Abstract
Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions. Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression. After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms. In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem.
Highlights
Better levels of insight are associated with the presence of depressive symptoms among patients with schizophrenia, but it would be useful to understand the relationship at symptom level.Lack of awareness into the illness is a common feature of schizophrenia that hampers adherence to treatment and complicates the clinical course [1, 2]
The study examined the relationship between insight and depressive symptoms in schizophrenia, a clinical phenomenon that has been termed “insight paradox.”
Having good insight is generally regarded as a favorable clinical feature: patients with greater awareness into their illness may present with depressive symptoms—a seemingly contradictory finding [8]
Summary
Better levels of insight are associated with the presence of depressive symptoms among patients with schizophrenia, but it would be useful to understand the relationship at symptom level.Lack of awareness into the illness is a common feature of schizophrenia that hampers adherence to treatment and complicates the clinical course [1, 2]. Having good levels of insight may bring about negative consequences, namely depressive symptoms [3] or even suicidal ideation [4, 5] This phenomenon has been termed the “insight paradox” and possibly results from the painful realization of the implications and consequences of suffering from a chronic and stigmatized illness. Pooled results suggest that this phenomenon is complex and highly variable, both in terms of strength of the association and underlying psychopathological mechanisms [11] This relationship may depend on a number of clinical, contextual, and cultural factors, such as socioeconomic status, engagement with mental health services, stigmatization, and severity of the illness [1, 6, 12, 13]. Person-centered and narrative psychotherapeutic approaches may be fit to improve patient insight without dampening self-esteem
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
