بینش و آسیب شناسی روانی در اسکیزوفرنی هرگز درمان نشده

Insight is a feature of schizophrenia related to psychopathology, which could be modified by treatment. The real relationship will be more evident in the never-treated state. This study compared insight and its relationship to psychopathology in 143 never-treated patients with chronic schizophrenia with 183 treated patients. The treated patients had not received any structured intervention for improvement of insight. The item on insight and judgment from the Positive and Negative Syndrome Scale for schizophrenia was used as a measure of insight. Never-treated patients were more ill and poorer in insight than the TT group. Sex, age, duration of illness, negative symptoms related to insight only in the TT group. Positive symptoms score correlated with insight in both the groups, but negative symptoms correlated with insight only among the treated patients. Delusions, uncooperativeness, and poor attention predicted 27% of variation in the level of insight in the never-treated, whereas age; duration of illness; and symptoms of emotional withdrawal, difficulty in abstract thinking, and uncooperativeness predicted 30.3% of variation in insight of the TT group. The observed differences between the never-treated and treated subjects were due to influence of treatment on the association between insight and psychopathology. A subgroup of patients with a treatment-resistant trait of negative symptoms associated with poor insight was hypothesized.

Insight or self-awareness is a quality highly valued by most clinicians in the mental health field, largely because a strong link is assumed between good insight and better quality of life [1]. It was proposed that insight is not an “all-or-none” phenomenon but composed of 3 distinct overlapping dimensions, namely, the recognition that one has a mental illness, compliance with treatment, and the ability to relabel unusual mental events (delusions and hallucinations) as pathological [2]. Severe self-awareness deficits are a prevalent feature of schizophrenia, perhaps stemming from the neuropsychological dysfunction associated with the disorder, and are more common in schizophrenia than in other psychotic disorders [3]. The concept of insight into psychosis has received scant attention in the psychiatric literature [1] but during the past decade, there is a resurgence of interest in investigating the relationship between insight and symptoms in schizophrenia [4]. Insight may be associated with the overall severity of psychopathology [5] and [6]. Several studies have identified specific associations of insight with positive, negative, and mood symptoms [6], [7] and [8], although some did not [9]. Studies on insight were carried out with patients receiving treatment. Treatment modified both psychopathology and insight. Hence, one could not be sure how far artifacts of drug treatment and associated factors influenced the descriptions of the relationship between insight and psychopathology. The nature of this relationship in the natural chronic untreated state is not known. Knowledge of this is not merely of clinical interest but of importance in understanding the neuropathology of the illness. We had the opportunity to study a group of patients with chronic schizophrenia in India, who never entered any treatment process for their illness. We report here an analysis of insight and its relation to psychosis in these subjects and compared them with a group of patients who received antipsychotic treatment.

Insight is a feature of schizophrenia related to psychopathology. This study has found that the association of insight with age, sex, duration of illness, and psychopathology was different in the untreated illness from the treated illness. The differences may be due to the influence of antipsychotic drug treatment and associated processes on the association between insight and psychosis. A subgroup of patients with a trait of negative symptoms associated with poor insight and resistant to treatment was proposed.