Insight correlates in child- and adolescent-onset first episodes of psychosis: results from the CAFEPS study

2008 ◽  
Vol 39 (9) ◽  
pp. 1433-1445 ◽  
Author(s):  
M. Parellada ◽  
D. Fraguas ◽  
I. Bombín ◽  
S. Otero ◽  
J. Castro-Fornieles ◽  
...  
Keyword(s):  
Treatment Compliance ◽  
Psychotic Symptoms ◽  
Global Functioning ◽  
Recent Onset ◽  
Need For Treatment ◽  
Early Onset Psychosis ◽  
Different Dimensions ◽  
Linear Regressions ◽  
Insight Into

BackgroundThe correlates of insight in early-onset psychosis have received little previous attention.MethodWe studied clinical correlates of insight in a sample of 110 adolescent recent-onset psychosis patients (mean age 15.53 years; psychotic symptoms present for <6 months). Insight was measured with the Scale to Assess Unawareness of Mental Disorder (SUMD) at baseline, 6 months and 12 months follow-up.ResultsInsight improved over the early phases of the illness, in parallel with psychopathological improvement. Poor insight at baseline and 6 months correlated with poor functioning at 6 and 12 months respectively. Schizophrenia patients had poorer insight than patients with bipolar disorder at 6 and 12 months but not at baseline. Logistic and linear regressions were used to predict 12-month diagnoses and functioning based on insight measurements. Baseline awareness of illness was a significant predictor for diagnosis [odds ratio (OR) 1.4, 95% confidence interval (CI) 1.05–1.97]. Treatment compliance at 6 months did not correlate with baseline SUMD subscores, but correlated with insight into having a disorder (Spearman's ρ=0.21, p=0.039), its consequences (Spearman's ρ=0.28, p=0.006) and the need for treatment (Spearman's ρ=0.26, p=0.012) at 6 months. The ‘attribution of symptoms’ dimension of insight is poorly correlated with other insight dimensions and with other clinical variables.ConclusionsPoor insight correlates with symptom severity and global functioning but also has some trait value for schizophrenia, which is apparent once acute psychotic symptomatology is not prominent. A multi-dimensional approach to the assessment of insight is necessary, as different dimensions are influenced by different factors.

Remission and functioning after two years undergoing Long-Acting Injectable Risperidone (LAIR) in recent-onset schizophrenia

2011 ◽  
Vol 26 (S2) ◽  
pp. 1344-1344
Author(s):  
A. Batalla ◽  
A. Pons ◽  
A. Ortiz ◽  
I. Grande ◽  
J. Undurraga ◽  
...  
Keyword(s):  
Social Performance ◽  
Adherence Rate ◽  
Global Functioning ◽  
Recent Onset ◽  
Schizophrenic Patients ◽  
Remission Criteria ◽  
Improved Performance ◽  
Long Acting

IntroductionImproving adherence in the early stages of illness by means of long-acting antipsychotics can lead to reduced number of readmissions and enhanced remission rates, which could lead to improved performance in the medium-long term.ObjectivesAssessing clinical remission, number of admissions and personal and social performance in recent-onset schizophrenic patients undergoing LAIR.MethodsLongitudinal retrospective study of a cohort of thirty-one recent-onset schizophrenic patients ( ≤ 2 years) who started LAIR treatment between 2004–2008. Twenty-six (83.9%) were treated for two years. PANSS scale was assessed at baseline; PANSS, Personal and Social Performance scale (PSP) and remission criteria after two years.ResultsTwenty-six patients (83.9%), 61.5% male aged between 16–44 years old, completed two years of treatment. All patients met criteria for schizophrenia (DSM-IV) with an average duration of 0.8 year since diagnosis. The main reason to using LAIR was poor adherence (76.9%). The PANSS total and all its subscale scores improved significantly (p < 0.005) with 80.8% of patients showing a ≥ 50% improvement on the PANSS total. Seventeen patients (65.4%) achieved remission criteria. Five patients (19.2%) were admitted during the follow-up. The average on global functioning (PSP) was 72.4 (IC 95%, 66.4-78.4). LAIR doses at baseline were 25 mg (46.2%), 37.5 mg (30.8%) or 50 mg (23.1%); after two years, 25 mg (34.6%), 37.5 mg (34.6%), 50 mg (23.1%) or 75 mg (7.7%).ConclusionsDespite the limitation of retrospective observational studies, our data, including the good adherence rate (83.9%), suggest that LAIR could be effective in the treatment of recent-onset schizophrenia.

