The Relationship between Insight and Psychopathology in the Treatment of Schizophrenia with Acute Psychotic Episode

Sang-Won Park; Nam Young Lee; Seong-Hoon Jeong; Tak Youn; Yong Sik Kim; In-Won Chung

doi:10.4306/jknpa.2013.52.1.33

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Park, Lee, Jeong, Youn, Kim, and Chung: The Relationship between Insight and Psychopathology in the Treatment of Schizophrenia with Acute Psychotic Episode

Original Article

Journal of Korean Neuropsychiatric Association

Journal of Korean Neuropsychiatric Association 2013; 52(1): 33-41.

Published online: 31 January 2013

DOI: https://doi.org/10.4306/jknpa.2013.52.1.33

The Relationship between Insight and Psychopathology in the Treatment of Schizophrenia with Acute Psychotic Episode

Sang-Won Park, MD^1,², Nam Young Lee, MD, PhD^1,², Seong-Hoon Jeong, MD, PhD³, Tak Youn, MD, PhD^1,², Yong Sik Kim, MD, PhD^1,^2,^4,⁵, In-Won Chung, MD, PhD^1,²

¹Department of Neuropsychiatry Dongguk University International Hospital, Goyang, Korea.

²Institute of Clinical Psychopharmacology, Dongguk University International Hospital, Goyang, Korea.

³Department of Psychiatry, Eulji University College of Medicine, Daejeon, Korea.

⁴Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea.

⁵Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea.

Address for correspondence: In-Won Chung, MD, PhD. Department of Neuropsychiatry, Dongguk University International Hospital, 814 Siksa-dong, Ilsandong-gu, Goyang 410-773, Korea. Tel +82-31-961-7231, Fax +82-31-961-7230, ciw@duih.org

Received 28 October 2012 Revised 4 December 2012 Accepted 3 January 2013

Abstract

Objectives

Lack of insight has been regarded as the key feature of schizophrenia since the era of Kraepelin. The relationship between insight and psychopathology has been known to be statistically modest and non-linear. The aim of this study was to investigate psychopathological factors influencing insight achievement during treatment of acute psychotic episodes in schizophrenia, using the Korean version of the Scale to Assess Unawareness of Mental Disorder (SUMD-K) and the Positive and Negative Syndrome Scale (PANSS).

Methods

Information on demographic characteristics, SUMD-K, and PANSS were collected from the medical records of patients who were admitted to the psychiatric ward of Dongguk University International Hospital from March 1, 2009 to February 28 and were diagnosed as schizophrenia by the DSM-IV TR 2010. A total of 29 patients met the inclusion criteria. The scores of total and sub-items of SUMD-K for both current and past illnesses were assessed at five weeks after hospitalization and the scores of total and five factors of PANSS were assessed on hospitalization and at five weeks after hospitalization, respectively, and the changes in score between two time points were calculated. Statistical analysis of the relationships between the various items of the SUMD-K and the clinical characteristics, the total and sub-scores of PANSS was performed using the Pearson correlation test and multiple regression analysis with stepwise variable selection.

Results

Total score and five factor scores of PANSS for hospitalization and PANSS changes did not show statistical correlation with SUMD-K. The total score of general items and awareness of mental disorder of SUMD-K at five weeks after hospitalization showed significant associations with duration of education, depressed and cognitive factors for current illness of PANSS at five weeks after hospitalization, respectively. In addition, depressed factor and cognitive factor of PANSS showed a significant association with awareness of social consequences and awareness of the achieved affect of medication, respectively.

Conclusion

During treatment of acute psychotic episodes in patients with schizophrenia, various domains of psychopathology were differentially correlated with insight, which implied the multidimensional construct on a continuum. Conduct of further studies of neurobiological approaches underlying factors showing correlation with insight is needed.

Keywords: Insight, Psychopathology, Schizophrenia

Figures and Tables

Fig. 1

Past. total : Total score for past illness, Past. dis : Awareness of mental disorder for past illness, Past. med : Awareness of achieved effects of medication for past illness, Past. soc : Awareness of social consequences of mental illness for past illness, Past. sym : Awareness of symptoms for past illness, Curr. total : Total score for current illness. Curr.dis : A awareness of mental disorder for current illness, Curr. med : Awareness of achieved effects of medication for current illness, Curr. soc : Awareness of social consequences of mental illness for current illness, Curr. sym : Awareness of symptoms for current illness. ^*: Changes of subitems of PANSS between on hospitalization and after 5 weeks after hospitalization. EDU : Education, POS : Positive, NEG : Negative, EC : Excited, DEP : Depressive, COG : cognitive, PANSS : Positive and Negative Syndrome Scale.

Table 1

Demographic and clinical characteristics of in-patients with acute psychotic episode of schizophrenia (n=29)

DUP1 and DUP2 mean the duration of untreated psychosis (DUP) from onset age of prodromal period to age of first treatment and from onset age of first psychotic symptoms to age of first treatment respectively. Positive and Negative Symptom Scale (PANSS) baseline and PANSS follow-up mean the PANSS on hospitalization and at 5 weeks after hospitalization, respectively. PANSS change (%) means the change of PANSS score between on hospitalization and at 5 weeks after hospitalization presenting in percentage [=100×(PANSS baseline-PANSS follow-up)/PANSS baseline]. IQ : Intelligence quotient

Table 2

Correlation coefficients between the scores of SUMD-K and the scores of PANSS follow-up in in-patients with acute psychotic episode of schizophrenia (n=29)

Positive and Negative Symptom Scale (PANSS) follow-up means the score of PANSS at 5 weeks after hospitalization. ^*: p<0.01. SUMD-K : Korean version of Scale to Assessment Unawareness of Mental Disorder

Acknowledgments

This study was supported in part by a research grant (0420070680) of the Seoul National University Hospital, Republic of Korea.

Notes

Dr. YS Kim received grants, research support and honoraria from AstraZeneca, Eli Lilly, GlaxoSmithKline, Janssen, Novartis, Pfizer, Organon, Otsuka, Sanofi-Aventis and Servier. Other authors except Dr. YS Kim have no financial conflict of interest.

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