Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-03T15:48:18.894Z Has data issue: false hasContentIssue false
  • English
  • Français

The relationship between insight and neurological dysfunction in first-episode psychosis

Published online by Cambridge University Press:  15 April 2020

M. Hill ,
N. Crumlish ,
P. Whitty ,
M. Clarke ,
S. Browne ,
M. Gervin ,
A. Kinsella ,
J.L. Waddington ,
C. Larkin  and
E. O’Callaghan
M. Hill
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Massachusetts General Hospital and Harvard Medical School, Boston, USA
N. Crumlish
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, Trinity College, Dublin, Ireland
P. Whitty
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland
M. Clarke
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland
S. Browne
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland
M. Gervin
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland
A. Kinsella
Affiliation:
Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
J.L. Waddington
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
C. Larkin
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
E. O’Callaghan*
Affiliation:
Stanley Research Unit, Cluain Mhuire Family Centre, St John of God Adult Psychiatric Service, Dublin, Ireland Department of Psychiatry, School of Medicine, University College, Dublin, Ireland Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
*
*Corresponding author. Tel.: +353 1 2791700. [email protected] (E. O’Callaghan).
Get access

Abstract

Purpose

Impaired insight is commonly seen in psychosis and some studies have proposed that is a biologically based deficit. Support for this view comes from the excess of neurological soft signs (NSS) observed in patients with psychoses and their neural correlates which demonstrate a degree of overlap with the regions of interest implicated in neuroimaging studies of insight. The aim was to examine the relationship between NSS and insight in a sample of 241 first-episode psychosis patients.

Method

Total scores and subscale scores from three insight measures and two NSS scales were correlated in addition to factors representing overall insight and NSS which we created using principal component analysis.

Results

There were only four significant associations when we controlled for symptoms. “Softer” Condensed Neurological Evaluation (CNE) signs were associated with our overall insight factor (r = 0.19, P = 0.02), with total Birchwood (r = −0.24, P<0.01), and the Birchwood subscales; recognition of mental illness (r = −0.24, P<0.01) and need for treatment (r = −0.18, P = 0.02). Total Neurological Evaluation Scale (NES) and recognition of the achieved effects of medication were also weakly correlated (r = 0.14, P = 0.04).

Conclusion

This study does not support a direct link between neurological dysfunction and insight in psychosis. Our understanding of insight as a concept remains in its infancy.

