Scale Of Unawareness Of Mental Disorder Research Articles

Impact of Delusions and Hallucinations on Clinical Insight Dimensions in Schizophrenia Spectrum Disorders

Introduction: Insight in psychosis has been conceptualized as a continuous, dynamic, and multidimensional phenomenon. This study aims to determine the impact of delusions and hallucinations in different dimensions of clinical insight in schizophrenia spectrum disorders. Methods: Cross-sectional multicenter study including 516 patients (336 men) diagnosed with schizophrenia spectrum disorders. Based on dichotomized scores of Positive and Negative Syndrome Scale (PANSS) items P1 (delusions) and P3 (hallucinations), patients were assigned to four groups according to current clear presence of delusions (scores 4 or above 4 in PANSS item P1) and/or hallucinations (scores 4 or above 4 in PANNS item P3). Insight was assessed using the three main dimensions of the Scale of Unawareness of Mental Disorder (SUMD). Results: Around 40% of patients showed unawareness of illness; 30% unawareness of the need for treatment; and 45% unawareness of the social consequences of the disorder. Patients with current clear presence of delusions had higher overall lack of awareness, regardless of current clear presence of hallucinations. Similarly, the clear presence of delusions showed a greater predictive value on insight than the presence of hallucinations, although the implication of both in the prediction was modest. Conclusions: Our results confirm that lack of insight is highly prevalent in schizophrenia spectrum disorders, particularly when patients experience delusions. This study adds insight-related data to the growing symptom-based research, where specific types of psychotic experiences such as hallucinations and delusions could form different psychopathological patterns, linking the phenomenology of delusions to a lack of clinical insight.

Unawareness of the disease in patients with schizophrenia: diagnosis and insight-oriented psychotherapy

Relevance. Phenomenon of patients' unawareness of their illness (insight) is a pathognomonic diagnostic criterion that distinguishes schizophrenia from many other psychiatric disorders. More than half of patients with schizophrenia do not realize their illness that makes their treatment more difficult. Diagnosis of insight in patients with schizophrenia is an important issue. The volume and content of rehabilitation programs depends on it. The purpose of research is to study the structure of insight in patients with schizophrenia, its relationship with certain clinical, social and psychological indicators, and to assess the influence of insight-oriented psychotherapy on the outcomes of schizophrenia. Material and methods. 237 patients with schizophrenia were studied: 139 (58.6 %) men and 98 (41.4 %) women aged 18-35 years. Patients of the main group (122 people) received pharmacotherapy and were included in the program of insight-oriented psychotherapy. Patients of the comparison group (115 people) received standard treatment. Measurement of the insight level was carried out using the scale of unawareness of mental disorder (SUMD). To study social indicators the scale of social functioning in various spheres was used (Zaitsev, 1999). The quality of life level and social stigma were measured by WHOQOL-BREF and adapted version of the self-stigmatization scale (SSMIS). Evaluation of outcomes in schizophrenia was carried out using the IMR and RMQ scales. The level of cognitive functioning was assessed by the GACF-CogFu scale. The severity of depression was measured by the scale developed by Beck (BDI). The mechanisms of psychological defense were assessed using the scale of R. Plutchik, H. Kellerman (1979). Mathematical processing of the results was also carried out. Results. Correlations were found between a higher level of patient awareness of the disease and its better prognosis (r= -0.507; p<0.05), a higher level of social functioning (r= 0.478; p<0.05), quality of life (r= -0.311; p<0.05), cognitive functioning (r= -0.508; p<0.05) and a lower intensity of defensive psychological mechanisms (r= -0.401; p<0.05). A different predictive value of some insight components was found. There were detected correlations between a successful disease prognosis and a high degree of patient awareness of the disease symptoms (r = -0.318; p<0.05), the need for treatment (r = -0.603; p<0.05), the drug effect (r = -0.312; p<0.05) and a low awareness level of how people perceive the patient’s illness (r = 0.527; p<0.05) and its social consequences (r= 0.419; p<0.05). The highest association with the risk of depressive symptoms and self-stigmatization had the following insight components: awareness of the mental illness presence (r= -0.365 and r= -0.525, respectively; p<0.05) and perception by others (r= -0.654 and r= -0,417; p<0.05), awareness of the diagnosis (r= -0.312 and r= -0.45; p<0.05), social consequences of the disease (r= -0.3 and r= -0.621; p<0.05) and their perception by others (r= -0.531 and r= - 0.576; p<0.05). Conclusions. Insight-oriented psychotherapy has proven effective in patients with schizophrenia treatment. It is reasonable to increase the patients' awareness of the disease symptoms, their causes, the need for treatment and the effectiveness of medicines, while leaving intact those aspects of insight that increase the risk of depression, psychological distress and self-stigmatization.

