS and GAF scores. Depressive symptoms seem only to be relevant in the beginning of the treatment process. Our results point to a complex process in which the positive impact of insight on psychosocial functioning increases over time, even when considering depressive symptoms. Future studies and treatment approaches should consider the procedural aspect of insight.
Highlights
When comparing first-episode-psychosis patients to those suffering from other mental illnesses, the proportion of people showing no insight into their illness is especially high (Fennig et al 1996; Conus et al 2007; Saeedi et al 2007)
One recent study found an increasingly positive association of insight and social functioning over the period of 1 year in involuntarily admitted patients with schizophrenia. These findings indicate a positive correlation between insight and social integration, but they do not provide sufficient information regarding both the evolution and the causal direction of this relation in the early phase of psychosis
The present study investigated the modulating effect of insight in the early phase of psychosis on the evolution of psychosocial functioning over 3 years
Summary
When comparing first-episode-psychosis patients to those suffering from other mental illnesses, the proportion of people showing no insight into their illness is especially high (Fennig et al 1996; Conus et al 2007; Saeedi et al 2007). Insight has been associated with increased depressive symptoms (Crumlish et al 2005; McEvoy et al 2006; Buchy et al 2010; Cotton et al 2012), especially at the beginning of the treatment process (Saeedi et al 2007). Awareness of illness (insight) has been found to have contradictory effects for different functional outcomes after the early course of psychosis. Whereas it is related to psychotic symptom reduction and medication adherence, it is associated with increased depressive symptoms In this line, the specific effects of insight on the evolution of functioning over time have not been identified, and social indicators, such as socio-occupational functioning have barely been considered. Drawing from social identity theory we investigated the impact of insight on the development of psychosocial outcomes and the interactions of these variables over time
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