Awareness Of Need For Treatment Research Articles

A Measure to Assess Illness Awareness in Problem Gambling: Gambling Awareness and Insight Scale (GAS).

Impaired subjectiveawareness of problem gambling may act as a barrier to help-seeking and treatment adherence. However, the impact of impaired problem gamblingawareness on clinical and social outcomes has received little empirical study. The aim of this study was to develop and investigate the psychometric properties of a novel scale that measures impaired illnessawareness in individuals with problem gambling. We developed the Gambling Awareness and Insight Scale (GAS), a self-report measure that assesses the core theoretical constructs of illness awarenessin problem gambling, namely General Disorder or Problem Awareness, Accurate Symptom Attribution, Awareness of Need for Treatment and the Negative Consequences attributable to problem gambling( www.illnessawarenessscales.com ). Data were acquired from an online survey platform, Dynata, to evaluate the psychometric properties of the GAS.A total of 100 participantsaged 18years or older with problem gambling defined by a score of 4 or more on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Pathological Gambling Diagnostic Form were included. The GAS demonstrated good convergent (r = 0.57, p < 0.001) and discriminant validity (r = -0.18, p = 0.080). It also demonstrated good internal consistency (Cronbach's α = 0.80) and one-month test-retest reliability (intra-class correlation = 0.86). An exploratory factor analysis suggested retention of two components.The GAS is a novel psychometric tool designed to evaluate impaired subjectiveillnessawareness in problem gambling. Initial evidence suggests that the GAS can be used in research and clinical settings to evaluate the impact of impaired problem gambling awareness on adherence to treatment programs, clinical and psychosocial outcomes. Replication in applied settings is needed.

Comparison of three scales (BIS, SUMD and BCIS) for measuring insight dimensions and their evolution after one-year of follow-up: Findings from the FACE-SZ Cohort

The aim of our study was to compare the performance of three different instruments measuring clinical and cognitive dimensions of insight.Data on 182 outpatients with schizophrenia and one-year follow-up assessments was drawn from the FACE-SZ cohort. Awareness of clinical state (« clinical insight ») was measured using both a clinician-rated measure (the Scale to assess Unawareness of Mental Disorder (SUMD)), and a self-report measure (the Birchwood Insight Scale (BIS). Cognitive insight was measured using a self-report measure (the Beck Cognitive Insight Scale (BCIS)). For each scale, change in insight was examined at the follow-up.Correlations between SUMD and BIS subscales measuring same dimensions were significant. BIS-BCIS correlations were weak for all combinations except between BIS illness dimension and BCIS composite score. At the follow-up, BIS and SUMD awareness of treatment need improved whereas illness and symptom awareness increased only on the SUMD. Conversely, cognitive insight composite scores decreased.Despite relatively good overall agreement between the two clinical insight instruments, considerable variability for similar insight dimensions measured by different instruments was found. Agreement between cognitive and clinical insight is moderate. Our study strengthens the argument that insight is harder to operationalize than other symptoms and may explain why it is so seldom explicitly targeted in schizophrenia treatment.

DAS: The Diabetes Awareness and Insight Scale

Background and aimsDiabetes mellitus affects approximately 8.5% of the world’s population with the majority of cases diagnosed with type 2 diabetes (T2DM). Impaired awareness or denial of T2DM is a common yet understudied construct that may negatively contribute to clinical outcomes. The aim of this study was to develop the Diabetes Awareness and Insight Scale (DAS), a self-report scale that measures illness awareness in persons with T2DM. MethodsNine items were developed for the DAS that measure four domains of illness awareness, namely General Illness Awareness, Accurate Symptom Attribution, Awareness of Need for Treatment, and Awareness of Negative Consequences attributable to T2DM (www.illnessawarenessscales.com). A total of 100 participants with a diagnosis of T2DM were recruited using a digital data collection platform. ResultsThe DAS demonstrated good convergent and discriminant validity, internal consistency, and one-month test-retest reliability. An exploratory factor analysis showed that the DAS exhibited three factors. ConclusionsOverall, the DAS is a novel and easy-to-administer scale that comprehensively measures subjective illness awareness in persons with T2DM. As the first scale of its kind, the DAS holds promise for use in epidemiology studies to examine the extent to which impaired illness awareness or illness denial contributes to clinical outcomes and T2DM management.

Impaired Awareness of Problem and Pathological Gambling: A Review.