Insight and suicidality in psychosis: A cross-sectional study

AimsWe aimed to test whether specific insight dimensions are associated with suicidality in patients with psychotic disorders. Methods143 patients with schizophrenia spectrum disorders were recruited. Suicidality was assessed by item 8 of the Calgary Depression Scale for Schizophrenia (CDSS). Insight was measured by the Scale of Unawareness of Mental Disorder (SUMD) and the Markova and Berrios Insight Scale. Bivariate analyses and multivariable logistic regression models were conducted. ResultsThose subjects aware of having a mental illness and its social consequences had higher scores on suicidality than those with poor insight. Awareness of the need for treatment was not linked with suicidality. The Markova and Berrios Insight scale total score and two specific domains (awareness of “disturbed thinking and loss of control over the situation” and “having a vague feeling that something is wrong”) were related to suicidality. However, no insight dimensions survived the multivariable regression model, which found depression and previous suicidal behaviour to predict suicidality. ConclusionsSuicidality in psychosis was linked with some insight dimensions: awareness of mental illness and awareness of social consequences, but not compliance. Depression and previous suicidal behaviour mediated the associations with insight; thus, predicting suicidality.

A deeper view of insight in schizophrenia: Insight dimensions, unawareness and misattribution of particular symptoms and its relation with psychopathological factors

Objective1. To describe insight in a large sample of schizophrenia subjects from a multidimensional point of view, including unawareness of general insight dimensions as well as unawareness and misattribution of particular symptoms. 2. To explore the relationship between unawareness and clinical and socio-demographic variables. Methods248 schizophrenia patients were assessed with the Positive and Negative Syndrome Scale (PANSS, five factor model of Lindenmayer) and the full Scale of Unawareness of Mental Disorder (SUMD). Bivariate associations and multiple linear regression analyses were used to investigate the relationship between unawareness, symptoms and socio-demographic variables. ResultsAround 40% of the sample showed unawareness of mental disorder, of the need for medication and of the social consequences. Levels of unawareness and misattribution of particular symptoms varied considerably. General unawareness dimensions showed small significant correlations with positive, cognitive and excitement factors of psychopathology, whereas these symptom factors showed higher correlations with unawareness of particular symptoms. Similarly, regression models showed a small significant predictive value of positive symptoms in the three general unawareness dimensions while a moderate one in the prediction of particular symptoms. Misattribution showed no significant correlations with any symptom factors. ConclusionsResults confirm that insight in schizophrenia is a multi-phased phenomenon and that unawareness into particular symptoms varies widely. The overlap between unawareness dimensions and psychopathology is small and seems to be restricted to positive and cognitive symptoms, supporting the accounts from cognitive neurosciences that suggest that besides basic cognition poor insight may be in part a failure of self–reflection or strategic metacognition.

Effect of empathy on the insight in patients with first-episode schizophrenia

Objective To investigate the effects of empathy on the insight of first-episode schizophrenia. Methods Empathy with the interpersonal reactivity index-C (IRI-C) was applied to 71 patients with first-episode schizophrenia and 69 healthy controls. In addition, schizophrenic patients were evaluated with scale of unawareness of mental disorder (SUMD) for the scores of clinical insight and positive and negative syndrome scale (PANSS) for clinical symptoms. Results Compared with the control group, the schizophrenic patients showed lower scores in the perspective taking ((13.85±1.86) vs (6.74±2.56), P<0.01), empathic concern ((14.28±2.16) vs (17.49±2.73), P<0.01) of IRI-C, but higher subscale score ((10.28±2.78) vs (8.93±1.93), P<0.01) in personal distress. Pearson correlation analysis showed that, there were negatively significant correlations between insight score and perspective taking (r=-0.429, P<0.01), empathic concern (r=-0.709, P<0.01) subscores of IRI-C respectively. In addition, the insight total score was positively correlated with the positive symptoms subscores (r=0.545, P<0.01) of PANSS. Conclusion Patients with first-episode schizophrenia have significant empathy defects. And the empathic deficits are associated with the insight impairment among the schizophrenic patients, suggesting that patients' insight level can change by improving their empathy ability. Key words: First-episode schizophrenia; Empathy; Symptom; Insight

Revisiting Poor Insight into Illness in Anorexia Nervosa

To investigate and validate a novel approach to distinguishing between two possible sources of poor insight in anorexia nervosa: true unawareness, in which a patient is not aware that other people think there is a problem, and disagreement, in which a patient does recognize that others think there is a problem. Thirty-nine patients with anorexia nervosa or eating disorder not otherwise specified-anorexia nervosa were given two versions of the Scale of Unawareness of Mental Disorder (SUMD), one in which they were asked about their own opinion and one in which they were asked about their clinicians' opinion. Clinicians also completed the SUMD with their opinion about the patient's illness. Patients and clinicians both also completed a Visual Analog Scale assessing treatment acceptance. About 57% of the overall level of poor insight was explained by disagreement. Prediction of treatment acceptance was significantly improved when poor insight was broken down into true unawareness and disagreement. These data suggest that impaired insight in anorexia nervosa is an additive outcome of true unawareness and disagreement.

