Investigating the Role of Insight, Decision-Making and Mentalizing in Functional Outcome in Schizophrenia: A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample
2.2. Variables
2.2.1. Outcome Measures
2.2.2. Independent Variables
2.2.3. Statistics
3. Results
3.1. Sample Characteristics
3.2. Bivariate Analyses
3.3. Multivariable Regression Models
3.3.1. General Functioning—GAF
3.3.2. Disability—WHODAS
3.3.3. Quality of Life—SLDS
4. Discussion
4.1. Principal Findings
4.2. General Functioning
4.3. Disability
4.4. Quality of Life
4.5. Strengths and Limitations
4.6. Clinical Implications and Directions for Future Research
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Jongsma, H.E.; Gayer-Anderson, C.; Lasalvia, A.; Quattrone, D.; Mulè, A.; Szöke, A.; Selten, J.-P.; Turner, C.; Arango, C.; Tarricone, I.; et al. Treated Incidence of Psychotic Disorders in the Multinational EU-GEI Study. JAMA Psychiatry 2018, 75, 36–46. [Google Scholar] [CrossRef] [PubMed]
- Hjorthøj, C.; Stürup, A.E.; McGrath, J.J.; Nordentoft, M. Years of Potential Life Lost and Life Expectancy in Schizophrenia: A Systematic Review and Meta-Analysis. Lancet Psychiatry 2017, 4, 295–301. [Google Scholar] [CrossRef]
- Delay, J.; Deniker, P.; Harl, J.M. Therapeutic use in psychiatry of phenothiazine of central elective action (4560 RP). Ann. Med. Psychol. 1952, 110, 112–117. [Google Scholar]
- Madras, B.K. History of the Discovery of the Antipsychotic Dopamine D2 Receptor: A Basis for the Dopamine Hypothesis of Schizophrenia. J. Hist. Neurosci. 2013, 22, 62–78. [Google Scholar] [CrossRef]
- NICE. Psychosis and Schizophrenia in Adults: Prevention and Management (CG178). 2014. Available online: https://www.nice.org.uk/guidance/cg178 (accessed on 10 November 2021).
- NICE. Rehabilitation for Adults with Complex Psychosis (NG181). 2020. Available online: https://www.nice.org.uk/guidance/ng181 (accessed on 10 November 2021).
- Lambert, M.; Schimmelmann, B.G.; Naber, D.; Schacht, A.; Karow, A.; Wagner, T.; Czekalla, J. Prediction of Remission as a Combination of Symptomatic and Functional Remission and Adequate Subjective Well-Being in 2960 Patients with Schizophrenia. J. Clin. Psychiatry 2006, 67, 1690–1697. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ulas, H.; Akdede, B.B.; Ozbay, D.; Alptekin, K. Effect of Thought Disorders on Quality of Life in Patients with Schizophrenia. Prog. Neuro-Psychopharmacol Biol. Psychiatry 2008, 32, 332–335. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. How to Use the ICF: A Practical Manual for Using the International Classification of Functioning, Disability and Health (ICF). In Exposure Draft for Comment; WHO: Geneva, Switzerland, 2013. [Google Scholar]
- World Health Organization. The World Health Organization Quality of Life (WHOQOL); WHO: Geneva, Switzerland, 2012. [Google Scholar]
- Tolman, A.W.; Kurtz, M.M. Neurocognitive Predictors of Objective and Subjective Quality of Life in Individuals with Schizophrenia: A Meta-Analytic Investigation. Schizophr. Bull. 2012, 38, 304–315. [Google Scholar] [CrossRef] [Green Version]
- Desalegn, D.; Girma, S.; Abdeta, T. Quality of Life and Its Association with Psychiatric Symptoms and Socio-Demographic Characteristics among People with Schizophrenia: A Hospital-Based Cross-Sectional Study. PLoS ONE 2020, 15, e0229514. [Google Scholar] [CrossRef]
- O’Connor, J.A.; Wiffen, B.; Diforti, M.; Ferraro, L.; Joseph, C.; Kolliakou, A.; Bonaccorso, S.; Murray, R.M.; David, A.S. Neuropsychological, Clinical and Cognitive Insight Predictors of Outcome in a First Episode Psychosis Study. Schizophr. Res. 2013, 149, 70–76. [Google Scholar] [CrossRef]
