ارتباط بینشی طول عمر و شناخت در روان پریشی

Poor insight has been related to poor course in psychosis. However, the role of cognition in insight remains unclear. The aim of this study was to examine the influence of cognition and lifetime psychopathological dimensions on insight in psychosis. We followed up 42 patients with psychotic disorders over 10 years. Lifetime psychopathological dimensions and cognitive performance were assessed. Patients were divided into two groups by lifetime patterns of insight and compared with 42 healthy volunteers. Lower IQ and poorer social cognition were associated with higher risks of poorer lifetime insight of feeling ill and global insight respectively. Lifetime negative symptoms were associated with a higher risk of poorer lifetime insight into symptoms. Lifetime lack of insight is independent of cognitive impairment in specific domains, except for social cognition. Higher IQ may contribute to better lifetime awareness of illness, while better ability to manage emotions is involved in lifetime global insight.

Patients with psychotic disorders often exhibit lack of awareness of their illness, commonly known as lack of insight. David (1990) differentiated three components of insight into psychosis: recognition that one has an illness, the ability to recognise the symptoms of the illness and the compliance with treatment. Poor insight is associated with psychosocial dysfunction, as well as poor treatment adherence and more rehospitalisations (Amador and David, 2004). Hence, an understanding of the mechanisms of insight is necessary for improving outcomes in psychotic disorders. Among the various different aetiological models for lack of insight in psychosis, the neuropsychological model has generated extensive research in recent years. Studies investigating lack of insight and cognition have obtained inconsistent findings. On the one hand, lack of insight has been found to have a small but significant association with cognitive functioning, especially executive functioning, memory and global cognition (Aleman et al., 2006 and Nair et al., 2014), while on the other, some authors observed a non-specific relationship with general cognitive deficits (Morgan et al., 2010) or no relationship at all (Mintz et al., 2004). Most of the research on this topic has focused on executive functioning, in many cases assessed by the Wisconsin Card Sorting Test (Rossell et al., 2003, Keshavan et al., 2004 and Saeedi et al., 2007), based on the idea that a failure to change cognitive set and to monitor errors may lead to impaired insight. Again, results have been inconclusive. The purpose of this study was to examine the relationship between cognitive performance and lifetime patterns of insight over 10 years in a sample of outpatients with a diagnosis of a psychotic disorder, controlling for the lifetime psychopathological dimensions. We hypothesised that the evolution of lifetime patterns of insight would be independent of current cognitive performance.