Correlates of insight with symptomatology and executive function in patients with first-episode schizophrenia-spectrum disorder: A longitudinal perspective

The present study aimed to examine the relationships of insight with symptomatology and executive function, both cross-sectionally and longitudinally in patients with first-episode schizophrenia-spectrum disorders. Ninety-two medication-naïve patients were recruited and 71 completed the assessments. Insight, symptoms and executive function were assessed at baseline, 6 months and 1 year. Insight was measured with the abridged version of Scale of Unawareness of Mental Disorder (SUMD). Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Executive function was measured with the Modified Wisconsin Card Sorting Test (MCST). The most significant improvement of insight and symptomatology was found over the first 6 months, whereas the perseverative errors of MCST were significantly improved between 6 and 12 months. Differential correlations of perseverative errors of the MCST and PANSS scores with SUMD were found at different time points. This suggests the involvement of different mechanisms in insight deficit at different stages of the illness. The baseline MCST perseverative errors were correlated significantly with the SUMD total score at 6 months and the change of SUMD scores over the first 6 months. Although the variance explained was small, it suggests better set-shifting capacity facilitates the improvement of insight at an early stage of the illness.

The nature and evolution of insight in schizophrenia: A multi-informant longitudinal study of first-episode versus chronic patients

Background and aimsThis study investigated a novel distinction between two possible sources of poor insight in schizophrenia: primary unawareness, in which the ill person is not aware that other people think one has a problem, and secondary unawareness (or disagreement), in which a person does appreciate that other people think one has a problem. A secondary goal was to compare the evolution of insight in first-episode and chronic schizophrenia. MethodsSixty-eight first-episode and 51 chronic patients were administered two versions of the Scale of Unawareness of Mental Disorder (SUMD) at three time points: hospital admission, discharge, and 6-month post-discharge. In the first standard SUMD version, they were asked about their own opinions, whereas in the second modified version, they were asked about their best guess of their doctor's opinion. ResultsWhile overall level of unawareness remained stable within each single episode, there were significant Type of Unawareness (primary versus secondary) by Clinical Status (admission versus discharge versus 6-month post-discharge) and Type of Unawareness by Phase of Illness (first-episode versus chronic) interaction effects. More specifically, in the first-episode group, primary unawareness steadily decreased over time. In contrast, in the chronic group, primary unawareness decreased markedly during hospitalization and returned to baseline after discharge. ConclusionsThese results provide preliminary support for the notion that impaired insight is an additive outcome of primary unawareness and disagreement, and that change in insight over time occurs mostly at the level of their relative proportion as opposed to their overall sum. Implications for studying and treating poor insight in schizophrenia are discussed.

The neurocognitive basis of insight into illness in anorexia nervosa: A pilot metacognitive study

The primary goal of the present study was to explore the neuropsychological basis of insight into illness in anorexia nervosa by evaluating its differential and joint links with cognitive vs. metacognitive performance. Participants in the study were 25 women with anorexia nervosa (AN) and 25 healthy comparisons (HC). All participants completed a computerized version of the Wisconsin Card Sorting Task (WCST) and the Computerized Body-Size Discrimination task (CBSD). In addition to the standard administration of the tasks, subjects were also asked to rate their level of confidence in the correctness of each sort and to choose whether they wanted each sort to be “counted” toward their overall performance score on the test. Insight into illness in the AN group was assessed with the Scale of Unawareness of Mental Disorder (SUMD). Prediction of poor insight was significantly improved when adding the new, free-choice metacognitive measures to the conventional measures in both tasks, but not the other way around. These preliminary results suggest that metacognition might be an important mediator between basic cognitive deficits and poor insight and that it might be even more relevant to poor insight than cognitive deficits per se.

Türkiye’de Şizofrenili Hastalarda Sigara Kullanımı: Psikopatoloji, Sosyodemografik Ve Klinik Özelliklerle İlişkisi / Cigarette Smoking In Patients With Schizophrenia In Turkey: Relationships To Psychopathology, Socio-Demographic And Clinical Characteristics

