Exploratory study of the association between insight and Theory of Mind (ToM) in stable schizophrenia patients.
BACKGROUND
Poor insight and impairment in Theory of Mind (ToM) reasoning are common in schizophrenia, predicting poorer clinical and functional outcomes. The present study aimed to explore the relationship between these phenomena.


METHODS
61 individuals with a DSM-IV diagnosis of schizophrenia during a stable phase were included. ToM was assessed using a picture sequencing task developed by Langdon and Coltheart (1999), and insight with the Scale to Assess Unawareness of Mental Disorder (SUMD; Amador et al., 1993). Multivariate linear regression analysis was carried out to estimate the predictive value of insight on ToM, taking into account several possible confounders and interaction variables.


RESULTS
No direct significant associations were found between any of the insight dimensions and ToM using bivariate analysis. However, a significant linear regression model which explained 48% of the variance in ToM was revealed in the multivariate analysis. This included the 5 insight dimensions and 3 interaction variables. Misattribution of symptoms--in aware patients with age at onset >20 years--and unawareness of need for medication--in patients with GAF >60--were significantly predictive of better ToM.


CONCLUSIONS
Insight and ToM are two complex and distinct phenomena in schizophrenia. Relationships between them are mediated by psychosocial, clinical, and neurocognitive variables. Intact ToM may be a prerequisite for aware patients to attribute their symptoms to causes other than mental illness, which could in turn be associated with denial of need for medication.
Pousa
Esther
E
Psychiatry Department, Parc Taulí Hospital, Sabadell, and Department of Clinical and Health Psychology, Psychopathology and Neuropsychology Research Unit, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain. epousa@tauli.cat
Duñó
Rosó
R
Blas Navarro
J
J
Ruiz
Ada I
AI
Obiols
Jordi E
JE
David
Anthony S
AS
D000328:Adult; D003071:Cognition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D012044:Regression Analysis; D012565:Schizophrenic Psychology