Although well-recognized and clinically relevant, impaired awareness of problem and pathological gambling (IAPPG) is a poorly understood phenomenon that contributes to treatment denial and negative clinical and social outcomes. In this study, we aimed to conduct a systematic review of the measures available to assess problem gambling awareness, evaluate their psychometric properties, and determine the extent to which they cover the core domains of illness awareness: General Disorder Awareness, Symptom Attribution, Awareness of Need for Treatment, and Awareness of Negative Consequences. A systematic search using OVID database (Medline®, PsycINFO, and Embase) was performed to identify English language papers describing gambling awareness measures. We identified only 8 measures partially assessing IAPPG. Measures differed in their effectiveness and comprehensiveness in evaluating IAPPG. Most measures were principally developed to evaluate barriers or motivators to treatment-seeking among gamblers and were not specific to IAPPG. Two were psychometrically validated, but the items were not specific to the evaluation of subjective awareness of the disorder and they only covered up to two domains of IAPPG. With the development and psychometric validation of an easy-to-use, comprehensive measure of subjective IAPPG, future studies will be able to investigate the role of IAPPG in help-seeking behavior, treatment adherence, and clinical and social outcomes.

Reprint of OASIS – Obesity Awareness and Insight Scale

AimsImpaired illness awareness or not accepting that one has obesity is an understudied phenomenon that may negatively influence treatment adherence and clinical outcomes. The purpose of this study was to perform a systematic review of available measures of obesity awareness, and subsequently develop and validate a novel scale that measures the core domains of obesity awareness. MethodsA systematic review of the literature revealed no illness specific measure of subjective obesity awareness. As such, we designed the Obesity Awareness and Insight Scale (OASIS) to assess the following core domains of illness awareness: General Illness Awareness, Symptom Attribution, Awareness of Need for Treatment and the Negative Consequences attributable to the illness (www.illnessawarenessscales.com). Participants (n=100) were recruited from an online survey platform to assess the psychometric properties of OASIS. ResultsThe OASIS demonstrated strong internal consistency (Cronbach's alpha=0.89), convergent (r(98)=0.65, p<0.001) and discriminant validity, and test-retest reliability (intra-class correlation=0.76). An exploratory factor analysis of OASIS revealed a single latent component. ConclusionsOASIS is an obesity-specific instrument that comprehensively measures subjective obesity awareness. OASIS can be used in epidemiological studies, intervention trials, and clinical practice to assess the impact of obesity awareness on treatment adherence and outcomes.

OASIS: The Obesity Awareness and Insight Scale

AimsImpaired illness awareness or not accepting that one has obesity is an understudied phenomenon that may negatively influence treatment adherence and clinical outcomes. The purpose of this study was to perform a systematic review of available measures of obesity awareness, and subsequently develop and validate a novel scale that measures the core domains of obesity awareness. MethodsA systematic review of the literature revealed no illness specific measure of subjective obesity awareness. As such, we designed the Obesity Awareness and Insight Scale (OASIS) to assess the following core domains of illness awareness: General Illness Awareness, Symptom Attribution, Awareness of Need for Treatment and the Negative Consequences attributable to the illness (www.illnessawarenessscales.com). Participants (n = 100) were recruited from an online survey platform to assess the psychometric properties of OASIS. ResultsThe OASIS demonstrated strong internal consistency (Cronbach's alpha = 0.89), convergent (r(98) = 0.65, p < 0.001) and discriminant validity, and test-retest reliability (intra-class correlation = 0.76). An exploratory factor analysis of OASIS revealed a single latent component. ConclusionsOASIS is an obesity-specific instrument that comprehensively measures subjective obesity awareness. OASIS can be used in epidemiological studies, intervention trials, and clinical practice to assess the impact of obesity awareness on treatment adherence and outcomes.

Innovative potential treatment strategies for schizophrenia and biomarkers for Alzheimer’s disease

