Unawareness of the disease in patients with schizophrenia: diagnosis and insight-oriented psychotherapy

Authors

  • O. I. Osokina Donetsk National Medical University, Lyman, Ukraine.,
  • B. B. Ivnyev Donetsk National Medical University, Lyman, Ukraine,
  • G. G. Putyatin Donetsk National Medical University, Lyman, Ukraine,
  • Ye. M. Denisov Donetsk National Medical University, Lyman, Ukraine,
  • S. G. Ushenin Donetsk National Medical University, Lyman, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2018.3.130551

Keywords:

insight, schizophrenia, psychotherapy

Abstract

Relevance. Phenomenon of patients' unawareness of their illness (insight) is a pathognomonic diagnostic criterion that distinguishes schizophrenia from many other psychiatric disorders. More than half of patients with schizophrenia do not realize their illness that makes their treatment more difficult. Diagnosis of insight in patients with schizophrenia is an important issue. The volume and content of rehabilitation programs depends on it.

The purpose of research is to study the structure of insight in patients with schizophrenia, its relationship with certain clinical, social and psychological indicators, and to assess the influence of insight-oriented psychotherapy on the outcomes of schizophrenia.

Material and methods. 237 patients with schizophrenia were studied: 139 (58.6 %) men and 98 (41.4 %) women aged 18-35 years. Patients of the main group (122 people) received pharmacotherapy and were included in the program of insight-oriented psychotherapy. Patients of the comparison group (115 people) received standard treatment. Measurement of the insight level was carried out using the scale of unawareness of mental disorder (SUMD). To study social indicators the scale of social functioning in various spheres was used (Zaitsev, 1999). The quality of life level and social stigma were measured by WHOQOL-BREF and adapted version of the self-stigmatization scale (SSMIS). Evaluation of outcomes in schizophrenia was carried out using the IMR and RMQ scales. The level of cognitive functioning was assessed by the GACF-CogFu scale. The severity of depression was measured by the scale developed by Beck (BDI). The mechanisms of psychological defense were assessed using the scale of R. Plutchik, H. Kellerman (1979). Mathematical processing of the results was also carried out.

Results. Correlations were found between a higher level of patient awareness of the disease and its better prognosis (r= -0.507; p<0.05), a higher level of social functioning (r= 0.478; p<0.05), quality of life (r= -0.311; p<0.05), cognitive functioning (r= -0.508; p<0.05) and a lower intensity of defensive psychological mechanisms (r= -0.401; p<0.05). A different predictive value of some insight components was found. There were detected correlations between a successful disease prognosis and a high degree of patient awareness of the disease symptoms (r = -0.318; p<0.05), the need for treatment (r = -0.603; p<0.05), the drug effect (r = -0.312; p<0.05) and a low awareness level of how people perceive the patient’s illness (r = 0.527; p<0.05) and its social consequences (r= 0.419; p<0.05). The highest association with the risk of depressive symptoms and self-stigmatization had the following insight components: awareness of the mental illness presence (r= -0.365 and r= -0.525, respectively; p<0.05) and perception by others (r= -0.654 and r= -0,417; p<0.05), awareness of the diagnosis (r= -0.312 and r= -0.45; p<0.05), social consequences of the disease (r= -0.3 and r= -0.621; p<0.05) and their perception by others (r= -0.531 and r= - 0.576; p<0.05).

Conclusions. Insight-oriented psychotherapy has proven effective in patients with schizophrenia treatment. It is reasonable to increase the patients' awareness of the disease symptoms, their causes, the need for treatment and the effectiveness of medicines, while leaving intact those aspects of insight that increase the risk of depression, psychological distress and self-stigmatization.

References

Likholetova, O. I. (2013). Insajt pri pervom psikhoticheskom e'pizode shizofrenii [Insight in patients with the first psychotic episode of schizophrenia. Aktualni pytannia suchasnoi medytsyny. Abstracts of Papers of the International scientific conference of students and young scientists dedicated to the 20th anniversary of the medical faculty of the Kharkiv National University named by. V.N. Karazin. (pp. 201–202). Kharkiv. [in Russian].

Joseph, B., Narayanaswamy, J. C., & Venkatasubramanian, G. (2015) Insight in Schizophrenia: Relationship to Positive, Negative and Neurocognitive Dimensions. Indian J. Psychol. Med., 37(1), 5–11. doi: 10.4103/0253-7176.150797.

Konstantakopoulos, G., Ploumpidis, D., Oulis, P., Patrikelis, P., Nikitopoulou, S., Papadimitriou, G. N., & Davidb, A. S. (2014) The relationship between insight and theory of mind in schizophrenia. Schizophr. Res., 152, 217–222. doi: 10.1016/j.schres.2013.11.022.