Objective: In individuals with schizophrenia, the prevalence of cigarette smoking is significantly higher than that of the general population. This appears to be associated with specific psychosocial and clinical characteristics. However, there is limited data regarding the relationship between smoking and psychopathology, insight, impulsivity, suicidality, hopelessness and depression in patients with schizophrenia. In this regard, the purpose of this study was to examine the relationship between these characteristics and smoking in patients with schizophrenia in Turkey. Method: In this cross-sectional study, 133 outpatients with DSM-IV diagnosis of schizophrenia were recruited and independently interviewed for nicotine dependency with tobacco use. Scale for Assessment of Negative and Positive Symptoms (SANS and SAPS), Calgary Depression Scale for Schizophrenia (CDSS), Beck Hopelessness Scale (BHS), Barrat Impulsivity Scale (BIS), The Yale-Brown Obsessive–Compulsive Scale (YBOCS), Beck Cognitive Insight Scale, Scale of Unawareness of Mental Disorder (SUMD) were used to evaulate related psychopathologic variables. Results: The results revealed that smokers with schizophrenia had higher rates of hospitalization, lifetime suicide attempts, more severe psychopathology, higher impulsivity and hopelessness scores than non-smokers with schizophrenia. In addition, another important result was that smokers with schizophrenia have higher unemployment rates. Conclusion: From this study, we may gain new insights into the role of cigarette smoking in patients of schizophrenia in Turkey. Our findings suggest that cigarette smoking is associated with not only severe psychopathology but also with impulsivity and hopelessness which are related to suicidality, in patients with schizophrenia. This relationship between suicidality, impulsivity and hopelessness may be of clinical importance for patients with schizophrenia.

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 and quality of life in long‐term hospitalized Japanese patients with chronic schizophrenia

The aim of the study was to investigate the relationship between insight and quality of life (QOL) and the respective predictive factors in long-term hospitalized patients with chronic schizophrenia. The present subjects were 47 Japanese patients with chronic schizophrenia who were hospitalized for >1 year (mean hospitalization period, 9.8 years). Assessments were made using the Scale of Unawareness of Mental Disorder (SUMD) and the EuroQoL-5 Dimensions (EQ-5D) scale. Sociodemographic details and illness-related variables were also evaluated, including use of the Positive and Negative Syndrome Scale. There was no association between SUMD and EQ-5D scores. Hallucinatory behavior was a predictor of good insight. Poor rapport was a predictor of bad insight. Poor attention was a predictor of bad QOL. The relationship between insight and QOL and the respective predictive factors might be different between acute and chronic stages. Further studies are needed to investigate how these changes occur.

Call It a Monster for Lack of Anything Else

Individuals diagnosed with schizophrenia often appear to be unaware of having an illness or actively reject their diagnostic label. It is unclear, however, how this lack of awareness relates to important outcomes. Broadening the definition of awareness to include "narrative insight" may clarify this issue. The objective of this study was to identify profiles of narrative insight and test how these relate to standardized measure of insight. Sixty-five individuals with schizophrenia spectrum disorders participated in an assessment that included the Scale of Unawareness of Mental Disorder (SUMD) and an in-depth semi-structured interview. Qualitative analysis revealed 5 central themes related to insight on the basis of which each interview was then rated. Cluster analysis of these ratings resulted in 4 profiles of narrative insight: (1) accepts illness/rejects label, (2) rejects illness/searches for a name (3) passive insight of illness and label, and (4) integrative insight. The SUMD differentiated between individuals assigned to profile 2 who showed low insight to their illness and those assigned to the other profiles of narrative insight, but could not differentiate between them. Results support the claim that illness narratives are multifaceted and that traditional measures of insight may not be sensitive to different ways in which people understand their illness.

P.4.a.005 Rapid onset anxiolitic efficacy after a single dose of pregabalin: evaluation using dental anxiety model

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.

0075 AN ANALYSIS OF THE SYMPTOMS OF EARLY PSYCHOSIS

This study investigated a novel distinction between two possible sources of poor insight in schizophrenia: primary unawareness, in which the ill person is not aware that other people think one has a problem, and secondary unawareness (or disagreement), in which a person does appreciate that other people think one has a problem. A secondary goal was to compare the evolution of insight in first-episode and chronic schizophrenia.Sixty-eight first-episode and 51 chronic patients were administered two versions of the Scale of Unawareness of Mental Disorder (SUMD) at three time points: hospital admission, discharge, and 6-month post-discharge. In the first standard SUMD version, they were asked about their own opinions, whereas in the second modified version, they were asked about their best guess of their doctor's opinion.While overall level of unawareness remained stable within each single episode, there were significant Type of Unawareness (primary versus secondary) by Clinical Status (admission versus discharge versus 6-month post-discharge) and Type of Unawareness by Phase of Illness (first-episode versus chronic) interaction effects. More specifically, in the first-episode group, primary unawareness steadily decreased over time. In contrast, in the chronic group, primary unawareness decreased markedly during hospitalization and returned to baseline after discharge.These results provide preliminary support for the notion that impaired insight is an additive outcome of primary unawareness and disagreement, and that change in insight over time occurs mostly at the level of their relative proportion as opposed to their overall sum. Implications for studying and treating poor insight in schizophrenia are discussed.

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.