- Davies, G.; Greenwood, K. A Meta-Analytic Review of the Relationship between Neurocognition, Metacognition and Functional Outcome in Schizophrenia. J. Ment. Health 2020, 29, 496–505. [Google Scholar] [CrossRef]
- Flavell, J.H. Metacognition and Cognitive Monitoring: A New Area of Cognitive-Developmental Inquiry. Am. Psychol. 1979, 34, 906–911. [Google Scholar] [CrossRef]
- Wells, A.; Purdon, C. Metacognition and Cognitive-Behaviour Therapy: A Special Issue. Clin. Psychol. Psychother. 1999, 6, 71–72. [Google Scholar] [CrossRef]
- Beck, A.T.; Baruch, E.; Balter, J.M.; Steer, R.A.; Warman, D.M. A New Instrument for Measuring Insight: The Beck Cognitive Insight Scale. Schizophr. Res. 2004, 68, 319–329. [Google Scholar] [CrossRef]
- Dimaggio, G.; Lysaker, P.H. Metacognition and Severe Adult Mental Disorders: From Research to Treatment; Routledge: London, UK; New York, NY, USA, 2010; ISBN 978/0-203/85578/2. [Google Scholar]
- Moritz, S.; Woodward, T.S. Metacognitive Training in Schizophrenia: From Basic Research to Knowledge Translation and Intervention. Curr. Opin. Psychiatry 2007, 20, 619–625. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Moritz, S.; Andreou, C.; Schneider, B.C.; Wittekind, C.E.; Menon, M.; Balzan, R.P.; Woodward, T.S. Sowing the Seeds of Doubt: A Narrative Review on Metacognitive Training in Schizophrenia. Clin. Psychol. Rev. 2014, 34, 358–366. [Google Scholar] [CrossRef] [Green Version]
- Eichner, C.; Berna, F. Acceptance and Efficacy of Metacognitive Training (MCT) on Positive Symptoms and Delusions in Patients With Schizophrenia: A Meta-Analysis Taking Into Account Important Moderators. Schizophr. Bull. 2016, 42, 952–962. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Liu, Y.-C.; Tang, C.-C.; Hung, T.-T.; Tsai, P.-C.; Lin, M.-F. The Efficacy of Metacognitive Training for Delusions in Patients With Schizophrenia: A Meta-Analysis of Randomized Controlled Trials Informs Evidence-Based Practice. Worldviews Evid. Based Nurs. 2018, 15, 130–139. [Google Scholar] [CrossRef]
- Philipp, R.; Kriston, L.; Lanio, J.; Kühne, F.; Härter, M.; Moritz, S.; Meister, R. Effectiveness of Metacognitive Interventions for Mental Disorders in Adults-A Systematic Review and Meta-Analysis (METACOG). Clin. Psychol. Psychother. 2019, 26, 227–240. [Google Scholar] [CrossRef]
- Ochoa, S.; López-Carrilero, R.; Barrigón, M.L.; Pousa, E.; Barajas, A.; Lorente-Rovira, E.; González-Higueras, F.; Grasa, E.; Ruiz-Delgado, I.; Cid, J.; et al. Randomized Control Trial to Assess the Efficacy of Metacognitive Training Compared with a Psycho-Educational Group in People with a Recent-Onset Psychosis. Psychol. Med. 2017, 47, 1573–1584. [Google Scholar] [CrossRef]
- Lopez-Morinigo, J.-D.; Ajnakina, O.; Martínez, A.S.-E.; Escobedo-Aedo, P.-J.; Ruiz-Ruano, V.G.; Sánchez-Alonso, S.; Mata-Iturralde, L.; Muñoz-Lorenzo, L.; Ochoa, S.; Baca-García, E.; et al. Can Metacognitive Interventions Improve Insight in Schizophrenia Spectrum Disorders? A Systematic Review and Meta-Analysis. Psychol. Med. 2020, 50, 2289–2301. [Google Scholar] [CrossRef]
- Baron-Cohen, S.; Leslie, A.M.; Frith, U. Does the Autistic Child Have a “Theory of Mind”? Cognition 1985, 21, 37–46. [Google Scholar] [CrossRef]
- Bora, E.; Pantelis, C. Theory of Mind Impairments in First-Episode Psychosis, Individuals at Ultra-High Risk for Psychosis and in First-Degree Relatives of Schizophrenia: Systematic Review and Meta-Analysis. Schizophr. Res. 2013, 144, 31–36. [Google Scholar] [CrossRef] [PubMed]
