Trait and state attributes of insight in first episodes of early-onset schizophrenia and other psychoses: a 2-year longitudinal study

Abstract

Background: Increasing evidence supports the important role of illness state and individual characteristics in insight.

Methods: Insight, as measured with the Scale to Assess Unawareness of Mental Disorder, over the first 2 years of early-onset first-episode psychosis and its correlations with clinical, socio-demographic, cognitive, and structural brain variables are studied.

Results: (1) insight at 2 years is poorer in schizophrenia spectrum disorders (SSDs) than in subjects with other psychoses; (2) the more severe the psychosis, the worse the insight. In SSD, depressive symptoms, poorer baseline executive functioning, lower IQ, longer duration of untreated psychosis (DUP), and poorer premorbid infancy adjustment are associated with poorer insight; frontal and parietal gray matter (GM) reductions at baseline correlate with worse insight into having psychotic symptoms at 2 years; (3) insight into having a mental disorder (Scale to Assess Unawareness of Mental Disorder [SUMD]1) at 1 year, DUP, and baseline IQ are the most consistent variables explaining different aspects of insight at 2 years in SSD patients. IQ and SUMD1 at 1 year, together with left frontal and parietal GM volumes, explain 80% of the variance of insight into having specific psychotic symptoms in SSD patients (adjusted R(2) = 0.795, F = 15.576, P < .001).

Conclusion: Insight is a complex phenomenon that depends both on severity of psychopathology and also on disease and subject characteristics, such as past adjustment, IQ, DUP, cognitive functioning, frontal and parietal GM volumes, and age, gender, and ethnicity.

Fig. 1.

Insight into Having a Disorder (Scale to Assess Unawareness of Mental Disorder [SUMD]1), Depressive Symptomatology (Hamilton Score), and Total Psychopathology (Total Positive and Negative Symptom Scale [PANSS] Score), in Schizophrenia Spectrum Disorder Patients. Mean and SE represented. Axis to the left represents the score in the PANSS. Axis to the right represents score in SUMD1 and Hamilton.

Fig. 2.

Insight into Having a Disorder (Scale to Assess Unawareness of Mental Disorder [SUMD]1), Depressive Symptomatology (Hamilton Score), and Total Psychopathology (Total Positive and Negative Symptom Scale [PANSS] Score), in Non-Schizophrenia Spectrum Disorder Patients. Mean and SE represented. Axis to the left represents the score in the PANSS. Axis to the right represents score in SUMD1 and Hamilton.

Fig. 3.

Spearman Partial Correlations between Baseline Frontal and Parietal (Left and Right) Gray Matter (GM) and Insight into Having Psychosis Symptoms at 2 Years (SUMDTOT1).