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

Published online by Cambridge University Press:  18 December 2008

M. Parellada ,
D. Fraguas ,
I. Bombín ,
S. Otero ,
J. Castro-Fornieles ,
I. Baeza ,
A. Gonzalez-Pinto ,
M. Graell ,
C. Soutullo  and
B. Paya
...Show all authors
M. Parellada*
Affiliation:
Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM
D. Fraguas
Affiliation:
Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM
I. Bombín
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM Reintegra: Neurological Rehabilitation Centre, Oviedo, Spain
S. Otero
Affiliation:
Child and Adolescent Mental Health Unit, Department of Psychiatry and Psychology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
J. Castro-Fornieles
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona, Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, Spain
I. Baeza
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona, Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, Spain
A. Gonzalez-Pinto
Affiliation:
Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM Stanley Institute International Mood-Disorders Research Centre, Hospital Santiago Apóstol, Vitoria, Spain
M. Graell
Affiliation:
Section of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
C. Soutullo
Affiliation:
Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, University Clinic, College of Medicine, University of Navarra, Pamplona, Spain
B. Paya
Affiliation:
Child and Adolescent Mental Health Unit, Department of Psychiatry and Psychology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
C. Arango
Affiliation:
Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM
*
*Address for correspondence: Dr M. Parellada, Adolescent Unit, Department of Psychiatry, Hospital Gregorio Marañón, Ibiza 43, Madrid 28009, Spain. (Email: parellada@hggm.es)
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Abstract

Background

The correlates of insight in early-onset psychosis have received little previous attention.

Method

We 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.

Results

Insight 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.

Conclusions

Poor 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.

Keywords

Adolescencefirst-episode psychosisinsight
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 9 , September 2009 , pp. 1433 - 1445
Copyright
Copyright © 2008 Cambridge University Press

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