- Morelli, M.; Casagrande, M.; Forte, G. Decision Making: A Theoretical Review. Integr. Psychol. Behav. Sci. 2021, 15, 1–12. [Google Scholar] [CrossRef] [PubMed]
- Forte, G.; Morelli, M.; Casagrande, M. Heart Rate Variability and Decision-Making: Autonomic Responses in Making Decisions. Brain Sci. 2021, 11, 243. [Google Scholar] [CrossRef]
- Garety, P.A.; Freeman, D.; Jolley, S.; Dunn, G.; Bebbington, P.E.; Fowler, D.G.; Kuipers, E.; Dudley, R. Reasoning, Emotions, and Delusional Conviction in Psychosis. J. Abnorm. Psychol. 2005, 114, 373–384. [Google Scholar] [CrossRef]
- Garety, P. Reasoning and Delusions. Br. J. Psychiatry 1991, 159, 14–18. [Google Scholar] [CrossRef]
- Falcone, M.A.; Murray, R.M.; Wiffen, B.D.R.; O’Connor, J.A.; Russo, M.; Kolliakou, A.; Stilo, S.; Taylor, H.; Gardner-Sood, P.; Paparelli, A.; et al. Jumping to Conclusions, Neuropsychological Functioning, and Delusional Beliefs in First Episode Psychosis. Schizophr. Bull. 2015, 41, 411–418. [Google Scholar] [CrossRef] [Green Version]
- Hasson-Ohayon, I.; Kravetz, S.; Roe, D.; David, A.S.; Weiser, M. Insight into Psychosis and Quality of Life. Compr. Psychiatry 2006, 47, 265–269. [Google Scholar] [CrossRef]
- Cotton, S.M.; Lambert, M.; Schimmelmann, B.G.; Filia, K.; Rayner, V.; Hides, L.; Foley, D.L.; Ratheesh, A.; Watson, A.; Rodger, P.; et al. Predictors of Functional Status at Service Entry and Discharge among Young People with First Episode Psychosis. Soc. Psychiatry Psychiatr. Epidemiol. 2017, 52, 575–585. [Google Scholar] [CrossRef]
- Margariti, M.; Ploumpidis, D.; Economou, M.; Christodoulou, G.N.; Papadimitriou, G.N. Quality of Life in Schizophrenia Spectrum Disorders: Associations with Insight and Psychopathology. Psychiatry Res. 2015, 225, 695–701. [Google Scholar] [CrossRef]
- Lopez-Morinigo, J.-D.; Ruiz-Ruano, V.G.; Martínez, A.S.E.; Estévez, M.L.B.; Mata-Iturralde, L.; Muñoz-Lorenzo, L.; Sánchez-Alonso, S.; Artés-Rodríguez, A.; David, A.S.; Baca-García, E. Study Protocol of a Randomised Clinical Trial Testing Whether Metacognitive Training Can Improve Insight and Clinical Outcomes in Schizophrenia. BMC Psychiatry 2020, 20, 30. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sheehan, D.V.; Lecrubier, Y.; Sheehan, K.H.; Amorim, P.; Janavs, J.; Weiller, E.; Hergueta, T.; Baker, R.; Dunbar, G.C. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The Development and Validation of a Structured Diagnostic Psychiatric Interview for DSM-IV and ICD-10. J. Clin. Psychiatry 1998, 59 (Suppl. 20), 22–33. [Google Scholar] [PubMed]
- Wechsler, D. The Psychometric Tradition: Developing the Wechsler Adult Intelligence Scale. Contemp. Educ. Psychol. 1981, 6, 82–85. [Google Scholar] [CrossRef]
- Endicott, J.; Spitzer, R.L.; Fleiss, J.L.; Cohen, J. The Global Assessment Scale. A Procedure for Measuring Overall Severity of Psychiatric Disturbance. Arch. Gen. Psychiatry 1976, 33, 766–771. [Google Scholar] [CrossRef]
- Üstün, T.B.; Kostanjsek, N.; Chatterji, S.; Rehm, J. Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0); World Health Organization: Geneva, Switzerland, 2010. [Google Scholar]
- Carlson, J.; Ochoa, S.; Haro, J.M.; Escartín, G.; Ahuir, M.; Gutierrez-Zotes, A.; Salamero, M.; Valero, J.; Cañizares, S.; Bernardo, M.; et al. Adaptation and Validation of the Quality-of-Life Scale: Satisfaction with Life Domains Scale by Baker and Intagliata. Compr. Psychiatry 2009, 50, 76–80. [Google Scholar] [CrossRef] [PubMed]
- Vatnaland, T.; Vatnaland, J.; Friis, S.; Opjordsmoen, S. Are GAF Scores Reliable in Routine Clinical Use? Acta Psychiatr. Scand. 2007, 115, 326–330. [Google Scholar] [CrossRef] [PubMed]
