[Long-term impact of the diagnostic announcement on the insight of patients suffering from schizophrenic disorders].
BACKGROUND
The importance of insight in patients with schizophrenia is linked to the notion that few subjects are conscious of their pathology and that some treatments fail due to a lack of consciousness of the necessity of medication. Since then, studies have been frequently undertaken into the insight of schizophrenic patients. It is believed that a good degree of insight could influence the quality of acceptance by the patient of the disease. This would facilitate closer medicinal supervision, resulting in fewer relapses and thus a decrease in the number of hospitalizations and subsequent improved quality of life for the patients. In 2002, a protocol of diagnostic announcement was set up for schizophrenic patients in the Ville-Evrard Hospital. Two years later, we observed a high level of compliance in these patients (70 %).


OBJECTIVE
The aim of our new study is therefore to assess insight in stabilized schizophrenic patients having benefited from the protocol of diagnostic announcement and to compare their degree of insight with a control population.


METHODS
Two scales of insight were used: the hetero-questionnaire Scale to Assess Unawareness of Mental Disorder (SUMD, Schizophr Bull 17 (1991) 113-32), and the self-questionnaire: Self Appraisal of Ilness Questionnaire (SAIQ, Schizophr Res 45 (2000) 203-11). The clinical symptom of psychosis was assessed by the Positive and Negative Syndrome Scale (PANSS). The Man and Whitney Test was used for the quantitative data and the exact Fisher test for qualitative data.


RESULTS
A total of 31 patients were included, 15 in the group having received the diagnostic announcement - population with protocol (P) and 16 in the control group without protocol (SP). The socio-demographic data analysis of the population P (having received the diagnostic announcement) showed a younger population with a shorter evolution of the disease compared to the population "SP". The P group is in demand as regards information on their disorders. In addition, in patients having lived with this disease for many years, these episodes have taken on a taboo status compared to patients in the early stage of the disease. One can consider that the psychiatrists proposed this psycho-informative protocol to younger patients. The results obtained with the SUMD scale were improved in the population "P" as regards development of insight (significantly with the factor 5). Attribution (factor 5) is the factor which the patients had the greatest difficulty estimating. Attribution is the result of external training, rather than awareness which solicits greater introspection. Therefore, psycho-education support played the role of "apprenticeship". Degree of insight was globally of good quality in this questionnaire (compared with the self-questionnaire). Results of the self-questionnaire: SAIQ shows that the degree of insight is quite low in both populations. Few authentic and reflected answers were possible in either of the two groups. However, the presence of a correlation between the overall two scores confirms that we did assess the same phenomenon. The PANSS clinical evaluation shows that the population "P" has symptoms of lesser intensity overall and significantly fewer positive symptoms than the population "SP". The limits of our study are linked to the small number of patients included, despite a homogeneous sample.


CONCLUSIONS
In conclusion, the protocol of diagnostic announcement and psycho-education have helped stabilize schizophrenic patients in order to improve their insight, without increasing the intensity of this disease in the short- or long-term. Work on insight should allow a new understanding of the patient's relation with the disease along with the medical team and his close relations.
Gastal
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URC, service G03, EPS Ville-Evrard, 202, avenue J.-Jaurès, 93330 Neuilly-sur-Marne, France. urcve1@gmail.com
Januel
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D000223:Adaptation, Psychological; D001364:Awareness; D005500:Follow-Up Studies; D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D010353:Patient Education as Topic; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012563:Schizophrenia, Paranoid / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D012803:Sick Role