Insight, social functioning and readmission to hospital in patients with schizophrenia-spectrum disorders: prospective associations.

It has been claimed that insight is capable of predicting important clinical outcomes among people with schizophrenia. However, the supporting evidence is sparse. Although many cross-sectional studies have been undertaken, only prospective studies can provide convincing evidence. The aims of the present research were to assess the ability of insight to predict subsequent readmissions to hospital and social functioning. Patients with schizophrenia-spectrum disorders (N=90) were recruited at the time of an acute psychotic episode and then re-assessed after 6, 12, and 24 months. Assessments included insight, three measures of social functioning, and symptoms of psychosis. There was no evidence that having been readmitted to hospital since a previous assessment was associated with insight at the previous assessment. None of the associations between insight at one assessment and social functioning at subsequent assessments was significant. Changes in insight were associated with changes in contemporary functioning, but it was found that changes in insight made no significant contributions to changes in functioning which were independent of changes in symptoms. The general aim of improving clinical outcomes would probably be better met with interventions designed to improve functioning rather than interventions to improve insight.

Insight and recovery from acute psychotic episodes: the effects of cognitive behavior therapy and premature termination of treatment.

Research suggests that insight in schizophrenia is only weakly responsive to targeted psychosocial interventions. One of the aims of the present study was to examine the effects on insight of cognitive behavior therapy (CBT) for acutely psychotic patients. A second aim was to test predictions drawn from research on recovery styles that patients who reject psychological assistance will show a reduction in insight while those who continue to accept psychological assistance will show increases in insight over time. Patients with acute schizophrenia-spectrum disorders were assigned at random to treatment-as-usual (TAU) or TAU plus CBT. The latter were also divided into those who terminated treatment prematurely (dropouts) and those who did not (stay-ins). Insight was assessed at baseline and three follow-up assessments. Insight increased over the follow-up period, but there were no differences between the CBT and TAU groups. Within the CBT group, dropouts showed a reduction in insight at the 6-month assessment before returning to their baseline level, while the stay-ins showed linear improvement up to 12 months. Possible explanations for these contrasting patterns, in terms of resilience, attachment styles, and an insecure sense of self, are discussed.

North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: two-year follow-up and economic evaluation.

BACKGROUND: There is good evidence now that cognitive behaviour therapy (CBT) is effective in the treatment of people suffering from schizophrenia. There is also some evidence that the benefits of CBT persist after the end of treatment and that the direct costs of providing CBT as an adjunct to standard care are no higher than the direct costs of standard care alone. The aims of the present study were to discover if the benefits of CBT for acute schizophrenia which were found 1 year after index admission persist for another year, and to evaluate the comparative costs of providing CBT. METHOD: Consecutive admissions meeting criteria were recruited. After screening, 43 were assigned at random to a treatment-as-usual (TAU) control group and 47 were assigned to TAU plus CBT. Patients (73% of original) were rated on symptoms and social functioning 2 years after index admission. An evaluation of the direct costs of services was also completed. RESULTS: The CBT group had maintained its advantage over the TAU group on negative symptoms and social functioning but had lost the advantage it previously enjoyed in positive symptoms. The difference between groups in total direct costs over the 2 years was not statistically significant despite the cost of providing CBT. CONCLUSIONS: Some of the benefits of CBT for patients suffering acute psychotic episodes persist for 2 years. After the end of regular treatment, CBT should probably be targeted on the appearance of early signs of relapse to forestall the re-emergence of positive symptoms.

Anomalous experiences and the contents of persecutory delusions during acute psychotic episodes.

Criteria for judging the presence of persecutory delusions, and theoretical distinctions between different kinds of persecutory delusions, depend on the identification of the contents of such delusions. The first aim of this study was to assess whether contents can be assessed reliably. It has been suggested that anomalous experiences are involved in the formation and maintenance of delusions. The second aim of this study was to assess whether independent judges could agree when persecutory delusions depend on such experiences. Twenty-two inpatients suffering from acute psychotic episodes were recruited. Two independent raters categorized the contents of their delusions in terms of the timing, agent, intention, motivation, type, and severity of harm using information from a variety of sources. Agreement between the raters was adequate for all content areas and for judgments of associations with anomalous experiences. Using ideas of reference as evidence for the persecution was associated with believing that the harm is already very severe, that multiple types of harm are occurring, and that worse persecution is imminent. Theoretical explanations need to be elaborated to account for the variety of contents that can be identified reliably. Associations with anomalous experiences might guide such elaborations.

The concurrent validity of the Global Assessment of Functioning (GAF).

BACKGROUND: Few studies of the validity of the Global Assessment of Functioning (GAF) have been published and none has shown how GAF ratings are associated with concurrent ratings of symptoms and social functioning. This article provides such data. METHOD: Patients suffering from schizophrenia were assessed at admission to hospital and at six- and 12-month follow-up, using the GAF, the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS) and the Social Behaviour Schedule. RESULTS: GAF ratings were highly correlated with ratings of symptoms and social behaviour at both follow-ups but not at initial assessment, although the inter-rater reliabilities for the measures were good. CONCLUSIONS: The GAF can be rated reliably after minimal training. It provides a valid summary of symptoms and social functioning among schizophrenic patients provided they are not assessed when suffering from acute psychotic episodes.