- Hernando-Merino, E.; Baca-Garcia, E.; Barrigón, M.L. Comparison of Disability between Common Mental Disorders and Severe Mental Disorders Using WHODAS 2.0. Rev. Psiquiatr. Salud Ment. (Engl. Ed.) 2021. [Google Scholar] [CrossRef]
- Holmberg, C.; Gremyr, A.; Torgerson, J.; Mehlig, K. Clinical Validity of the 12-Item WHODAS-2.0 in a Naturalistic Sample of Outpatients with Psychotic Disorders. BMC Psychiatry 2021, 21, 147. [Google Scholar] [CrossRef]
- Cannon-Spoor, H.E.; Potkin, S.G.; Wyatt, R.J. Measurement of Premorbid Adjustment in Chronic Schizophrenia. Schizophr. Bull. 1982, 8, 470–484. [Google Scholar] [CrossRef]
- Peralta Martín, V.; Cuesta Zorita, M.J. Validation of positive and negative symptom scale (PANSS) in a sample of Spanish schizophrenic patients. Actas Luso Esp. Neurol. Psiquiatr. Cienc. Afines 1994, 22, 171–177. [Google Scholar]
- Wallwork, R.S.; Fortgang, R.; Hashimoto, R.; Weinberger, D.R.; Dickinson, D. Searching for a Consensus Five-Factor Model of the Positive and Negative Syndrome Scale for Schizophrenia. Schizophr. Res. 2012, 137, 246–250. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Reitan, R.M. Validity of the Trail Making Test as an Indicator of Organic Brain Damage. Percept. Mot. Skills 1958, 8, 271–276. [Google Scholar] [CrossRef]
- Wiffen, B.D.R.; O’Connor, J.A.; Russo, M.; Lopez-Morinigo, J.D.; Ferraro, L.; Sideli, L.; Handley, R.; David, A.S. Are There Specific Neuropsychological Deficits Underlying Poor Insight in First Episode Psychosis? Schizophr. Res. 2012, 135, 46–50. [Google Scholar] [CrossRef] [PubMed]
- Soriano-Barceló, J. Insight Assessment in Psychosis and Psychopathological Correlates: Validation of the Spanish Version of the Schedule for Assessment of Insight-Expanded Version. Eur. J. Psychiat. 2016, 30, 55–65. [Google Scholar]
- Kemp, R.; David, A. Psychological Predictors of Insight and Compliance in Psychotic Patients. Br. J. Psychiatry 1996, 169, 444–450. [Google Scholar] [CrossRef] [PubMed]
- David, A.S. Insight and Psychosis. Br. J. Psychiatry 1990, 156, 798–808. [Google Scholar] [CrossRef]
- Brett-Jones, J.; Garety, P.; Hemsley, D. Measuring Delusional Experiences: A Method and Its Application. Br. J. Clin. Psychol. 1987, 26, 257–265. [Google Scholar] [CrossRef]
- O’Connor, J.A.; Ellett, L.; Ajnakina, O.; Schoeler, T.; Kollliakou, A.; Trotta, A.; Wiffen, B.D.; Falcone, A.M.; Di Forti, M.; Murray, R.M.; et al. Can Cognitive Insight Predict Symptom Remission in a First Episode Psychosis Cohort? BMC Psychiatry 2017, 17, 54. [Google Scholar] [CrossRef] [Green Version]
- Gutiérrez-Zotes, J.A.; Valero, J.; Cortés, M.J.; Labad, A.; Ochoa, S.; Ahuir, M.; Carlson, J.; Bernardo, M.; Cañizares, S.; Escartin, G.; et al. Spanish Adaptation of the Beck Cognitive Insight Scale (BCIS) for Schizophrenia. Actas. Esp. Psiquiatr. 2012, 40, 2–9. [Google Scholar]
- Corcoran, R.; Mercer, G.; Frith, C.D. Schizophrenia, Symptomatology and Social Inference: Investigating “Theory of Mind” in People with Schizophrenia. Schizophr. Res. 1995, 17, 5–13. [Google Scholar] [CrossRef]
- Baron-Cohen, S.; Wheelwright, S.; Hill, J.; Raste, Y.; Plumb, I. The “Reading the Mind in the Eyes” Test Revised Version: A Study with Normal Adults, and Adults with Asperger Syndrome or High-functioning Autism. J. Child Psychol. Psychiatry 2001, 42, 241–251. [Google Scholar] [CrossRef] [PubMed]
