Insight In First-episode Schizophrenia Research Articles

Cognitive insight in first-episode schizophrenia: Further evidence for a role of the ventrolateral prefrontal cortex

In people with psychoses, Self-Reflectiveness may rely on the right ventrolateral prefrontal cortex (VLPFC). We used functional magnetic resonance imaging (fMRI) and a novel virtual reality paradigm to evaluate the role of the VLPFC for Self-Reflectiveness in 25 first-episode of schizophrenia (FES) participants and 24 controls. Participants first viewed 20 characters each paired with a unique object/location, and later completed source memory judgements during fMRI scanning. Self-Reflectiveness, measured with the Beck Cognitive Insight Scale, was significantly and positively correlated to activation in bilateral VLPFC in FES, but not in controls, providing further evidence that the VLPFC supports Self-Reflectiveness in FES.

Differential effects of antipsychotic drugs on insight in first episode schizophrenia: Data from the European First-Episode Schizophrenia Trial (EUFEST)

Although antipsychotics are widely prescribed, their effect of on improving poor illness insight in schizophrenia has seldom been investigated and therefore remains uncertain. This paper examines the effects of low dose haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone on insight in first-episode schizophrenia, schizoaffective disorder, or schizophreniform disorder. The effects of five antipsychotic drugs in first episode psychosis on insight were compared in a large scale open randomized controlled trial conducted in 14 European countries: the European First-Episode Schizophrenia Trial (EUFEST). Patients with at least minimal impairments in insight were included in the present study (n=455). Insight was assessed with item G12 of the Positive and Negative Syndrome Scale (PANSS), administered at baseline and at 1, 3, 6, 9, and 12 months after randomization. The use of antipsychotics was associated with clear improvements in insight over and above improvements in other symptoms. This effect was most pronounced in the first three months of treatment, with quetiapine being significantly less effective than other drugs. Effects of spontaneous improvement cannot be ruled out due to the lack of a placebo control group, although such a large spontaneous improvement of insight would seem unlikely.

Do Antipsychotics Affect Insight in Psychosis Differentially? Data From the EUFEST Trial.

Background Although antipsychotics are widely prescribed, their effect of on improving poor illness insight in schizophrenia has seldom been investigated and therefore remains uncertain. This paper examines the effects of low dose haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone on insight in first-episode schizophrenia, schizoaffective disorder, or schizophreniform disorder. Method The effects of five antipsychotic drugs in first episode psychosis on insight were compared in a large scale open randomized controlled trial conducted in fourteen European countries: the European First-Episode Schizophrenia Trial (EUFEST). Patients with at least minimal impairments in insight were included in the present study (n=455). Insight was assessed with item G12 of the Positive and Negative Syndrome Scale (PANSS), administered at baseline and at 1, 3, 6, 9, and 12 months after randomization. Results The use of antipsychotics was associated with clear improvements in insight, independent of other symptoms. This effect was most pronounced in the first three months of treatment, with quetiapine being significantly less effective than other drugs. Conclusions Use of antipsychotics was associated with an improvement in insight, over and above their effects on other symptoms of schizophrenia. Effects of spontaneous improvement cannot be ruled out due to the lack of a placebo control group, although such a large spontaneous improvement seems unlikely. Notably, the improvement of insight was less pronounced for quetiapine compared to haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone.

Predictors of insight in first-episode schizophrenia: A 5-year cohort study from India

There is a dearth of data on the predictors of insight in schizophrenia. This study attempted to assess the predictors of insight in a cohort of first-episode schizophrenia followed up over 5 years. Patients diagnosed to have Diagnostic and statistical manual of mental disorders (4th ed.; DSM-IV) schizophrenia (n = 131) were assessed prospectively for insight, psychopathology and explanatory models of illness over a 5-year period using standard instruments. Multiple linear regression and generalized estimating equations (GEE) were employed to assess predictors of insight. We could follow up 95 (72.5%) patients, 5 years after recruitment. A total of 65 of these patients interviewed at 60 months (68.4%) achieved remission. Cross-sectional evaluations suggest a relationship between insight, psychosis rating and explanatory models of illness with good insight and medical models associated with good outcome. However, baseline and early illness data do not predict insight scores at 5 years. Serial longitudinal assessment of insight is negatively associated with Brief Psychiatric Rating Scale (BPRS) scores and positively associated with the number of nonmedical explanatory models of illness held by patients. These findings argue that insight and explanatory models of illness are secondary to psychopathology, course and outcome. They are dependent on the trajectory of the person's illness, are not independent of the condition and call for multifaceted understanding of the issues.

