洞察力受损对精神分裂症患者的治疗提出了挑战,因为它有可能危及治疗参与和药物依从性。这项研究探讨了洞察力障碍,从没有到极端,与患者报告的精神健康状况有关,抑郁症,和精神分裂症的神经认知。
在对临床抗精神病药物干预有效性试验(CATIE)研究(NCT00014001)的事后分析中,使用阳性和阴性综合征量表(PANSS)项目G12(缺乏洞察力)测量洞察力。此分析的其他评估包括12项短期健康调查(SF-12)精神成分摘要(MCS),医生和患者报告的临床总体印象严重程度(CGI-S),数学共识认知电池,和卡尔加里抑郁量表治疗精神分裂症。评估患者报告的结果与PANSS总数和项目G12评级之间的关系。
在这项分析的1431名CATIE研究参与者中,基线时自知能力日益受损与患者报告的生活质量(QoL)显著相关,较低的基线抑郁,医生和患者报告的疾病严重程度之间的差异更大。与医生报告相比,洞察力受损更严重的患者报告病情更轻。特别是那些中度-重度至极度损害(PANSS项目G12评级≥5),大约10%(138/1431)的CATIE参与者。对于90%的PANSS项目G12评分<5的患者,患者报告的QoL随着症状的增加而降低。SF-12MCS评分与基线PANSS总分线性相关,仅在PANSS总分<90(中度疾病或更好)的患者中,更好的症状评分与更高的QoL相关。没有观察到洞察力和神经认知之间的显著关系。
在CATIE研究的精神分裂症患者和PANSS项目G12评分≥5的小亚组(10%)中,中度-重度-重度/极端的自知力损害与患者对QoL和疾病严重程度的更积极感知相关。在其余90%的正常至中度洞察力受损的患者中未观察到这种情况。这表明,作为对自我报告有效性的威胁,缺乏洞察力是罕见的。
Impaired insight poses a challenge in the treatment of patients with schizophrenia because of its potential to jeopardize therapeutic engagement and medication adherence. This
study explored how insight impairment, graded from none to extreme, is related to patient-reported mental health status, depression, and neurocognition in schizophrenia.
In a post hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)
study (NCT00014001), insight was measured using the Positive and Negative Syndrome Scale (PANSS) Item G12 (lack of insight). Additional assessments for this analysis included the 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS), physician- and patient-reported Clinical Global Impression-Severity (CGI-S), MATRICS Consensus Cognitive Battery, and Calgary Depression Scale for Schizophrenia. Relationships between patient-reported outcomes and PANSS total and Item G12 ratings were evaluated.
Among 1431 CATIE
study participants in this analysis, increasingly impaired insight at baseline was significantly associated with better patient-reported quality of life (QoL), lower baseline depression, and greater divergence between physician- and patient-reported illness severity. Patients with more severely impaired insight reported milder illness compared with physician reports, particularly those with moderate-severe to extreme impairment (PANSS Item G12 rating ≥ 5), approximately 10% (138/1431) of CATIE participants. For the 90% of patients with PANSS Item G12 ratings < 5, patient-reported QoL decreased with increasing symptoms. SF-12 MCS scores were linearly related to baseline
PANSS total score only in patients with
PANSS total score < 90 (moderately ill or better), and better symptom scores were associated with higher QoL. No significant relationship between insight and neurocognition was observed.
In the small subgroup (10%) of CATIE
study patients with schizophrenia and
PANSS Item G12 ratings ≥5, moderate-severe-severe/extreme insight impairment was associated with significantly more positive perception of QoL and illness severity by the patient versus the treating physician. This was not observed in the remaining 90% of patients with normal to moderately impaired insight, suggesting that poor insight as a threat to the validity of self-report is uncommon.