In this issue, we are starting with a series of invited reviews on innovative and potential future therapeutic strategies in schizophrenia and affective disorders. Hasan et al. [1] outline that cognitive symptoms do not respond to antipsychotic treatment and are a main predictor for poor social and functional outcome in schizophrenia. During the last years, epigenetic mechanisms mediating the influence of environmental factors on chromatin regulation and gene expression have been reported to play an important role in the pathophysiology of the disease. Therefore, histone deacetylase (HDAC) inhibitors might be potential epigenetic targets in the treatment of schizophrenia. After clarification of target selectivity, adverse effects and identification of eligible patients, future clinical studies should follow this trail. DNA-methylation is a further epigenetic mechanism in which the relationship with environmental experience and brain activation has to be assessed [2]. Aripiprazole is a potent atypical antipsychotic drug with high effectivity and tolerability [3]. Besides its well-known effects on the dopamine system, aripiprazole may also influence other neurotransmitter systems which currently is under investigation. Peselmann et al. [4] treated rats chronically with aripiprazole in different doses and found the vesicular c-amino-butyric (GABA) transporter and the GABA synthesizing enzyme GAD67 to be induced in the hippocampus, amygdala and cerebral cortex. Since reduced expression of GAD67 and a dysfunctional GABA ergic system possibly are involved in the pathophysiology of schizophrenia, alterations of regulatory connections between the dopaminergic, serotonergic and GABA ergic system may play a role in the mode of action of aripiprazole. However, alterations in GAD-immunoreactive neurons have also been shown to occur in patients with bipolar I depression [5], suggesting a neurobiological overlap within the affective-schizophrenia continuum. Poor outcome, often a hallmark of schizophrenia, might be related to patients’ impaired insight into their condition and awareness of need for treatment. Pijnenborg et al. [6] show a strong contribution of affective empathy to insight, suggesting that being able to feel empathy with other peoples’ feelings may enhance insight. Alcohol-induced psychotic disorder is a rare complication of alcohol use disorder, but has an extremely high rehospitalization rate indicating a more chronic course and worse prognosis [7]. Single psychiatric symptoms such as hallucination involving the oral area are categorized as delusional disorder. In a SPECT study, Umezaki et al. [8] revealed right [ left brain perfusion asymmetry in frontal and temporal brain areas in these patients. The rate of transition of mild cognitive impairment (MCI) to Alzheimer’s disease (AD) is an important measure. Thus, the use of biomarkers according to the likelihood of the presence of AD pathology could help classifying patients with increased risk for developing dementia. In a follow-up study, Guo et al. [9] show that neuroimaging (PET, structural MRI) can contribute to identify MCI patients with high, intermediate or low likelihood of the presence of AD pathology and investigated progression toward AD. MCI-high patients had a higher risk of developing AD than the other subgroups. Therefore, the new clinical research criteria of the National Institute on Aging-Alzheimer’s Association (NIA-AA) represent a valuable research instrument in diagnosing MCI. In line A. Schmitt (&) P. Falkai Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nusbaumstr. 7, 80336 Munich, Germany e-mail: Andrea.Schmitt@med.uni-muenchen.de

Sub-optimal asthma control in teenagers in the midland region of Ireland

Internationally, many children with asthma are not attaining achievable asthma control. To examine the prevalence of asthma in teenagers in four midland counties, their asthma control and the barriers, if any, to gaining control of asthma. International Study of Asthma and Allergies in Children (ISAAC) methodology was used in a survey of Junior Cycle Year 2 second-level students. The prevalence of "wheeze ever" was 49.8%, "wheeze in the last 12months" was 32.6% and "asthma ever" was 23.5%. Of teenagers with current asthma, 96% had evidence of sub-optimal asthma control during the previous year. For the majority of the teenagers with asthma, treatment was not guideline concordant; infrequent lung function testing, insufficient review after acute care and poor use of written asthma action plans. Barriers included lack of awareness of need for treatment. If asthma guidelines are implemented fully, these children may experience better health.

Negative Symptoms and Poor Insight as Predictors of the Similarity Between Client and Therapist Ratings of Therapeutic Alliance in Cognitive Behavior Therapy for Patients With Schizophrenia

Recent studies have found that clients with schizophrenia rate therapeutic alliance more highly than therapists. Unclear is whether there are clinical characteristics which predict the degree of difference in client and therapist ratings. To explore this, we correlated client and therapist ratings of therapeutic alliance with baseline assessments of positive negative, and disorganized symptoms and awareness of need for treatment. Participants were 40 adults with schizophrenia enrolled in a 6-month program of cognitive behavior therapy. Results indicated that clients produced higher ratings of therapeutic alliance than therapists and that therapist and client general ratings were more disparate when clients had fewer negative symptoms and better insight. Higher overall client ratings of therapeutic alliance were linked to lower levels of positive, negative, and disorganized symptoms and better awareness of need for treatment. Higher overall therapist ratings were linked only to lower levels of disorganized symptoms among clients.

