Insight and its clinical correlates in a sample of hospitalized psychotic patients

Abstract

© 2019 Egyptian Journal of Psychiatry | Published by W Background Insight is a complex phenomenon including many dimensions, such as insight about the illness, about need for treatment, and about consequences of having that illness. Assessment of insight in psychiatric patients is important as it is implicated in the course of illness, adherence to treatment, and prognosis. Objective The aim was to evaluate the level of insight in schizophrenia spectrum disorders and also in bipolar and major depressive disorders with psychotic features and to examine the relationship between level of insight and sociodemographic and illness-related characteristics, including severity of symptoms. Patients and methods A total of 85 patients diagnosed with schizophrenia spectrum disorders (group 1) and 44 patients diagnosed with bipolar disorder with psychotic features and major depressive disorder with psychotic features (group 2) who were admitted to Minia Psychiatry Hospital in a period of 6 months were included in the study. Diagnosis was done using Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-5 research version. Level of insight was assessed using Scale to assess Unawareness of Mental Disorder assessing awareness of mental disorder, awareness of the need for treatment and awareness of social consequences of mental disorder. Severity of symptoms and psychopathology was assessed using Positive and Negative Syndrome Scale and Clinical Global Impression Scale (CGI). Results Patients diagnosed with schizophrenia spectrum disorders (group 1) tended to have poorer insight than those with bipolar affective disorder (BAD) and major depressive disorder (MDD) with psychotic features (group 2) on admission and also on discharge. Levels of insight of both groups differed significantly on discharge when compared with their levels of insight on admission, but that difference was more profound in group 2. Stepwise multiple linear regression analysis predicting level on insight revealed that blunted affect, lack of judgment and insight, conceptual disorganization, and CGI severity of illness were the most implicated factors in determining insight on admission whereas CGI efficacy index, grandiosity, motor retardation, and passive/apathetic social withdrawal were factors determining insight on discharge. Conclusion Patients diagnosed with schizophrenia spectrum disorders have poorer insight than those diagnosed with BAD and MDD with psychotic features. Predictors of insight differ on admission than on discharge.