Insight change and its relationship to subjective well-being during acute atypical antipsychotic treatment in schizophrenia
Jong-Hoon Kim MD PhD
Department of Psychiatry, Gil Hospital, Gachon University of Medicine and Science, Namdong-Gu, Incheon, South Korea
Search for more papers by this authorJun-Hyung Ann BSc
Department of Psychiatry, Gil Hospital, Gachon University of Medicine and Science, Namdong-Gu, Incheon, South Korea
Search for more papers by this authorJinyoung Lee BA
Department of Psychiatry, Gil Hospital, Gachon University of Medicine and Science, Namdong-Gu, Incheon, South Korea
Search for more papers by this authorJong-Hoon Kim MD PhD
Department of Psychiatry, Gil Hospital, Gachon University of Medicine and Science, Namdong-Gu, Incheon, South Korea
Search for more papers by this authorJun-Hyung Ann BSc
Department of Psychiatry, Gil Hospital, Gachon University of Medicine and Science, Namdong-Gu, Incheon, South Korea
Search for more papers by this authorJinyoung Lee BA
Department of Psychiatry, Gil Hospital, Gachon University of Medicine and Science, Namdong-Gu, Incheon, South Korea
Search for more papers by this authorSummary
What is known and Objective: Poor insight is prevalent among patients with schizophrenia and improved insight is one of the major goals of treatment. The purpose of the present study was to examine the relationship between insight and subjective well-being during acute treatment of schizophrenia with atypical antipsychotics in a naturalistic clinical setting.
Methods: Forty inpatients with schizophrenia were examined before and 8 weeks after the initiation of new treatment with atypical antipsychotics.
Results: There were significant correlations between changes in insight and those in psychopathology and global functioning. The change in insight score was significantly correlated with that in subjective well-being score, indicating that the improvement in insight was positively related to improved subjective well-being. This correlation remained significant even after controlling for the influence of psychopathology. The insight score at baseline was also significantly correlated with the subsequent change in subjective well-being score.
What is new and conclusion: The improvement of insight was positively correlated not only with that of psychopathology and global functioning, but also with that of subjective well-being, suggesting the potential value of interventions that improve patients’ awareness of the nature of their illness and the need for pharmacological treatment.
References
- 1 Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM (1993) Assessment of insight in psychosis. American Journal of Psychiatry, 150, 873–879.
- 2 Amador XF, Flaum M, Andreasen NC, Strauss DH, Yale SA, Clark SC, Gorman JM (1994) Awareness of illness in schizophrenia and schizoaffective and mood disorders. Archives of General Psychiatry, 51, 826–836.
- 3 Buckley PF, Wirshing DA, Bhushan P, Pierre JM, Resnick SA, Wirshing WC (2007) Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs, 21, 129–141.
- 4 Mintz AR, Dobson KS, Romney DM (2003) Insight in schizophrenia: a meta-analysis. Schizophrenia Research, 61, 75–88.
- 5 Pini S, Cassano GB, Dell’Osso L, Amador XF (2001) Insight into illness in schizophrenia, schizoaffective disorder, and mood disorders with psychotic features. American Journal of Psychiatry, 158, 122–125.
- 6 Goldberg RW, Green-Paden LD, Lehman AF, Gold JM (2001) Correlates of insight in serious mental illness. Journal of Nervous and Mental Disease, 189, 137–145.
- 7 Karow A, Pajonk FG (2006) Insight and quality of life in schizophrenia: recent findings and treatment implications. Current Opinion of Psychiatry, 19, 637–641.
- 8 David A, Buchanan A, Reed A, Almeida O (1992) The assessment of insight in psychosis. British Journal of Psychiatry, 161, 599–602.
- 9 Kemp RA, Lambert TJ (1995) Insight in schizophrenia and its relationship to psychopathology. Schizophrenia Research, 18, 21–28.
- 10 Moore O, Cassidy E, Carr A, Callaghan EO (1999) Unawareness of illness and its relationship with depression and selfdeception in schizophrenia. European Psychiatry, 14, 264–269.
- 11 Sevy S, Nathanson K, Visweswaraiah H, Amador X (2004) The relationship between insight and symptoms in schizophrenia. Comprehensive Psychiatry, 45, 16–19.
- 12 Gharabawi GM, Lasser RA, Bossie CA, Zhu Y, Amador X (2006) Insight and its relationship to clinical outcomes in patients with schizophrenia or schizoaffective disorder receiving long-acting risperidone. International Clinical Psychopharmacology, 21, 233–240.
- 13 Gharabawi G, Bossie C, Turkoz I, Kujawa M, Mahmoud R, Simpson G (2007) The impact of insight on functioning in patients with schizophrenia or schizoaffective disorder receiving risperidone long-acting injectable. Journal of Nervous and Mental Disease, 195, 976–982.