Insight and Psychotic Illness

1995 ◽  
Vol 167 (5) ◽  
pp. 621-628 ◽  
Author(s):  
Anthony David ◽  
Jim van Os ◽  
Peter Jones ◽  
Ian Harvey ◽  
Alice Foerster ◽  
...  
Keyword(s):  
Strong Association ◽  
Recent Onset ◽  
Left Handedness ◽  
Frontal Lobe Function ◽  
The Relationship ◽  
Insight Into Illness ◽  
State Examination ◽  
Distinct Aspect ◽  
Insight Into

BackgroundInsight has recently re-emerged as an important aspect of psychopathology amenable to empirical study. We sought to examine the relationship between various aspects of insight into illness and clinical, sociodemographic and neuropsychological variables.MethodFrom an inner-London catchment area population, 150 in-patients with recent onset of psychosis were assessed on a variety of measures, including the Present State Examination (PSE). Subjects were followed up for a mean of four years and reassessed.ResultsHigh IQ was associated with better insight as rated on the PSE, while gender, ethnicity and a diagnosis of schizophrenia appeared to be unrelated. At follow-up, similar associations were found, as well as correlations with attitudes to treatment and a more elaborate measure of insight. Cerebral ventricular enlargement and tests of frontal lobe function did not correlate with insight, but there was a curious, strong association with left-handedness at both assessment points. Initial insight correlated significantly but weakly with insight at follow-up.ConclusionsThe assessment of insight in psychosis has concurrent validity and is a distinct aspect of psychotic phenomenology. It may, in part, have a neuropsychological basis.

Public pastoral leaders: The purpose of theological training

2005 ◽  
Vol 39 (3) ◽  
Author(s):  
M. Malan Nel
Keyword(s):  
Theological Education ◽  
Research Problem ◽  
The Public ◽  
The Core ◽  
Different Dimensions ◽  
Pastoral Leaders ◽  
Point Of Departure ◽  
Insight Into ◽  
Theological Training

This article is a follow-up of an article in which I attempted to gain insight into the corporate nature of being called to ministry. The mentioned article was also aimed at discerning the specifics of the ministry of the “public pastoral leader”. While the question is even asked whether theological training is necessary at all, I accept, as point of departure, the critical need for such training. What is of more importance is the discernment of what I call in this article the “teleological core” of theological education. I purposefully chose to explore the contributions of a number of well-known scholars who devoted much of their research to this field: Schner, Farley, Wood, Hough and Cobb, Heitink, Van der Ven and a few others. The ultimate finding is that some consensus about the telos of theological education does exist. The nature of the telos is phrased differently, but the different dimensions identified are indeed complementary. Concepts like “vision and discernment”, “critical reflection” “reflective practitioner”, “hermeneutical-communicative com- petence” and others are discussed as they relate to the core research problem. Attention is also given to the necessity of training a “basic pastor” as well as to the importance of “limited specialisation” in theological training.

scholarly journals Reappraising insight in psychosis

2000 ◽  
Vol 177 (3) ◽  
pp. 233-240 ◽  
Author(s):  
Manuel J. Cuesta ◽  
Victor Peralta ◽  
Amalia Zarzuela
Keyword(s):  
Affective Disorder ◽  
Schizoaffective Disorder ◽  
Predictive Value ◽  
Acute Episode ◽  
Psychotic Symptoms ◽  
Significant Relationships ◽  
Insight Into ◽  
Over Time

BackgroundMany patients suffering from psychosis are unaware of their disorder and symptoms.AimsTo investigate whether insight changes with time, and how it relates to patients' psychopathology, and to examine the correlations between insight scales in patients with psychoses.MethodSeventy-five consecutively admitted in-patients with schizophrenia, affective disorder with psychotic symptoms, or schizoaffective disorder were examined after remission of an acute episode and at follow-up (>6 months). Three different scales were used to assess insight.ResultsTo some extent, insight into past episodes improved over time in patients with psychosis, regardless of diagnosis. Few significant relationships between insight and psychopathology remained stable at follow-up. The higher the negative and disorganisation dimensions at baseline, the less did attitudes to treatment vary when tested at follow-up. No predictive value for variability of psychopathological dimensions was found for insight dimensions. The insight scales used were highly intercorrelated, suggesting that they measure the same construct.ConclusionsInsight and psychopathology seem to be semi-independent domains.