- Cuesta, M.J.; Peralta, V.; Campos, M.S.; Garcia-Jalon, E. Can Insight Be Predicted in First-Episode Psychosis Patients? A Longitudinal and Hierarchical Analysis of Predictors in a Drug-Naïve Sample. Schizophr. Res. 2011, 130, 148–156. [Google Scholar] [CrossRef] [PubMed]
- Best, M.W.; Milanovic, M.; Iftene, F.; Bowie, C.R. A Randomized Controlled Trial of Executive Functioning Training Compared With Perceptual Training for Schizophrenia Spectrum Disorders: Effects on Neurophysiology, Neurocognition, and Functioning. Am. J. Psychiatry 2019, 176, 297–306. [Google Scholar] [CrossRef] [PubMed]
- Javed, A.; Charles, A. The Importance of Social Cognition in Improving Functional Outcomes in Schizophrenia. Front. Psychiatry 2018, 9, 157. [Google Scholar] [CrossRef]
- Tomotake, M.; Kaneda, Y.; Iga, J.-I.; Kinouchi, S.; Tayoshi, S.; Motoki, I.; Sumitani, S.; Yamauchi, K.; Taniguchi, T.; Ishimoto, Y.; et al. Subjective and Objective Measures of Quality of Life Have Different Predictors for People with Schizophrenia. Psychol. Rep. 2006, 99, 477–487. [Google Scholar] [CrossRef]
- Gardsjord, E.S.; Romm, K.L.; Røssberg, J.I.; Friis, S.; Barder, H.E.; Evensen, J.; Haahr, U.; Ten Velden Hegelstad, W.; Joa, I.; Johannessen, J.O.; et al. Depression and Functioning Are Important to Subjective Quality of Life after a First Episode Psychosis. Compr. Psychiatry 2018, 86, 107–114. [Google Scholar] [CrossRef]
- Nevarez-Flores, A.G.; Sanderson, K.; Breslin, M.; Carr, V.J.; Morgan, V.A.; Neil, A.L. Systematic Review of Global Functioning and Quality of Life in People with Psychotic Disorders. Epidemiol. Psychiatr. Sci. 2019, 28, 31–44. [Google Scholar] [CrossRef]
- Barrios, M.; Guilera, G.; Selb, M.; Gómez-Benito, J. Identification of Problems in the Functioning of Individuals with Schizophrenia from the Expert Perspective: An Internet-Based Survey. Disabil. Rehabil. 2017, 39, 2055–2062. [Google Scholar] [CrossRef]
- Izquierdo, A.; Cabello, M.; Leal, I.; Mellor-Marsá, B.; Ayora, M.; Bravo-Ortiz, M.-F.; Rodriguez-Jimenez, R.; Ibáñez, Á.; MacDowell, K.S.; Malpica, N.; et al. The Interplay between Functioning Problems and Symptoms in First Episode of Psychosis: An Approach from Network Analysis. J. Psychiatr. Res. 2021, 136, 265–273. [Google Scholar] [CrossRef]
- Canal-Rivero, M.; Lopez-Moriñigo, J.-D.; Barrigón, M.-L.; Ayesa-Arriola, R.; Crespo-Facorro, B.; Ruiz-Veguilla, M.; Obiols-Llandrich, J.E. Suicidal Behavior and Personality Traits Contribute to Disability in First-Episode Psychosis: A 1-Year Follow-up Study. Suicide Life Threat. Behav. 2019, 49, 798–810. [Google Scholar] [CrossRef]
- Chen, R.; Liou, T.-H.; Chang, K.-H.; Yen, C.-F.; Liao, H.-F.; Chi, W.-C.; Chou, K.-R. Assessment of Functioning and Disability in Patients with Schizophrenia Using the WHO Disability Assessment Schedule 2.0 in a Large-Scale Database. Eur. Arch. Psychiatry Clin. Neurosci. 2018, 268, 65–75. [Google Scholar] [CrossRef] [PubMed]
- Lu, S.-J.; Liou, T.-H.; Yen, C.-F.; Chang, F.-H.; Chen, Y.-L.; Escorpizo, R.; Strauser, D.R.; Pan, A.-W. Determinants of Employment Outcome for the People with Schizophrenia Using the WHODAS 2.0. J. Occup. Rehabil. 2019, 29, 375–383. [Google Scholar] [CrossRef]
- Correll, C.U.; Schooler, N.R. Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment. Neuropsychiatr. Dis. Treat. 2020, 16, 519–534. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Aleman, A.; Lincoln, T.M.; Bruggeman, R.; Melle, I.; Arends, J.; Arango, C.; Knegtering, H. Treatment of Negative Symptoms: Where Do We Stand, and Where Do We Go? Schizophr. Res. 2017, 186, 55–62. [Google Scholar] [CrossRef] [PubMed]
