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Insight in first-episode psychosis

Published online by Cambridge University Press:  02 June 2006

JOSEPH P. McEVOY ,
JACKIE JOHNSON ,
DIANA PERKINS ,
JEFFREY A. LIEBERMAN ,
ROBERT M. HAMER ,
RICHARD S. E. KEEFE ,
MAURICIO TOHEN ,
IRA D. GLICK  and
TONMOY SHARMA
JOSEPH P. McEVOY
Affiliation:
John Umstead Hospital, Duke University Department of Psychiatry, Butner, NC, USA
JACKIE JOHNSON
Affiliation:
Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
DIANA PERKINS
Affiliation:
Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
JEFFREY A. LIEBERMAN
Affiliation:
Department of Psychiatry, Columbia University, New York, NY, USA
ROBERT M. HAMER
Affiliation:
Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
RICHARD S. E. KEEFE
Affiliation:
John Umstead Hospital, Duke University Department of Psychiatry, Butner, NC, USA
MAURICIO TOHEN
Affiliation:
Lilly Research Laboratories, Indianapolis, IN, USA
IRA D. GLICK
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
TONMOY SHARMA
Affiliation:
Clinical Neuroscience Research Centre, Stonehouse Hospital, Dartford, Kent, UK
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Abstract

Background. We report here a study examining the relationships between insight and psychopathology, cognitive performance, brain volume and co-morbid depression in 251 patients experiencing a first episode of psychosis, who were then randomly assigned to 2 years of double-blind treatment with either olanzapine or haloperidol.

Method. Repeated measures of insight were obtained at baseline and 12, 24, 52 and 104 weeks by the Insight and Treatment Attitudes Questionnaire (ITAQ).

Results. Older age, female gender and white ethnicity were associated with more insight. Higher total, positive, negative and general psychopathology scores on the Positive and Negative Syndromes Scale (PANSS) were associated with less insight. Higher depression scores were associated with more insight. Better neurocognitive function and large brain volumes were associated with more insight. More insight throughout the study was associated with longer time to medication non-adherence. However, baseline insight was not significantly related to the probability of discontinuing the study before 2 years. Insight improved significantly over the course of the study, but the improvement in insight was not significantly different between the two antipsychotic treatment groups.

Conclusions. Multiple factors contribute to insight. Patients experiencing a first episode of psychosis who have little insight are at increased risk of discontinuing their medication.

Type
Original Article
Information
Psychological Medicine , Volume 36 , Issue 10 , October 2006 , pp. 1385 - 1393
Copyright
2006 Cambridge University Press

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