Insight into illness in patients and caregivers during early psychosis: A pilot study

BackgroundImpaired insight into illness is common during early psychosis and has been associated with treatment delays and poorer long-term outcomes. The relationship between patients' insight into illness and their caregivers' knowledge about psychosis is putatively associated with treatment outcome but there is limited research about this. This pilot study was designed to test the hypothesis that caregivers' levels of insight into illness is associated with patients' insight into illness in early psychosis and would be related to caregivers' levels of critical, rejecting attitudes toward patients. MethodsPatients with schizophrenia or schizoaffective disorder within 5years of psychosis onset (n=14) and caregivers (n=14) of the patients' choosing were studied. Insight into illness was assessed in patients using the Scale to assess Unawareness of Mental Disorder (SUMD). Caregiver insight into illness was assessed with a modified version of the SUMD with questions rephrased to probe caregivers' understanding of the patients' illness. Caregivers' critical attitudes toward patients were assessed with the Patient Rejection Scale (PRS). ResultsSignificant correlations were found between patients' and caregivers' awareness of need for treatment (r=.55, p=.02), awareness of symptoms (r=.48, p=.04) and between caregivers' awareness of illness and critical attitudes toward patients (r=.65, p=.01). ConclusionsThese findings suggest that caregivers' emotional characteristics and levels of insight into illness may be related to insight into illness in patients. Implications for family psychoeducational approaches to impairments of insight into illness during early psychosis are discussed.

Cortical thickness is associated with poor insight in first-episode psychosis

Through conceptualizing poor insight in psychotic disorders as a form of anosognosia (neurological deficit), frontal lobe dysfunction is often ascribed a vital role in its pathogenesis. Whether non-frontal brain regions are important for insight remains to be investigated. We used a multi-method approach to examine the neural morphometry of all cortical regions for insight in first-episode psychosis. Insight was rated in 79 people with a first-episode psychosis with the awareness of illness and awareness of treatment need and efficacy items of the Scale for assessment of Unawareness of Mental Disorder. Participants were assessed with magnetic resonance imaging. Cortical thickness analysis and voxel-based morphometry were utilized to identify the possible neuroanatomical basis of insight. Cortical thickness technique revealed that poorer awareness of illness was associated with regional thinning in left middle frontal and inferior temporal gyri. Poorer awareness of treatment need and efficacy was associated with cortical thinning in left medial frontal gyrus, precuneus and temporal gyri. No significant associations emerged between any insight measure and gray matter density using voxel-based morphometry. The results confirm predictions derived from the anosognosia/neuropsychology account and assert that regional thickness in frontal cortex is associated with awareness of illness in the early phase of psychosis. The fact that prominent thickness reductions emerged in non-frontal regions of the brain in parietal and temporal cortices for both awareness of illness and awareness of treatment need and efficacy suggests that the neural signature of insight involves a network of brain structures, and not only the frontal lobes as previously suggested.

Hirnstimulationsverfahren bei Therapieresistenz

In psychiatry there is growing awareness of the urgent need for treatment of patients with severe depression who are refractory to treatment. While highly efficacious over its nearly 70-year history, electroconvulsive treatment is tainted with two basic disadvantages: high relapse quotas and sometimes extensive cognitive side effects. Therefore novel methods of brain stimulation are being employed: transcranial magnetic stimulation, magnetic seizure stimulation, vagus nerve stimulation, and deep brain stimulation. These four techniques are used in individual cases but still outside the framework of scientific research studies. Their clinical effects and effectivity require further definition. This paper reports the current status of brain stimulation methods and describes possible further developments.

Awareness of Illness in Schizophrenia: Associations With Multiple Assessments of Executive Function

Awareness of Illness in Schizophrenia: Associations With Multiple Assessments of Executive Function

Awareness of Illness in Schizophrenia: Associations With Multiple Assessments of Executive Function

Though insight in schizophrenia is correlated with flexibility in abstract thought, it is unclear how differing dimensions of executive functions are linked to insight. Accordingly, the authors administered the Scale to Assess Unawareness of Mental Disorder and the Delis-Kaplan Executive Function System to 53 participants with schizophrenia spectrum disorders. Spearman Rho correlations revealed that symptom awareness was significantly related to Verbal Fluency, Color-Word, Tower, and Word Context scores. Awareness of treatment need was related to Color-Word, Tower, and Word Context tasks. Results suggest insight may be related to capacities to shift attention between differing environmental demands, plan ahead, and construct contextual understandings.