- Upthegrove, R.; Marwaha, S.; Birchwood, M. Depression and Schizophrenia: Cause, Consequence, or Trans-Diagnostic Issue? Schizophr. Bull. 2017, 43, 240–244. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Arraras, J.I.; Ibañez, B.; Pereda, N.; Iribarren, S.; Basterra, I. The Association of Clinical Insight and Depression with Quality of Life in Schizophrenia. Psychiatry Res. 2019, 279, 350–352. [Google Scholar] [CrossRef]
- Galuppi, A.; Turola, M.C.; Nanni, M.G.; Mazzoni, P.; Grassi, L. Schizophrenia and Quality of Life: How Important Are Symptoms and Functioning? Int. J. Ment. Health Syst. 2010, 4, 31. [Google Scholar] [CrossRef] [Green Version]
- Montemagni, C.; Castagna, F.; Crivelli, B.; De Marzi, G.; Frieri, T.; Macrì, A.; Rocca, P. Relative Contributions of Negative Symptoms, Insight, and Coping Strategies to Quality of Life in Stable Schizophrenia. Psychiatry Res. 2014, 220, 102–111. [Google Scholar] [CrossRef]
- Rocca, P.; Castagna, F.; Mongini, T.; Montemagni, C.; Bogetto, F. Relative Contributions of Psychotic Symptoms and Insight to Quality of Life in Stable Schizophrenia. Psychiatry Res. 2010, 177, 71–76. [Google Scholar] [CrossRef]
- Eack, S.M.; Newhill, C.E. Psychiatric Symptoms and Quality of Life in Schizophrenia: A Meta-Analysis. Schizophr. Bull. 2007, 33, 1225–1237. [Google Scholar] [CrossRef] [Green Version]
- Kim, J.-H.; Lee, S.; Han, A.-Y.; Kim, K.; Lee, J. Relationship between Cognitive Insight and Subjective Quality of Life in Outpatients with Schizophrenia. Neuropsychiatr. Dis. Treat. 2015, 11, 2041–2048. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sevilla-Llewellyn-Jones, J.; Cano-Domínguez, P.; de-Luis-Matilla, A.; Espina-Eizaguirre, A.; Moreno-Kustner, B.; Ochoa, S. Subjective Quality of Life in Recent Onset of Psychosis Patients and Its Association with Sociodemographic Variables, Psychotic Symptoms and Clinical Personality Traits. Early Interv. Psychiatry 2019, 13, 525–531. [Google Scholar] [CrossRef] [PubMed]
- Haro, J.M.; Novick, D.; Perrin, E.; Bertsch, J.; Knapp, M. Symptomatic Remission and Patient Quality of Life in an Observational Study of Schizophrenia: Is There a Relationship? Psychiatry Res. 2014, 220, 163–169. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kurtz, M.M.; Tolman, A. Neurocognition, Insight into Illness and Subjective Quality-of-Life in Schizophrenia: What Is Their Relationship? Schizophr. Res. 2011, 127, 157–162. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Puolakka, K.; Pitkänen, A. Effectiveness of Psychosocial Interventions on Quality of Life of Patients with Schizophrenia and Related Disorders: A Systematic Review. Arch. Psychiatr. Nurs. 2019, 33, 73–82. [Google Scholar] [CrossRef] [PubMed]
- Costa, R.; Bastos, T.; Probst, M.; Seabra, A.; Abreu, S.; Vilhena, E.; Rosenbaum, S.; Ward, P.B.; Corredeira, R. Association of Lifestyle-Related Factors and Psychological Factors on Quality of Life in People with Schizophrenia. Psychiatry Res. 2018, 267, 382–393. [Google Scholar] [CrossRef]
- Morgades-Bamba, C.I.; Fuster-Ruizdeapodaca, M.J.; Molero, F. Internalized Stigma and Its Impact on Schizophrenia Quality of Life. Psychol. Health Med. 2019, 24, 992–1004. [Google Scholar] [CrossRef]
Socio-Demographic Variables | |
---|---|
Age (years) | 47.69 ± 9.76 |
Gender (males) | 41 (53.2%) |
Education level (primary) | 13 (16.9%) |
Marital status (unmarried) | 61 (79.2%) |
Employment status (unemployed) | 56 (72.7%) |
Living status (alone) | 8 (10.4%) |
Premorbid Adjustment (PAS) | |
Childhood | 5.80 ± 3.79 |
Early adolescence | 7.64 ± 4.64 |
Late adolescence | 7.69 ± 4.90 |
Clinical variables | |
Diagnosis | |
