Insight as a predictor of the outcome of first-episode nonaffective psychosis in a prospective cohort study in England
Drake R, Dunn G, Tarrier N, Bentall RP, Haddock G, Lewis SW
Journal of Clinical Psychiatry. 2007;68 (1).
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Objective: To estimate the effect of insight on time to relapse and readmission and on social function and symptoms after following up a cohort of first-episodes of non-affective psychosis for eighteen months. Method: Patients with first episodes of DSM IV schizophreniform disorder, schizophrenia, schizoaffective disorder and psychosis NOS, aged 16-65, (excluding primary substance induced or organic psychoses) were recruited over 26 months from July 1996 to September 1998 from consecutive admissions to day-patient & inpatient units in England with a catchment area population of 2.3m. They were interviewed with the Positive And Negative Syndrome Scale, Birchwood Insight Scale and Social Functioning Scales at baseline and eighteen months. Results: The hazard ratio for relapse, per unit increase in the insight score, was estimated in a Cox proportional hazards model to be 0.943 (95% CI 0.892, 0.996; p0.035). Those with the best insight scores had an estimated rate of relapse which was 39% of that of those with the worst scores (CI 16-93%). Readmission was highly correlated with relapse so poor insight also predicted readmission (hazard ratio 0.934; 95% CI 0.876, 0.996; p0.036). However, insight did not independently predict symptoms or social function after adjustment for other predictors of outcome. Conclusion: Insight predicted both relapse and readmission. The details of the beliefs and assumptions determining outcome remain unclear but intervening to alter them appears to be justified.