Insight in first-episode psychosis.
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.


METHODS
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.
McEvoy
Joseph P
JP
John Umstead Hospital, Duke University Department of Psychiatry, Butner, NC 27509, USA. jpmcevoy@duke.edu
Johnson
Jackie
J
Perkins
Diana
D
Lieberman
Jeffrey A
JA
Hamer
Robert M
RM
Keefe
Richard S E
RS
Tohen
Mauricio
M
Glick
Ira D
ID
Sharma
Tonmoy
T
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D001569:Benzodiazepines / Q000627:therapeutic use; D001921:Brain / Q000033:anatomy & histology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D000077152:Olanzapine; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000706:statistics & numerical data
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D006220:Haloperidol; D000077152:Olanzapine