Schizophrenia | 48 (62.3%) |
Other psychoses | 29 (37.7%) |
Previous suicidal behaviour (present) | 31 (40.3%) |
Duration of illness (>5 years) | 69 (89.6%) |
Number of previous admissions | 3.46 ± 3.99 |
Psychopathology (PANSS) | |
Positive | 8.44 ± 3.67 |
Negative | 14.91 ± 5.89 |
Disorganisation | 6.05 ± 2.61 |
Depression | 6.25 ± 1.86 |
Mania | 6.94 ± 2.70 |
Insight (SAI-E) | |
Total Insight | 15.55 ± 2.29 |
Illness Recognition | 5.36 ± 2.68 |
Symptoms relabelling | 5.87 ± 2.81 |
Treatment Compliance | 4.31 ± 1.57 |
Neurocognition | |
IQ | 104.61 ± 11.72 |
TMT B-A | 68.91 ± 43.65 |
Metacognition | |
JTC_85:15 | 42 (56.0%) |
JTC_60:40 | 38 (51.4%) |
BCIS-SR | 15.43 ± 5.11 |
BCIS-SC | 7.67 ± 3.42 |
BCIS-CI | 7.74 ± 6.66 |
Hinting Task | 2.25 ± 1.33 |
ERTF | 16.86 ± 2.16 |
Functioning | |
General Functioning (GAF) | 61.81 ± 7.48 |
Disability (WHODAS) | 15.40 ± 10.14 |
Quality of Life (SLDS) | 80.14 ± 11.46 |
General Functioning (GAF) | Disability (WHODAS) | Quality of Life (SLDS) | |||||||
---|---|---|---|---|---|---|---|---|---|
Mean (SD) | Statistic | p Value | Mean (SD) | Statistic | p Value | Mean (SD) | Statistic | p Value | |
Gender | |||||||||
Males | 61.83 (8.20) | 13.49 (11.65) | 80.97 (11.44) | ||||||
Females | 61.78 (6.69) | t75 = 0.03 | 0.98 | 17.08 (8.48) | t74 = −1.52 | 0.13 | 79.25 (11.58) | t70 = 0.63 | 0.53 |
Education level | |||||||||
Primary | 60.23 (9.18) | 12.23 (5.99) | 83.73 (11.90) | ||||||
Secondary (or above) | 62.13 (7.13) | t75 = −0.83 | 0.41 | 15.75 (11.04) | t31.70 = −1.62 | 0.11 | 79.49 (11.36) | t70 = 1.13 | 0.26 |
Marital status | |||||||||
Unmarried | 61.57 (7.70) | 15.26 (9.97) | 80.28 (10.55) | ||||||
Married | 62.69 (6.74) | t75 = −0.053 | 0.60 | 14.67 (12.40) | t74 = 0.20 | 0.84 | 79.60 (14.84) | t70 = 0.20 | 0.84 |
Living status | |||||||||
Alone | 61.13 (9.30) | 20.50 (9.43) | 76.00 (10.02) | ||||||
Not alone | 61.88 (7.32) | t75 = −0.27 | 0.79 | 14.51 (10.39) | t74 = 1.55 | 0.12 | 80.58 (11.58) | t70 = −1.01 | 0.32 |
Employment status | |||||||||
Unemployed | 59.93 (6.91) | 15.67 (10.06) | 80.39 (11.62) | ||||||
Employed | 66.81 (5.74) | t75 = −3.92 | <0.001 | 13.76 (11.40) | t74 = 0.71 | 0.48 | 79.52 (11.30) | t70 = 0.29 | 0.77 |
Diagnosis | |||||||||
Schizophrenia | 61.73 (7.45) | 15.77 (10.67) | 80.06 (11.63) | ||||||
Other psychoses | 61.93 (7.68) | t75 = −0.11 | 0.91 | 14.07 (10.02) | t74 = 0.68 | 0.50 | 80.27 (11.38) | t70 = −0.07 | 0.94 |
Previous SB | |||||||||
Present | 62.35 (7.56) | 18.39 (9.87) | 77.24 (12.55) | ||||||
Absent | 61.43 (7.49) | t75 = 0.53 | 0.60 | 12.91 (10.27) | t74 = 2.32 | 0.02 | 82.09 (10.35) | t70 = −1.79 | 0.078 |
Duration of illness | |||||||||
≤5 years | 66.00 (8.91) | 14.50 (11.40) | 74.00 (9.43) | ||||||
>5 years | 61.32 (7.22) | t75 = 1.69 | 0.094 | 15.22 (10.37) | t74 = 0.18 | 0.85 | 80.80 (11.52) | t70 = 1.50 | 0.14 |
JTC | |||||||||
Present | 60.40 (6.75) | 15.12 (9.30) | 81.35 (10.73) | ||||||
Absent | 63.52 (8.21) | t73 = −1.80 | 0.076 | 15.50 (11.96) | t72 = −0.015 | 0.88 | 78.21 (12.27) | t68 = 1.14 | 0.26 |
General Functioning (GAF) | Disability (WHODAS) | Quality of Life SLDS | ||||
---|---|---|---|---|---|---|
r | p | r | p | r | p | |
Age | −0.31 | 0.005 | 0.17 | 0.13 | 0.069 | 0.57 |
PAS Child | −0.12 | 0.29 | 0.14 | 0.21 | −0.12 | 0.31 |
PAS early | −0.11 | 0.32 | −0.02 | 0.89 | 0.00 | >0.99 |
PAS late | −0.22 | 0.060 | 0.03 | 0.81 | −0.04 | 0.74 |
PANSS-Positive | −0.00 | 0.97 | 0.14 | 0.24 | −0.18 | 0.13 |
PANSS-Negative | −0.52 | <0.001 | 0.32 | 0.005 | −0.09 | 0.47 |
PANSS-Disorganization | −0.43 | <0.001 | 0.10 | 0.39 | 0.09 | 0.44 |