Quee, P. J., Van der Meer, L., Krabbendam, L., de Haan, L., Chan, W. Y., Wiersma, D., et al. (2014). Insight change in psychosis: relationship with neurocognition, social cognition, clinical symptoms and phase of illness. Acta psychiatrica scandinavica, 129(2), 126–133. doi: 10.1111/acps.12138.

Ekinci, O., & Ekinci, A. (2013) Association between insight, cognitive insight, positive symptoms and violence in patients with schizophrenia. Nord J. Psychiatry, 67, 116–123. doi: 10.3109/08039488.2012.687767.

Osokina, O. I., Putyatin, G. G., Pyrkov, S. G., Vygovskaya, Е. M., Golodenko, О. N., & Mangush, T. N. (2014) Insajt i pokazateli klinicheskogo, social'nogo i lichnostnogo vyzdorovleniya bol'nykh s manifestnym pristupom shizofrenii [Insight and indicators of clinical, social and personal recovery of patients with a manifestation of schizophrenia]. Pytannia eksperymentalnoi ta klinichnoi medytsyny, 18(2), 167–174. [in Russian].

Krupchenko, D. A. (2012) Klinicheskoe znachenie osoznaniya bolezni pri shizofrenii [Clinical significance of awareness of the disease in schizophrenia]. Psikhiatriya, psikhoterapiya i klinicheskaya psikhologiya, 1(07), 6–16. [in Russian].

Mingrone, C., Rocca, P., Castagna, F., Montemagni, C., Sigaudo, M., Scalese, M., et al. (2013) Insight in stable schizophrenia: Relations with psychopathology and cognition. Compr. Psychiatry, 54, 484–492. doi: 10.1016/j.comppsych.2012.12.014.

Abramov, V. A., Osokina, O. I., & Ivniev, B. B. (2014) Zhizn' s psihikheskim rasstrojstvom: e'kzistencial'no-lichnostnye aspekty vyzdorovleniya [Life with a mental disorder: the existential and personal aspects of recovery]. Doneck : Kashtan. [in Russian].

Osokina, O. I. (2016) Shizophreniya: analiz spektra psikhozov [Schizophrenia: analysis of the psychosis spectrum]. Kramatorsk: Kashtan. [in Russian].

Harchuk, Y. V. (2013) Otnoshenie k bolezni u pacientov s sochetaniem paranoidnoj shizofrenii i gipertonicheskoj bolezni [Attitude to disease in patients with paranoid schizophrenia and hypertension comorbidity]. Ukrainskyi medychnyi chasopys, 3(95), 157–159. [in Russian].

Irzhevskaya, V. P. (2009) Narushenie osoznaniya psikhicheskoj bolezni pri shizofrenii (Dis… kand. psikhol. nauk). [Unawareness of mental illness in schizophrenia. Dr. psikhol. sci. diss.]. Moscow. [in Russian].

(2009). Outcome Measures. Mental Health Services. County of San Diego. Health and Human Services Agency.

Zajcev, V. V. (1999) Vliyanie semejnykh otnoshenij na social'nuyu adaptaciyu i kachestvo zhizni bol'nykh shizofreniej (Avtoref. dis…kand. med. nauk). [Influence of family relations on social adaptation and quality of life of patients with schizophrenia]. (Extended abstract of candidate’s thesis). Saint Petersburg. [in Russian].

Maruta, N. O., Abramov, V. A., Osokina, O. I., Riapolova, T. L., Vygovska, O. M., & Studzinskii, O. H. (2013) Metodychnyi kompleks otsinky ekzystentsiino-osobystisnoho vidnovlennia khvorykh z pershym psykhotychnym epizodom [Methodical complex of estimation of existential-personal recovery of patients with the first psychotic episode]. Donetsk. [in Ukrainian].

Alphs, L., Rappard, F., & Haig, G. (2004) Cognitive Functioning Scale: A Scale for Rating Functioning Related to Cognitive Impairment in Schizophrenia. Pfizer, UCLA.

Maruta, N. O., Abramov, V. A., Osokina, O. I., Holodenko, O. M., Denisov, E. M., Studzinskii, O. G., & Maltapar, O. K. (2013) Insait-oriientovana psykhoterapiia u khvorykh z pershym psykhotychnym epizodom [Insight-oriented psychotherapy in patients with the first psychotic episode]. Donetsk. [in Ukrainian].

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How to Cite

1.
Osokina OI, Ivnyev BB, Putyatin GG, Denisov YM, Ushenin SG. Unawareness of the disease in patients with schizophrenia: diagnosis and insight-oriented psychotherapy. Zaporozhye Medical Journal [Internet]. 2018May30 [cited 2024Nov.23];(3). Available from: http://zmj.zsmu.edu.ua/article/view/130551

Issue

No. 3 (2018)

Section

Original research

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