Clinical and cognitive correlates of insight in first-episode schizophrenia

This study aims to explore the relationship between clinical symptoms and cognitive functions with different insight dimensions in patients with first-episode schizophrenia. Seventy-nine patients were assessed following six months of treatment. Insight was assessed using the abridged version of Scale of Unawareness of Mental Disorder (SUMD). Symptoms were assessed using Positive and Negative Syndrome Scale (PANSS). Cognitive functions were assessed using the Modified Wisconsin Card Sorting Test (MWCST), semantic verbal fluency and the letter-number sequencing (LNS) test from the Wechsler Adult Intelligence Scale (WAIS). Positive, negative and disorganized symptoms were found to be correlated with overall insight and all three general insight dimensions. Only perseverative errors and categories completed of MWCST were correlated with overall insight. Perseverative errors and non-perseverative errors of MWCST were correlated with the awareness of medication effects; perseverative errors of MWCST were also correlated with the awareness of social consequence of the illness. These support the link between poor insight and impaired executive function particularly measured by MWCST. The specific correlation of cognitive functions and different dimensions of insight suggests different underlying mechanism within each dimension of insight. The combined model of symptomatology and cognitive function explained 20.6% to 36.4% of the variance in the lack of insight within the different dimensions. The modest combined relationship of clinical and cognitive function with insight suggests that the exploration of other models in relationship to different insight dimensions is important.

Insight in first-episode schizophrenia

Objective. To compare insight impairment, including its temporal changes, between remitters and nonremitters in patients with first-episode schizophrenia. Method. Males, consecutively hospitalized with diagnosed first-episode schizophrenia (according to ICD 10), who provided written informed consent, and were reassessed at the 1-year follow-up were included. The psychopathology was evaluated using the Positive and Negative Syndrome Scale (PANSS) prior to acute treatment – on admission; at the end of the acute treatment – at discharge; at the 1-year follow-up. Insight was measured using item G12 from the PANSS. Results. Ninety-three patients (mean age 23 years, mean duration of illness 0.77 years) were reassessed after 1 year. A total of 73/93 patients (78%) fulfilled the criteria for remission. When compared, remitters and nonremitters showed no significant difference in impaired judgement and insight on admission. The mean value of this item was significantly lower at discharge even in nonremitters; however, a significantly higher value was found after 1 year in nonremitters. In remitters the impaired insight decreased significantly at discharge and there was a significant additional decrease after 1 year. In nonremitters there was a significant decrease at discharge; however, a significant increase was observed after 1 year. In the 73 remitters the rate of insight impairment was 79.4% on admission, 46.6% at discharge and 10.9% after 1 year; the same values were 90, 20 and 70% in the 20 nonremitters. In both remitters and nonremitters the lack of judgement and insight was the first or second most frequently observed item at all three time points. The impaired insight on admission was strongly associated with the overall symptomatology, including positive, negative and general psychopathology on admission in both remitters and nonremitters. Only in remitters was the impaired insight at discharge associated with symptoms at discharge, on admission and also after 1 year. The impaired insight at the 1-year follow-up was associated with some symptoms after 1 year in both remitters and nonremitters. Conclusion. Insight may be state dependent, especially in patients with a good outcome. Attitudes towards treatment and insight into the illness may vary during the course of the illness. However, more longitudinal prospective studies are needed to verify such state-related change, and the factors that may underlie the acquisition of insight.