PANSS-Mania | −0.00 | 0.98 | −0.05 | 0.64 | 0.06 | 0.60 |
PANSS-Depression | −0.24 | 0.83 | 0.35 | 0.002 | −0.46 | <0.001 |
IQ | 0.22 | 0.054 | 0.08 | 0.47 | −0.14 | 0.24 |
TMT_B-A | −0.27 | 0.021 | 0.03 | 0.81 | 0.13 | 0.27 |
Recognition | 0.34 | 0.002 | 0.13 | 0.26 | −0.28 | 0.015 |
Relabelling | −0.02 | 0.87 | −0.02 | 0.89 | 0.01 | 0.90 |
Compliance | −0.04 | 0.70 | 0.13 | 0.27 | 0.01 | 0.92 |
INSIGHT | 0.15 | 0.19 | 0.10 | 0.41 | −0.13 | 0.26 |
BCIS-SR | 0.21 | 0.075 | 0.06 | 0.59 | −0.23 | 0.051 |
BCIS-SC | −0.04 | 0.73 | −0.05 | 0.65 | −0.05 | 0.69 |
BCIS-CI | 0.18 | 0.13 | 0.07 | 0.54 | −0.17 | 0.17 |
Hinting Task | 0.25 | 0.028 | −0.09 | 0.45 | 0.07 | 0.59 |
ERTF | 0.34 | 0.002 | −0.03 | 0.80 | −0.13 | 0.27 |
General Functioning (GAF) | Disability (WHODAS) | Quality of Life (SLDS) | |||||||
---|---|---|---|---|---|---|---|---|---|
R2 Change | F Change | p | R2 Change | F Change | p | R2 Change | F Change | p | |
Block 1—Demographic variables: Age, employment status | 0.211 | 7.884 | 0.001 | ||||||
Block 2—Clinical variables: Duration of illness, previous SB | 0.043 a | 3.341 | 0.073 | 0.068 b | 5.383 | 0.023 | 0.070 b | 5.155 | 0.026 |
Block 3—Premorbid adjustment | 0.049 | 4.027 | 0.050 | ||||||
Late PAS score | |||||||||
Block 4—PANSS: See below. | 0.087 c | 3.941 | 0.025 | 0.167 d | 7.867 | 0.001 | 0.157 e | 13.610 | <0.001 |
Block 5—Neurocognition: IQ (WAIS vocabulary), TMT B-A | 0.007 | 0.311 | 0.734 | ||||||
Block 6—Clinical Insight: | 0.023 | 2.109 | 0.161 | 0.046 | 4.216 | 0.044 | |||
Recognition | |||||||||
Block 7—Cognitive Insight | 0.001 | 0.097 | 0.757 | 0.001 | 0.069 | 0.793 | |||
SR | |||||||||
Block 8—JTC | 0.001 | 0.126 | 0.724 | ||||||
JTC | |||||||||
Block 9—Theory of Mind | 0.066 | 3.120 | 0.053 | ||||||
Hinting Task, ERTF | |||||||||
41.3% | 23.5% | 27.3% |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Escobedo-Aedo, P.J.; Forjan-González, A.; Sánchez-Escribano Martínez, A.; Ruiz-Ruano, V.G.; Sánchez-Alonso, S.; Mata-Iturralde, L.; Muñoz-Lorenzo, L.; Baca-García, E.; David, A.S.; Lopez-Morinigo, J.-D. Investigating the Role of Insight, Decision-Making and Mentalizing in Functional Outcome in Schizophrenia: A Cross-Sectional Study. Behav. Sci. 2022, 12, 28. https://doi.org/10.3390/bs12020028
Escobedo-Aedo PJ, Forjan-González A, Sánchez-Escribano Martínez A, Ruiz-Ruano VG, Sánchez-Alonso S, Mata-Iturralde L, Muñoz-Lorenzo L, Baca-García E, David AS, Lopez-Morinigo J-D. Investigating the Role of Insight, Decision-Making and Mentalizing in Functional Outcome in Schizophrenia: A Cross-Sectional Study. Behavioral Sciences. 2022; 12(2):28. https://doi.org/10.3390/bs12020028
Chicago/Turabian StyleEscobedo-Aedo, Paula Jhoana, Ana Forjan-González, Adela Sánchez-Escribano Martínez, Verónica González Ruiz-Ruano, Sergio Sánchez-Alonso, Laura Mata-Iturralde, Laura Muñoz-Lorenzo, Enrique Baca-García, Anthony S. David, and Javier-David Lopez-Morinigo. 2022. "Investigating the Role of Insight, Decision-Making and Mentalizing in Functional Outcome in Schizophrenia: A Cross-Sectional Study" Behavioral Sciences 12, no. 2: 28. https://doi.org/10.3390/bs12020028
APA StyleEscobedo-Aedo, P. J., Forjan-González, A., Sánchez-Escribano Martínez, A., Ruiz-Ruano, V. G., Sánchez-Alonso, S., Mata-Iturralde, L., Muñoz-Lorenzo, L., Baca-García, E., David, A. S., & Lopez-Morinigo, J. -D. (2022). Investigating the Role of Insight, Decision-Making and Mentalizing in Functional Outcome in Schizophrenia: A Cross-Sectional Study. Behavioral Sciences, 12(2), 28. https://doi.org/10.3390/bs12020028