Keywords

PsychosisFirst-episodeInsightNeurology
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 3 , April 2012 , pp. 200 - 205
Copyright
Copyright © Elsevier Masson SAS 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aleman, A., Agrawal, N., Morgan, K.D., David, A.S.Insight in psychosis and neuropsychological function: meta-analysis. Br J Psychiatry. 2006; 189: 204–212.CrossRefGoogle ScholarPubMed
Amador, X.F., Strauss, D.H., Yale, S.A., Gorman, J.M.Awareness of illness in schizophrenia. Schizophr Bull. 17 1: 1991 113–132.CrossRefGoogle Scholar
Amador, X.F., Strauss, D.H., Yale, S.A., Flaum, M.M., Endicott, J., Gorman, J.M.Assessment of insight in psychosis. Am J Psychiatry. 150 6: 1993 873–879.Google ScholarPubMed
American Psychiatric Association WD. Diagnostic and statistical manual of mental disorders, 3rd edition. 1980.Google Scholar
Arduini, L., Kalyvoka, A., Stratta, P., Rinaldi, O., Daneluzzo, E., Rossi, A.Insight and neuropsychological function in patients with schizophrenia and bipolar disorder with psychotic features. Can J Psychiatry. 48 5: 2003 338–341.CrossRefGoogle ScholarPubMed
Babinski, J.Contribution à l’etude de troubles mentaux dans l’hémiplégie organique cérébrale (anosognosie). Rev Neurol. 1914; 27: 845–888.Google Scholar
Birchwood, M., Smith, J., Drury, V., Healy, J., Macmillan, F., Slade, M.A self-report Insight Scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatr Scand. 89 1: 1994 62–67.CrossRefGoogle ScholarPubMed
Browne, S., Clarke, M., Gervin, M., Lane, A., Waddington, J.L., Larkin, C.et al.Determinants of neurological dysfunction in first episode schizophrenia. Psychol Med. 30 6: 2000 1433–1441.CrossRefGoogle ScholarPubMed
Buchanan, R.W., Heinrichs, D.W.The Neurological Evaluation Scale (NES): a structured instrument for the assessment of neurological signs in schizophrenia. Psychiatry Res. 27 3: 1989 335–350.CrossRefGoogle Scholar
Buchy, L., Bodnar, M., Malla, A., Joober, R., Lepage, M.A 12-month outcome study of insight and symptom change in first-episode psychosis. Early Interv Psychiatry. 4 1: 2010 79–88.CrossRefGoogle ScholarPubMed
Chan RC, Xu T, Heinrichs RW, Yu Y, Wang Y. Neurological soft signs in schizophrenia: a meta-analysis. Schizophr Bull 2009.CrossRefGoogle Scholar
Clarke, M., Whitty, P., Browne, S., McTigue, O., Kamali, M., Gervin, M.et al.Untreated illness and outcome of psychosis. Br J Psychiatry. 2006; 189: 235–240.CrossRefGoogle Scholar
Cohen JW. Statistical power analysis for the behavioural sciences. 2nd ed. 1988.Google Scholar
Cooke, M.A., Fannon, D., Kuipers, E., Peters, E., Williams, S.C., Kumari, V.Neurological basis of poor insight in psychosis: a voxel-based MRI study. Schizophr Res. 103 1–3: 2008 40–51.CrossRefGoogle ScholarPubMed
Cuesta, M.J., Peralta, V., Caro, F., de Leon, J.Is poor insight in psychotic disorders associated with poor performance on the Wisconsin Card Sorting Test?. Am J Psychiatry. 152 9: 1995 1380–1382.Google ScholarPubMed
David, A.S.Insight and psychosis. Br J Psychiatry. 1990; 156: 798–808.CrossRefGoogle ScholarPubMed
Dazzan, P., Murray, R.M.Neurological soft signs in first-episode psychosis: a systematic review. Br J Psychiatry Suppl. 2002; 43: s50–s57.CrossRefGoogle ScholarPubMed
Dazzan, P., Morgan, K.D., Orr, K.G., Hutchinson, G., Chitnis, X., Suckling, J.et al.The structural brain correlates of neurological soft signs in AESOP first-episode psychoses study. Brain. 127 Pt 1 2004 143–153.CrossRefGoogle ScholarPubMed
Dazzan, P., Morgan, K.D., Chitnis, X., Suckling, J., Morgan, C., Fearon, P.et al.The structural brain correlates of neurological soft signs in healthy individuals. Cereb Cortex. 16 8: 2006 1225–1231.CrossRefGoogle ScholarPubMed
Drake, R.J., Lewis, S.W.Insight and neurocognition in schizophrenia. Schizophr Res. 62 1–2: 2003 165–173.CrossRefGoogle Scholar
First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV Axis I disorders. New York State Psychiatric Institute; 1995.CrossRefGoogle Scholar
Freudenreich, O., Deckersbach, T., Goff, D.C.Insight into current symptoms of schizophrenia. Association with frontal cortical function and affect. Acta Psychiatr Scand. 110 1: 2004 14–20.CrossRefGoogle ScholarPubMed