Psychopathological syndromes in the functional psychoses: associations with course and outcome

1996 ◽  
Vol 26 (1) ◽  
pp. 161-176 ◽  
Author(s):  
J. Van Os ◽  
T. A. Fahy ◽  
P. Jones ◽  
I. Harvey ◽  
P. Sham ◽  
...  
Keyword(s):  
Subsequent Treatment ◽  
Psychotic Symptoms ◽  
Course Of Illness ◽  
Recent Onset ◽  
Functional Psychosis ◽  
Insidious Onset ◽  
Functional Psychoses ◽  
Icd 10 ◽  
Baseline Values

SynopsisThe aim of this study was to identify underlying dimensions of psychopathology in a cohort of patients with functional psychosis of recent onset, and to examine their prognostic value. Factor analysis of the psychopathological features of 166 consecutively admitted patients with functional psychosis of recent onset revealed seven psychopathological dimensions, which explained 63% of the variance. Five of these seven syndromes bore differential associations with subsequent treatment and illness course, independent of: (i) associations with DSM-III-R diagnosis; (ii) associations with other prognostic factors; and (iii) associations with the baseline values of outcome variables. The most striking associations were shown for an early and insidious onset syndrome with affective flattening, which predicted a more disabled course of illness on three of four outcome dimensions, and which was more common in males and unmarried individuals. A second syndrome, characterized by bizarre behaviour, inappropriate affect, catatonia, and poor rapport showed similar, slightly less striking, associations with illness course, as well as with poor pre-morbid social functioning. A third syndrome, characterized by positive psychotic symptoms was to a lesser degree associated with poorer outcome, whereas a fourth syndrome distinguished by manic symptomatology predicted a more benign illness course. A fifth syndrome identified by lack of insight predicted more time in hospital and admission under a section of the Mental Health Act during the follow-up period.A further finding was that dimensional representations of psychopathological features were considerably more useful than categorical representations (DSM-III-R and ICD-10) as predictors of illness course and treatment decisions.

scholarly journals Characterising cognitive heterogeneity in individuals at clinical high-risk for psychosis: a cluster analysis with clinical and functional outcome prediction

2021 ◽  
Author(s):  
Kate Haining ◽  
Ruchika Gajwani ◽  
Joachim Gross ◽  
Andrew I. Gumley ◽  
Robin A. A. Ince ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
High Risk ◽  
Functional Outcomes ◽  
Early Stage ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Cognitively Impaired ◽  
Clinical High Risk ◽  
Global Functioning

AbstractSchizophrenia is characterised by cognitive impairments that are already present during early stages, including in the clinical high-risk for psychosis (CHR-P) state and first-episode psychosis (FEP). Moreover, data suggest the presence of distinct cognitive subtypes during early-stage psychosis, with evidence for spared vs. impaired cognitive profiles that may be differentially associated with symptomatic and functional outcomes. Using cluster analysis, we sought to determine whether cognitive subgroups were associated with clinical and functional outcomes in CHR-P individuals. Data were available for 146 CHR-P participants of whom 122 completed a 6- and/or 12-month follow-up; 15 FEP participants; 47 participants not fulfilling CHR-P criteria (CHR-Ns); and 53 healthy controls (HCs). We performed hierarchical cluster analysis on principal components derived from neurocognitive and social cognitive measures. Within the CHR-P group, clusters were compared on clinical and functional variables and examined for associations with global functioning, persistent attenuated psychotic symptoms and transition to psychosis. Two discrete cognitive subgroups emerged across all participants: 45.9% of CHR-P individuals were cognitively impaired compared to 93.3% of FEP, 29.8% of CHR-N and 30.2% of HC participants. Cognitively impaired CHR-P participants also had significantly poorer functioning at baseline and follow-up than their cognitively spared counterparts. Specifically, cluster membership predicted functional but not clinical outcome. Our findings support the existence of distinct cognitive subgroups in CHR-P individuals that are associated with functional outcomes, with implications for early intervention and the understanding of underlying developmental processes.

