Lourdes Nieto

Insight, symptomatic dimensions, and cognition in patients with acute-phase psychosis

AIMS This study was designed to evaluate the relationship between insight and the severity of psychotic symptomatology in a sample of patients in an acute phase of psychosis, as well as to analyze the relationship between insight and the symptomatic profile of the patient. In addition, the role of general cognitive abilities in this relationship was explored. METHOD Cross-sectional observational study of 96 acute psychotic adults. To evaluate psychopathology we used the Positive and Negative Syndrome Scale; for insight, the Scale of Unawareness of Mental Disorder; and for general cognitive abilities, the Screen for Cognitive Impairment in Psychiatry. RESULTS Insight showed significant and moderate positive correlations with positive and general symptoms but not with negative symptoms. In the subgroup with positive symptomatic profile, awareness of the disorder and of the effects of medication were positively associated with severity of positive and general psychotic symptoms. Awareness of social consequences of the disease was positively associated with positive symptoms. In the subgroup with a negative symptomatic profile, awareness of the disorder and of the effects of medication were positively associated with severity of positive and general psychotic symptoms. In this subgroup, these relationships were significantly affected by general cognitive abilities. CONCLUSIONS Insight was not related with the severity of negative psychotic symptoms. The symptomatic profile of subjects played an important role in determining the relationship between insight and its dimensions and the severity of psychotic symptoms. Cognitive function moderated these relationships only in the negative symptomatic profile.

A deeper view of insight in schizophrenia: Insight dimensions, unawareness and misattribution of particular symptoms and its relation with psychopathological factors

OBJECTIVE 1. To describe insight in a large sample of schizophrenia subjects from a multidimensional point of view, including unawareness of general insight dimensions as well as unawareness and misattribution of particular symptoms. 2. To explore the relationship between unawareness and clinical and socio-demographic variables. METHODS 248 schizophrenia patients were assessed with the Positive and Negative Syndrome Scale (PANSS, five factor model of Lindenmayer) and the full Scale of Unawareness of Mental Disorder (SUMD). Bivariate associations and multiple linear regression analyses were used to investigate the relationship between unawareness, symptoms and socio-demographic variables. RESULTS Around 40% of the sample showed unawareness of mental disorder, of the need for medication and of the social consequences. Levels of unawareness and misattribution of particular symptoms varied considerably. General unawareness dimensions showed small significant correlations with positive, cognitive and excitement factors of psychopathology, whereas these symptom factors showed higher correlations with unawareness of particular symptoms. Similarly, regression models showed a small significant predictive value of positive symptoms in the three general unawareness dimensions while a moderate one in the prediction of particular symptoms. Misattribution showed no significant correlations with any symptom factors. CONCLUSIONS Results confirm that insight in schizophrenia is a multi-phased phenomenon and that unawareness into particular symptoms varies widely. The overlap between unawareness dimensions and psychopathology is small and seems to be restricted to positive and cognitive symptoms, supporting the accounts from cognitive neurosciences that suggest that besides basic cognition poor insight may be in part a failure of self-reflection or strategic metacognition.

Impaired Self-Monitoring of Inner Speech in Schizophrenia Patients with Verbal Hallucinations and in Non-clinical Individuals Prone to Hallucinations

Background: Previous research has shown that various memory errors reflecting failure in the self-monitoring of speech were associated with auditory/verbal hallucinations in schizophrenia patients and with proneness to hallucinations in non-clinical individuals. Method: We administered to 57 schizophrenia patients and 60 healthy participants a verbal memory task involving free recall and recognition of lists of words with different structures (high-frequency, low-frequency, and semantically organisable words). Extra-list intrusions in free recall were tallied, and the response bias reflecting tendency to make false recognitions of non-presented words was computed for each list. Results: In the male patient subsample, extra-list intrusions were positively associated with verbal hallucinations and inversely associated with negative symptoms. In the healthy participants the extra-list intrusions were positively associated with proneness to hallucinations. A liberal response bias in the recognition of the high-frequency words was associated with verbal hallucinations in male patients and with proneness to hallucinations in healthy men. Meanwhile, a conservative response bias for these high-frequency words was associated with negative symptoms in male patients and with social anhedonia in healthy men. Conclusion: Misattribution of inner speech to an external source, reflected by false recollection of familiar material, seems to underlie both clinical and non-clinical hallucinations. Further, both clinical and non-clinical negative symptoms may exert on verbal memory errors an effect opposite to that of hallucinations.