Friis, S., Larsen, T.K., Melle, I., Opjordsmoen, S., Johannessen, J.O., Haahr, U.et al.Methodological pitfalls in early detection studies – the NAPE Lecture 2002. Nordic Association for Psychiatric Epidemiology. Acta Psychiatr Scand. 107 1: 2003 3–9.CrossRefGoogle ScholarPubMed
Kamali, M., Kelly, L., Gervin, M., Browne, S., Larkin, C., O’Callaghan, E.Psychopharmacology: insight and comorbid substance misuse and medication compliance among patients with schizophrenia. Psychiatr Serv. 52 2: 2001 161–163.CrossRefGoogle ScholarPubMed
Kay, S.R., Fiszbein, A., Opler, L.A.The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 13 2: 1987 261–276.CrossRefGoogle Scholar
Kelly, B.D., Clarke, M., Browne, S., McTigue, O., Kamali, M., Gervin, M.et al.Clinical predictors of admission status in first-episode schizophrenia. Eur Psychiatry. 19 2: 2004 67–71.CrossRefGoogle ScholarPubMed
Kemp, R., David, A.Psychological predictors of insight and compliance in psychotic patients. Br J Psychiatry. 169 4: 1996 444–450.CrossRefGoogle ScholarPubMed
Keshavan, M.S., Sanders, R.D., Sweeney, J.A., Diwadkar, V.A., Goldstein, G., Pettegrew, J.W.et al.Diagnostic specificity and neuroanatomical validity of neurological abnormalities in first-episode psychoses. Am J Psychiatry. 160 7: 2003 1298–1304.CrossRefGoogle ScholarPubMed
Keshavan, M.S., Rabinowitz, J., DeSmedt, G., Harvey, P.D., Schooler, N.Correlates of insight in first episode psychosis. Schizophr Res. 70 2–3: 2004 187–194.CrossRefGoogle ScholarPubMed
Lane, A., Colgan, K., Moynihan, F., Burke, T., Waddington, J.L., Larkin, C.et al.Schizophrenia and neurological soft signs: gender differences in clinical correlates and antecedent factors. Psychiatry Res. 64 2: 1996 105–114.CrossRefGoogle ScholarPubMed
Laroi, F., Fannemel, M., Ronneberg, U., Flekkoy, K., Opjordsmoen, S., Dullerud, R.et al.Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests. Psychiatry Res. 100 1: 2000 49–58.CrossRefGoogle ScholarPubMed
McCabe, R., Quayle, E., Beirne, A.D., Anne Duane, M.M.Insight, global neuropsychological functioning, and symptomatology in chronic schizophrenia. J Nerv Ment Dis. 190 8: 2002 519–525.CrossRefGoogle ScholarPubMed
McGlynn, S.M., Schacter, D.L.Unawareness of deficits in neuropsychological syndromes. J Clin Exp Neuropsychol. 11 2: 1989 143–205.CrossRefGoogle ScholarPubMed
Mintz, A.R., Dobson, K.S., Romney, D.M.Insight in schizophrenia: a meta-analysis. Schizophr Res. 61 1: 2003 75–88.CrossRefGoogle ScholarPubMed
Mohamed, S., Fleming, S., Penn, D.L., Spaulding, W.Insight in schizophrenia: its relationship to measures of executive functions. J Nerv Ment Dis. 187 9: 1999 525–531.CrossRefGoogle ScholarPubMed
Rossi, A., De Cataldo, S., Di Michele, V., Manna, V., Ceccoli, S., Stratta, P.et al.Neurological soft signs in schizophrenia. Br J Psychiatry. 1990; 157: 735–739.CrossRefGoogle Scholar
Saeedi, H., Addington, J., Addington, D.The association of insight with psychotic symptoms, depression, and cognition in early psychosis: a 3-year follow-up. Schizophr Res. 89 1–3: 2007 123–128.CrossRefGoogle ScholarPubMed
Shad, M.U., Muddasani, S., Keshavan, M.S.Prefrontal subregions and dimensions of insight in first-episode schizophrenia: a pilot study. Psychiatry Res. 146 1: 2006 35–42.CrossRefGoogle ScholarPubMed
Smith, T.E., Hull, J.W., Israel, L.M., Willson, D.F.Insight, symptoms, and neurocognition in schizophrenia and schizoaffective disorder. Schizophr Bull. 26 1: 2000 193–200.CrossRefGoogle ScholarPubMed
Torrey EF. Surviving schizophrenia: a manual for families, consumers and providers. 3rd ed. 1995.Google Scholar
Whitty, P., Clarke, M., Browne, S., McTigue, O., Kamali, M., Feeney, L.et al.Prospective evaluation of neurological soft signs in first-episode schizophrenia in relation to psychopathology: state versus trait phenomena. Psychol Med. 33 8: 2003 1479–1484.CrossRefGoogle ScholarPubMed
Young, D.A., Davila, R., Scher, H.Unawareness of illness and neuropsychological performance in chronic schizophrenia. Schizophr Res. 10 2: 1993 117–124.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.