Abandonment Psychotherapy and Psychosocial Functioning Among Suicidal Patients With Borderline Personality Disorder: A 3-Year Naturalistic Follow-Up

2019 ◽  
pp. 1-11
Author(s):  
Antonio Andreoli ◽  
Yvonne Burnand ◽  
Laura Frambati ◽  
Donna Manning ◽  
Allen Frances
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Randomized Study ◽  
Borderline Personality ◽  
Psychotic Symptoms ◽  
Global Functioning ◽  
Treatment As Usual ◽  
Treatment Conditions

The authors present the results from a 3-year follow-up among 170 patients who had participated in the original randomized study, which consisted of three treatment conditions: (a) 3-month abandonment psychotherapy (AP) delivered by certified psychotherapists, (b) AP delivered by nurses, and (c) treatment as usual in a psychiatric crisis center. All subjects were recruited at the emergency room after a suicide attempt and met diagnostic criteria for borderline personality disorder and major depression. Psychotic symptoms, bipolar disorder, and mental retardation were exclusion criteria. At 3-year follow-up, 134 (78.8%) subjects had blind, reliable assessment by clinical psychologists. The intent-to-treat analysis indicated that those patients who had received AP during acute treatment had better global functioning, improved work adjustment, and less unemployment/disability at 3-year follow-up. No differences were found as a function of type of therapist delivering AP. The data confirm that short-term AP gains in psychosocial functioning are sustained over the longer term.

Cannabis use and outcome of recent onset psychosis

2005 ◽  
Vol 20 (4) ◽  
pp. 349-353 ◽  
Author(s):  
Anton Grech ◽  
Jim Van Os ◽  
Peter B. Jones ◽  
Shon W. Lewis ◽  
Robin M. Murray
Keyword(s):  
Negative Symptoms ◽  
Small Sample Size ◽  
Small Sample ◽  
Reference Points ◽  
Cannabis Use ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
Recent Onset ◽  
Male Subjects

AbstractPurposeTo test the hypothesis that recent onset psychotic patients who use cannabis will have psychotic symptoms that are more severe and more persistent than those who do not use cannabis.Subjects and methodsWe carried out a 4-year follow-up study of a cohort of 119 patients with recent onset of psychosis. The patients were divided into four groups according to duration of cannabis use, taking index admission and follow-up as reference points.ResultsThose subjects who persisted in the use of cannabis had more positive (but not negative) symptoms and a more continuous illness at follow-up.LimitationsThe main limitations of the study were: the relatively small sample size, and that the excess of male subjects and the presence of cannabis induced psychosis could have a confusing impact on the interpretation of the results.ConclusionIt is possible that psychotic patients who use cannabis are at a greater risk of a more continuous illness with more positive symptoms than those who do not.

scholarly journals General psychopathology links burden of recent life events and psychotic symptoms in a network approach

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Linda T. Betz ◽  
◽  
Nora Penzel ◽  
Lana Kambeitz-Ilankovic ◽  
Marlene Rosen ◽  
...  
Keyword(s):  
Life Events ◽  
Childhood Trauma ◽  
Negative Symptoms ◽  
Psychotic Symptoms ◽  
Network Approach ◽  
General Psychopathology ◽  
Recent Onset ◽  
Syndrome Scale ◽  
Before And After ◽  
The Individual

AbstractRecent life events have been implicated in the onset and progression of psychosis. However, psychological processes that account for the association are yet to be fully understood. Using a network approach, we aimed to identify pathways linking recent life events and symptoms observed in psychosis. Based on previous literature, we hypothesized that general symptoms would mediate between recent life events and psychotic symptoms. We analyzed baseline data of patients at clinical high risk for psychosis and with recent-onset psychosis (n = 547) from the Personalised Prognostic Tools for Early Psychosis Management (PRONIA) study. In a network analysis, we modeled links between the burden of recent life events and all individual symptoms of the Positive and Negative Syndrome Scale before and after controlling for childhood trauma. To investigate the longitudinal associations between burden of recent life events and symptoms, we analyzed multiwave panel data from seven timepoints up to month 18. Corroborating our hypothesis, burden of recent life events was connected to positive and negative symptoms through general psychopathology, specifically depression, guilt feelings, anxiety and tension, even after controlling for childhood trauma. Longitudinal modeling indicated that on average, burden of recent life events preceded general psychopathology in the individual. In line with the theory of an affective pathway to psychosis, recent life events may lead to psychotic symptoms via heightened emotional distress. Life events may be one driving force of unspecific, general psychopathology described as characteristic of early phases of the psychosis spectrum, offering promising avenues for interventions.

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