S218. INSIGHT AND SUBJECTIVITY

Abstract Background The awareness of mental disorder or insight refers to the ability to perceive the disorder itself and the symptoms, the effects of the treatment and the social consequences of the disorder; and also the ability to attribute the symptoms to a mental disorder. Lack of insight is frequent in schizophrenia and is associated with a low adherence to the treatment and to a worse evolution. A greater insight has been associated with a lower psychopathological severity and with higher levels of depression. On the other hand, subjective insight refers not only to what happens to the patient but also to how he feels and to the perception of the changes that he undergoes during the psychotic experience. The subjective perception of change is a position that can easily lead to connect with painful and depressive feelings, so it can be assumed that subjective insight could be related more consistently with the depressive symptoms than the clinical insight. Methods Observational cross-sectional study of a group of 114 schizophrenia patients treated in the psychiatry devices of the Parc de Salut Mar and Parc Taulí Instruments: SUMD, Markova and Berrios Scale and Calgary scale for depression in psychosis. Results Subjective insight is significantly correlated with Lindenmayer’s depressive factor and depression level measured by a Calgary scale. Clinical insight correlates with positive and excitatory symptoms. The time of evolution explains the non-awareness of the social consequences of the disease. Discussion The subjective insight into schizophrenia is mainly related to the depressive symptoms. The clinical insight into schizophrenia is related to positive symptoms.

S247. GENDER DIFFERENCES IN FUNCTIONALITY IN INPATIENT POPULATION AFFECTED WITH SCHIZOPHRENIA AND OTHER PSYCHOSIS

Abstract Background Studies that have examined gender differences in social functioning have found better performance in women but other studies failed to detect these differences (Ochoa et al, 2012). We aim to study gender differences in functionality in a severe sample of schizophrenia and schizophrenia spectrum disorder patients, and to analyse the relationships between functionality, psychopathological dimensions and gender. Methods Multicenter cross-sectional naturalistic study sample of 124 (66.9% men) schizophrenia and non-affective schizophrenia spectrum disorder inpatients from a University Hospital Acute Unit setting. Diagnosis was made following DSM IV-TR. Severity of psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS) Lindenmayer’s Factors (Kay et al., 1987). The deficit of insight and its three dimensions were evaluated by the Scale of Unawareness of Mental Disorders (SUMD) (Amador et al., 1993). Functionality was measured by the Global Assessment of Functioning Scale (GAF) and the Personal and Social Performance scale (PSP) (Morosini et al, 2000). Premorbid Intelligence Quotient (IQ) was estimated by verbal sub-scale of WAIS. Bivariate analysis and parametric correlations were performed in order to make a multiple linear regression model of insight dimensions. Results The sample included a 42.7% of people affected of schizophrenia, with a severe psychopatology (mean total PANSS scores 83.7, sd. 23) and different clinical situations. In our sample, there were no significant differences in functionality neither with the GAF or the PSP global scores. Women performed significatively worst in the PSP self-care subscale (p=0.024), and men performed significatively worst in the PSP disturbing and aggressive behaviours subscale (p=0.033). In the regression analysis, the total sample (men and women) showed a model for the PSP global scores including only the PANSS Lindenmayer’s Desorganized/Cognitive Factor (R2 0.412). PSP self-care subscale showed a model including only PANSS Lindenmayer’s Desorganized Factor (R2 0.319). PSP socially useful activities subscale showed a model including only PANSS Lindenmayer’s Negative Factor (R2 0.213). PSP personal and social relationships subscale showed a model including the PANSS Lindenmayer’s Negative and the Excitatory Factors (R2 0.533). PSP disturbing and aggressive behaviours subscale showed a model including only PANSS Lindenmayer’s Excitative Factor (R2 0.363). Gender and other clinical, sociodemographical or outcome factors did not have influence in the models. In men sample a model for the PSP global scores included only the PANSS Lindenmayer’s Desorganized Factor (R2 0.511). PSP self-care subscale showed a model including both PANSS Lindenmayer’s Desorganized Factor and IQ (R2 0.585). PSP socially useful activities subscale showed a model including only PANSS Lindenmayer’s Negative Factor (R2 0.394). PSP personal and social relationships subscale showed a model including only the PANSS Lindenmayer’s Negative Factor (R2 0.626). PSP disturbing and aggressive behaviours subscale showed a model including only PANSS Lindenmayer’s Excitative Factor (R2 0.478). In women in our sample, there were no explicative model. Moreover, global GAF scores were not explicated by a model in our sample. Discussion According to our data, men and women seem to be similar in levels of global functionality. Nevertheless, they showed several differences in specific domains of functionality measured by PSP. Model explainig the association of functionality with psychopatological and clinical variables showed a significative relatioship of isolated psychopatological factors and functional domains.

