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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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Abstract

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.

Record metadata

Manchester eScholar ID:
uk-ac-man-scw:1d13808
Created:
30th August, 2009, 12:55:29
Last modified by:
Drake, Richard
Last modified:
1st July, 2013, 18:35:28