- 14 Naber D, Moritz S, Lambert M, Pajonk FG, Holzbach R, Mass R, Andresen B (2001) Improvement of schizophrenic patients’ subjective well-being under atypical antipsychotic drugs. Schizophrenia Research, 50, 79–88.
- 15 Karow A, Naber D (2002) Subjective well-being and quality of life under atypical antipsychotic treatment. Psychopharmacology, 162, 3–10.
- 16 Awad AG, Voruganti LN (2004) Impact of atypical antipsychotics on quality of life in patients with schizophrenia. CNS Drugs, 18, 877–893.
- 17 Browne S, Garavan J, Gervin M, Roe M, Larkin C, O’Callaghan E (1998) Quality of life in schizophrenia: insight and subjective response to neuroleptics. Journal of Nervous and Mental Disease, 186, 74–78.
- 18 Williams CC, Collins A (2002) Factors associated with insight among outpatients with serious mental illness. Psychiatric Services, 53, 96–98.
- 19 Hofer A, Rettenbacher MA, Widschwendter CG, Kemmler G, Hummer M, Fleischhacker WW (2006) Correlates of subjective and functional outcomes in outpatient clinic attendees with schizophrenia and schizoaffective disorder. European Archives of Psychiatry and Clinical Neuroscience, 256, 246–255.
- 20 Lysaker PH, Bell MD, Bryson GJ, Kaplan E (1998) Insight and interpersonal function in schizophrenia. Journal of Nervous and Mental Disease, 186, 432–436.
- 21 Vaz FJ, Bejar A, Casado M (2002) Insight, psychopathology, and interpersonal relationships in schizophrenia. Schizophrenia Bulletin, 28, 311–317.
- 22 Ritsner M (2003) Predicting changes in domain-specific quality of life of schizophrenia patients. Journal of Nervous and Mental Disease, 191, 287–294.
- 23 Mohamed S, Rosenheck R, McEvoy J, Swartz M, Stroup S, Lieberman JA (2009) Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia. Schizophrenia Bulletin, 35, 336–346.
- 24 Hasson-Ohayon I, Kravetz S, Roe D, David AS, Weiser M (2006) Insight into psychosis and quality of life. Comprehensive Psychiatry, 47, 265–269.
- 25 Karow A, Pajonk FG, Reimer J, Hirdes F, Osterwald C, Naber D, Moritz S (2008) The dilemma of insight into illness in schizophrenia: self- and expert-rated insight and quality of life. European Archives of Psychiatry and Clinical Neuroscience, 258, 152–159.
- 26 Schwartz RC, Smith SD (2004) Suicidality and psychosis: the predictive potential of symptomatology and insight into illness. Journal of Psychiatric Research, 38, 185–191.
- 27 Sim K, Mahendran R, Siris SG, Heckers S, Chong SA (2004) Subjective quality of life in first episode schizophrenia spectrum disorders with comorbid depression. Psychiatry Research, 129, 141–147.
- 28 American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn (DSM-IV). Washington DC: American Psychiatric Association.
- 29 Naber D, Riedel M, Klimke A et al. (2005) Randomized double blind comparison of olanzapine vs. clozapine on subjective well-being and clinical outcome in patients with schizophrenia. Acta Psychiatrica Scandinavica, 111, 106–115.
- 30 Lambert M, Schimmelmann BG, Naber D, Schacht A, Karow A, Wagner T, Czekalla J (2006) Prediction of remission as a combination of symptomatic and functional remission and adequate subjective well-being in 2960 patients with schizophrenia. Journal of Clinical Psychiatry, 67, 1690–1697.
- 31 de Haan L, Weisfelt M, Dingemans PM, Linszen DH, Wouters L (2002) Psychometric properties of the Subjective Well-Being Under Neuroleptics scale and the Subjective Deficit Syndrome Scale. Psychopharmacology, 162, 24–28.
- 32 de Haan L, van Bruggen M, Lavalaye J, Booij J, Dingemans PM, Linszen D (2003) Subjective experience and D2 receptor occupancy in patients with recent-onset schizophrenia treated with low-dose olanzapine or haloperidol: a randomized, double-blind study. American Journal of Psychiatry, 160, 303–309.
- 33 Wehmeier PM, Kluge M, Schacht A, Helsberg K, Schreiber W (2007) Correlation of physician and patient rated quality of life during antipsychotic treatment in outpatients with schizophrenia. Schizophrenia Research, 91, 178–186.
- 34 Wehmeier PM, Kluge M, Schacht A, Helsberg K, Schreiber W, Schimmelmann BG, Lambert M (2008) Patterns of physician and patient rated quality of life during antipsychotic treatment in outpatients with schizophrenia. Journal of Psychiatric Research, 42, 676–683.
- 35 Karow A, Moritz S, Lambert M, Schoder S, Krausz M (2005) PANSS syndromes and quality of life in schizophrenia. Psychopathology, 38, 320–326.
