A 12-month outcome study of insight and symptom change in first-episode psychosis.
OBJECTIVE
We first aimed to evaluate the progression of insight and psychopathology over the first year of treatment for a psychosis. We hypothesized that improvement in insight would associate with improvement in positive and negative symptoms, and depressive and anxious symptom exacerbation. Secondly, in an exploratory analysis, we aimed to identify quantitatively distinct insight trajectory groups, and to describe the impact of psychopathology over time on the different trajectory groups.


METHODS
One-hundred and sixty-five patients were administered a comprehensive clinical evaluation, and insight was rated on the Scale for Assessment for Unawareness of Mental Disorder, item 1 (awareness of mental disorder), at admission and after 1, 2, 3, 6, 9 and 12 months.


RESULTS
In a generalized estimating equation (GEE) model of change, insight improved concurrently with positive, negative and anxious symptoms between baseline and month 1 in the entire cohort. Latent group-based trajectory analysis revealed five insight groups: good, increasing, decreasing, moderate poor and very poor. GEE modelling revealed that the very poor and moderate poor insight groups displayed greater overall negative symptoms than patients with good and increasing insight trajectories. The good insight group showed significantly greater overall depressive symptoms than the diminished and very poor insight groups.


CONCLUSIONS
The results suggest that specific longitudinal insight trajectories were driving the observed associations between insight and negative and depressive symptoms in the entire first-episode psychosis cohort. Persistently poor insight may be an important factor in negative symptom maintenance. Good or increasing course of insight may be early clinical indicators of a liability to depression.
Buchy
Lisa
L
Brain Imaging Group, Douglas Mental Health University Institute, Verdun, Quebec, Canada.
Bodnar
Michael
M
Malla
Ashok
A
Joober
Ridha
R
Lepage
Martin
M
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001007:Anxiety / Q000150:complications / Q000523:psychology; D001364:Awareness; D003863:Depression / Q000150:complications / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome
D014150:Antipsychotic Agents