S117. MODELLING THE RELATIONSHIP BETWEEN INSIGHT, PSYCHOPATHOLOGY AND GENDER IN SCHIZOPHRENIA USING STRUCTURAL EQUATIONS

Abstract Background Studies about the problem of the lack of awareness of the illness in psychosis have a long trajectory of research (Amador and David, 2004). Previous reported articles exert their insidious negative effects in the evolution and managing of the illness both by the patients and professionals. Lack of insight have been related to a generally poor prognosis of schizophrenia, predisposing to non-adherence with antipsychotic and other negatives influences on outcomes. In the last years, previous analysis from the Insight Barcelona Research Group tried to develop a deeper view of insight dimensions in schizophrenia (Pousa et al., 2017). The impact of gender in schizophrenia and first-episode psychosis has been studied extensively in recent decades (Riecher-Rössler and Häfner, 2000; Ochoa et al., 2011). Previous studies about the role of gender in the deficit of insight in psychosis showed inconclusive results. These contradictory findings may be related to differences in the study populations as well as to the use of different instruments to assess insight and other related variables. In these sense, our group presented a previous analysis focused on insight and gender (Cobo et al., 2016) into specific psychotic symptoms. Using the Spanish complete version of the Scale of Unawareness of Mental Disorder - SUMD (Ruiz et al., 2008) and the Five-PANSS Lidenmayer’s Factors (1995) - Positive, Negative, Cognitive, Depressive and Excitement. No gender differences in the three main dimensions of insight in psychosis were found, neither in awareness and attribution of symptoms when assessed globally. However, gender differences appear in awareness and attribution of particular symptoms when assessed separately, with women showing higher levels of unawareness and misattribution than men. On the other hand, a different pattern of clinical, sociodemographic and functional variables seem to affect insight in men and women differently. Aim The aim of this study was to modelling the influence of psychopathological factors in the deficit of insight in psychosis, taking in account the difference of gender as a relevant variable. Methods A multicenter sample of 305 patients with schizophrenia who agreed to participate was evaluated in four centers of the metropolitan area of Barcelona (Catalonia). Psychopathological assessment was performed using the Five-PANSS Wallwork’s Factors (2012). Insight and its dimensions were assessed by means of the SUMD. Structural Equation Models (SEM) was used to fix the model in the total sample and by gender. Results SEM models for the sample showed a moderate fix capacity. Insight SUMD Dimensions models in the schizophrenia sub-sample were related significantly to Positive, Excited and Depressed PANSS Wallwork’s Factors. Higher scores on Positive and Excited PANSS Wallwork’s Factors reduce de insight scores. Conversely, higher scores in Depressed PANSS Wallwork Factor were associated to greater awareness. In women affected of schizophrenia, SEM models fixed poorly and the lack of association for any isolated PANSS factor, probably due to the size of the subsample. Discussion There is a lack of studies in the area. In the previous SEM model of Xavier et al. (2017), disorganized symptoms had the strongest effect on insight. In addition, both in our study and in the study of Xavier et al. (2017), negative symptoms have no significative effect on either illness insight or treatment insight. In our opinion, the possible explanation of the principal differences between the studies is related to the instruments utilized and the sample characteristics. Our data also support gender differences in the influence of psychopatology factors on the insight dimensions.

Verbal Fluency in Male and Female Schizophrenia Patients: Different Patterns of Association With Processing Speed, Working Memory Span, and Clinical Symptoms.

Objective: Decreased processing speed in schizophrenia patients has been identified as a major impairment factor in various neuropsychological domains. Working memory span has been found to be involved in several deep or effortful cognitive processes. We investigated the impact that these 2 cognitive functions may have on phonological and semantic fluency in schizophrenia patients and healthy participants. Method: Fifty-five patients with schizophrenia and 60 healthy participants were administered a neuropsychological battery including phonological and semantic fluency, working memory, and cognitive and motor speed. Results: Regression analyses revealed that motor speed was related to phonological fluency in female patients, whereas cognitive speed was related to semantic fluency in male patients. In addition, working memory span was related to verbal fluency in women from both the patient and the healthy control groups. Decreased processing speed, but not decreased working memory span, accounted for the verbal fluency deficit in patients. Verbal fluency was inversely related to attention deficit in female patients and to negative symptoms in male patients. Conclusions: Decreased processing speed may be the main factor in verbal fluency impairment of patients. Further, the cognitive and clinical predictors of verbal fluency efficiency are different in men and women.