- 36 Yoon JS, Kook SH, Lee HY, Lee C, Paik IH (2000) The development of a Korean modification of the scale to measure Subjective Well-being under Neuroleptic Treatment (SWN). Journal of Korean Neuropsychiatric Association, 39, 987–998.
- 37 Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.
- 38 Beck AT, Ward CH, Mendelson M, Mock J, Erbauch J (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.
- 39 Bell MD, Lysaker PH, Beam-Goulet JL, Milstein RM, Lindenmayer JP (1994) Five-component model of schizophrenia: assessing the factorial invariance of the positive and negative syndrome scale. Psychiatry Research, 52, 295–303.
- 40 Whitehorn D, Brown J, Richard J, Rui Q, Kopala L (2002) Multiple dimensions of recovery in early psychosis. International Review of Psychiatry, 14, 273–283.
- 41 Hwang SS, Chang JS, Lee KY, Kim SH, Ahn YM, Kim YS (2009) Causal model of insight and psychopathology based on the PANSS factors: 1-year cross-sectional and longitudinal revalidation. International Clinical Psychopharmacology, 24, 189–198.
- 42 Stefanopoulou E, Lafuente AR, Saez Fonseca JA, Huxley A (2009) Insight, global functioning and psychopathology amongst in-patient clients with schizophrenia. Psychiatric Quarterly, 80, 155–165.
- 43 Inada T, Yagi G, Miura S (2002) Extrapyramidal symptom profiles in Japanese patients with schizophrenia treated with olanzapine or haloperidol. Schizophrenia Research, 57, 227–238.
- 44 Kim JH, Jung HY, Kang UG et al. (2002) Metric characteristics of the DIEPSS: a practical combined rating scale for drug-induced movement disorders. Movement Disorders, 17, 1354–1359.
- 45 Kim JH, Cho SY, Byun HJ, Kang UG, Ahn YM, Kim YS (2004) Multidimensional sensory phenomena in antipsychotic-induced akathisia. Journal of Clinical Psychopharmacology, 24, 618–623.
- 46 Keshavan MS, Rabinowitz J, DeSmedt G, Harvey PD, Schooler N (2004) Correlates of insight in first episode psychosis. Schizophrenia Research, 70, 187–194.
- 47 Drake RJ, Pickles A, Bentall RP, Kinderman P, Haddock G, Tarrier N, Lewis SW (2004) The evolution of insight, paranoia and depression during early schizophrenia. Psychological Medicine, 34, 285–292.
- 48 Lysaker PH, Buck KD, Salvatore G, Popolo R, Dimaggio G (2009) Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches. Expert Review of Neurotherapeutics, 9, 1035–1043.
- 49 Saeedi H, Addington J, Addington D (2007) The association of insight with psychotic symptoms, depression, and cognition in early psychosis: a 3-year follow-up. Schizophrenia Research, 89, 123–128.
- 50 Rocca P, Castagna F, Mongini T, Bogetto F (2010) Relative contributions of psychotic symptoms and insight to quality of life in stable schizophrenia. Psychiatry Research, 177, 71–76.
- 51 Smith TE, Hull JW, Huppert JD, Silverstein SM, Anthony DT, McClough JF (2004) Insight and recovery from psychosis in chronic schizophrenia and schizoaffective disorder patients. Journal of Psychiatric Research, 38, 169–176.
- 52 Addington D, Addington J, Maticka-Tyndale E (1993) Assessing depression in schizophrenia: the Calgary Depression Scale. British Journal of Psychiatry Supplement, 22, 39–44.
- 53 Mohr P (2007) Quality of life in the long-term treatment and the role of second-generation antipsychotics. Neuroendocrinology Letters, 28(Suppl. 1), 117–133.
- 54 Möller HJ (2005) Antipsychotic and antidepressive effects of second generation antipsychotics: two different pharmacological mechanisms? European Archives of Psychiatry and Clinical Neuroscience, 255, 190–201.
- 55 Kim JH, Ann JH, Kim MJ (in press) Relationship between improvements of subjective well-being and depressive symptoms during acute treatment of schizophrenia with atypical antipsychotics. Journal of Clinical Pharmacy and Therapeutics.
- 56 Mauri MC, Moliterno D, Rossattini M, Colasanti A (2008) Depression in schizophrenia: comparison of first- and second-generation antipsychotic drugs. Schizophrenia Research, 99, 7–12.
- 57 McEvoy JP, Apperson LJ, Appelbaum PS et al. (1989) Insight in schizophrenia. Its relationship to acute psychopathology. Journal of Nervous and Mental Disease, 177, 43–47.
- 58 Birchwood M, Smith J, Drury V, Healy J, Macmillan F, Slade M (1994) A self-report insight scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica, 89, 62–67.