背景:我们旨在探讨自知力损害与临床症状之间的性别差异,元认知,和精神病中的社会认知。
方法:对116名男性和56名女性首发精神病患者的数据进行了多个临床洞察力维度的回归分析。输入各种临床症状以及元认知和社会认知的指标作为预测因子。
结果:无论男女,妄想是所有洞察力维度的强大预测指标,和言语幻觉作为症状重新标记的强有力预测指标。在男人中,某些阴性症状以及自我确定性,缺乏自我反省,受损的心理理论,归因偏见,跳跃到结论的偏差是洞察力差的额外预测因素,虽然良好的洞察力与抑郁有关,焦虑,废除,钝的影响,和情感识别受损。在女性中,洞察力差与自我服务/外部化偏见有关,情感识别受损,和注意力障碍。
结论:首发精神病的低洞察力与元认知和社会认知的缺陷密切相关,男女在涉及损害的特定技能方面存在明显差异。同时,良好的洞察力与男性的各种情感表现有关。这些发现为更有针对性的认知干预提供了新的途径,以提高精神病的临床洞察力。
BACKGROUND: We aimed to explore gender-related differences in the associations of insight impairment with clinical symptoms, metacognition, and social cognition in psychosis.
METHODS: Regression analysis of several clinical insight dimensions was conducted on the data from 116 men and 56 women with first-episode psychosis. Various clinical symptoms and measures of metacognition and social cognition were entered as predictors.
RESULTS: In both men and women, delusions emerged as a strong predictor of all insight dimensions, and verbal hallucinations as a strong predictor of symptom relabelling. In men, certain negative symptoms as well as self-certainty, lack of self-reflectiveness, impaired theory of mind, attributional biases, and a jumping-to-conclusions bias were additional predictors of poor insight, while good insight was associated with depression, anxiety, avolition, blunted affect, and impaired emotional recognition. In women, poor insight was associated with a self-serving/externalising bias, impaired emotional recognition, and attention disorders.
CONCLUSIONS: Poor insight in first-episode psychosis is strongly linked to deficits in metacognition and social cognition, with marked differences between men and women with respect to the specific skills involved in the impairment. Meanwhile, good insight is linked to a variety of affective manifestations in men. These findings suggest new avenues for more targeted cognitive interventions to improve clinical insight in psychosis.