Relationship between insight, cognitive function, social function and symptomatology in schizophrenia

To examine the nature and clinical correlates of insight in first-episode schizophrenia, and how these differ from findings in established schizophrenia. Insight (and insight dimensions), clinical symptoms, neurocognitive function and social function were assessed in 94 patients with first-episode schizophrenia or schizophreniform disorder according to DSM-IV criteria. Greater global insight was associated with more severe depression. Poor overall insight was associated significantly with more severe negative and disorganisation symptoms as well as poor working memory, and at a trend level with lower current IQ. Patients with poor insight perceived themselves to have a better level of independent performance at daily living activities. In first-episode psychosis, the clinical correlates of poor insight are similar to those reported for established schizophrenia. Those patients with greater insight may be at risk of depression. The complex relationships between insight, positive and negative symptoms, neurocognitive dysfunction and social function may reflect the multidimensional nature of insight.

Prefrontal subregions and dimensions of insight in first-episode schizophrenia — A pilot study

Deficits in insight are multidimensional, and include symptom unawareness and misattribution. We and others have observed that these deficits may be related to a prefrontal dysfunction. However, few studies have examined the relationship between specific prefrontal sub-regions and the awareness and attributional dimensions of insight in schizophrenia. This study examined the correlation between insight dimensions of awareness and attribution of symptoms and dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC) volume in 14 subjects with first-episode, antipsychotic-naïve (FEAN) schizophrenia. In addition, 21 healthy subjects provided control data for volumetric assessments. Insight was assessed with Scale to Assess Unawareness of Mental Disorders. Morphometric assessments were adjusted for intra-cranial volume and were conducted by trained raters blind to clinical information using BRAINS-2. Average scores on current awareness of symptoms (1 = aware; 5 = unaware) were negatively correlated with right DLPFC volume and average scores on current attribution of symptoms (1 = attribute; 5 = misattribute) with right medial OFC volume. Unawareness and misattribution of symptoms in FEAN schizophrenia may have distinct neuroanatomical bases. DLPFC deficits may have resulted in illness unawareness by interfering with self-monitoring, while OFC abnormalities may have mediated symptom misattribution by conferring aberrant salience to perceived symptomatology.

The neuropsychological basis of insight in first-episode schizophrenia: a pilot metacognitive study

The aim of the present study was to explore the neuropsychological basis of insight in first-episode schizophrenia, by evaluating its differential and joint links with cognitive vs. metacognitive performance. Thirty first-episode patients were assessed with the Scale of Unawareness of Mental Disorder (SUMD) and a metacognitive version of the Wisconsin Card Sorting Test (WCST). In addition to the standard administration of the WCST, subjects were also asked to rate their level of confidence in the correctness of each sort (prior to getting the feedback), and to choose whether they wanted each sort to be “counted” toward their overall performance score on the test. Each “volunteered” sort received a bonus of 10 cents if correct, but an equal penalty if wrong. Insight into illness had higher correlations with free-choice metacognitive indices derived from confidence ratings and volunteered sorts than with the conventional scores from the WCST. Moreover, prediction of poor insight was significantly improved when adding the new, free-choice metacognitive measures to the conventional WCST measures, but not the other way around. These preliminary results suggest that metacognition is an important mediator between basic cognitive deficits and poor insight, and might be even more relevant to poor insight than cognitive deficits per se.

Insight in first-episode schizophrenia: A metacognitive neuropsychological study

The present study investigated general reality monitoring ability, and selective reality monitoring ability for anxiety relevant actions in a group of individuals with obsessive–compulsive disorder (OCD) and a group of non-anxious controls. In addition, reality monitoring confidence was assessed, as well as specific meta-cognitive beliefs related to cognitive confidence (by means of the Meta-Cognitions Questionnaire (MCQ)). No differences were found between both groups in actual reality monitoring ability. Unlike previous studies, the reality monitoring task included actions that were related to the individual concerns of the OCD patients and were ideographically selected. Nevertheless, no differential reality monitoring effect was observed for the anxiety relevant stimuli. Data from the MCQ, however, revealed that OCD patients had less overall confidence in their memory for actions and their reality monitoring ability. Analysis of the confidence ratings of the reality monitoring task showed that this reduced confidence was restricted to the neutral actions. No differences were observed for patients that reported low or high frequencies of checking behaviour. The whole of these data do not support memory deficit models of OCD, but are in line with recent emphasis on the importance of memory confidence and other meta-cognitive beliefs in OCD.