Trait and state attributes of insight in first episodes of early-onset schizophrenia and other psychoses: a 2-year longitudinal study.
BACKGROUND
Increasing evidence supports the important role of illness state and individual characteristics in insight.


METHODS
Insight, as measured with the Scale to Assess Unawareness of Mental Disorder, over the first 2 years of early-onset first-episode psychosis and its correlations with clinical, socio-demographic, cognitive, and structural brain variables are studied.


RESULTS
(1) insight at 2 years is poorer in schizophrenia spectrum disorders (SSDs) than in subjects with other psychoses; (2) the more severe the psychosis, the worse the insight. In SSD, depressive symptoms, poorer baseline executive functioning, lower IQ, longer duration of untreated psychosis (DUP), and poorer premorbid infancy adjustment are associated with poorer insight; frontal and parietal gray matter (GM) reductions at baseline correlate with worse insight into having psychotic symptoms at 2 years; (3) insight into having a mental disorder (Scale to Assess Unawareness of Mental Disorder [SUMD]1) at 1 year, DUP, and baseline IQ are the most consistent variables explaining different aspects of insight at 2 years in SSD patients. IQ and SUMD1 at 1 year, together with left frontal and parietal GM volumes, explain 80% of the variance of insight into having specific psychotic symptoms in SSD patients (adjusted R(2) = 0.795, F = 15.576, P < .001).


CONCLUSIONS
Insight is a complex phenomenon that depends both on severity of psychopathology and also on disease and subject characteristics, such as past adjustment, IQ, DUP, cognitive functioning, frontal and parietal GM volumes, and age, gender, and ethnicity.
Parellada
Mara
M
Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Ibiza 43, Madrid 28009, Spain. parellada@hggm.es
Boada
Leticia
L
Fraguas
David
D
Reig
Santiago
S
Castro-Fornieles
Josefina
J
Moreno
Dolores
D
Gonzalez-Pinto
Ana
A
Otero
Soraya
S
Rapado-Castro
Marta
M
Graell
Montserrat
M
Baeza
Inmaculada
I
Arango
Celso
C
D000293:Adolescent; D000367:Age Factors; D001364:Awareness; D001921:Brain / Q000473:pathology*; D002648:Child; D003071:Cognition; D003863:Depression; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000473:pathology; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D010296:Parietal Lobe / Q000473:pathology; D011618:Psychotic Disorders / Q000473:pathology / Q000523:psychology*; D012559:Schizophrenia / Q000175:diagnosis / Q000473:pathology*; D012565:Schizophrenic Psychology; D012737:Sex Factors; D012917:Social Adjustment