Psychological Medicine



Original Article

Insight in first-episode psychosis


JOSEPH P. McEVOY a1c1 1 , JACKIE JOHNSON a2a3 1 , DIANA PERKINS a2 1 , JEFFREY A. LIEBERMAN a4 1 , ROBERT M. HAMER a2a3 1 , RICHARD S. E. KEEFE a1 1 , MAURICIO TOHEN a5 1 , IRA D. GLICK a6 1 and TONMOY SHARMA a7 1
a1 John Umstead Hospital, Duke University Department of Psychiatry, Butner, NC, USA
a2 Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
a3 Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
a4 Department of Psychiatry, Columbia University, New York, NY, USA
a5 Lilly Research Laboratories, Indianapolis, IN, USA
a6 Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
a7 Clinical Neuroscience Research Centre, Stonehouse Hospital, Dartford, Kent, UK

Article author query
mcevoy jp   [PubMed][Google Scholar] 
johnson j   [PubMed][Google Scholar] 
perkins d   [PubMed][Google Scholar] 
lieberman ja   [PubMed][Google Scholar] 
hamer rm   [PubMed][Google Scholar] 
keefe rs   [PubMed][Google Scholar] 
tohen m   [PubMed][Google Scholar] 
glick id   [PubMed][Google Scholar] 
sharma t   [PubMed][Google Scholar] 

Abstract

Background. We report here a study examining the relationships between insight and psychopathology, cognitive performance, brain volume and co-morbid depression in 251 patients experiencing a first episode of psychosis, who were then randomly assigned to 2 years of double-blind treatment with either olanzapine or haloperidol.

Method. Repeated measures of insight were obtained at baseline and 12, 24, 52 and 104 weeks by the Insight and Treatment Attitudes Questionnaire (ITAQ).

Results. Older age, female gender and white ethnicity were associated with more insight. Higher total, positive, negative and general psychopathology scores on the Positive and Negative Syndromes Scale (PANSS) were associated with less insight. Higher depression scores were associated with more insight. Better neurocognitive function and large brain volumes were associated with more insight. More insight throughout the study was associated with longer time to medication non-adherence. However, baseline insight was not significantly related to the probability of discontinuing the study before 2 years. Insight improved significantly over the course of the study, but the improvement in insight was not significantly different between the two antipsychotic treatment groups.

Conclusions. Multiple factors contribute to insight. Patients experiencing a first episode of psychosis who have little insight are at increased risk of discontinuing their medication.

(Published Online June 2 2006)


Correspondence:
c1 Department of Psychiatry, John Umstead Hospital, 1003 12th Street, Butner, NC 27509, USA. (Email: jpmcevoy@duke.edu)


Footnotes

1 for the HGDH Research Group. See Appendix for HGDH Study Group members.



Metrics