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Insight in first-episode schizophrenia

Objective. To compare insight impairment, including its temporal changes, between remitters and nonremitters in patients with first-episode schizophrenia. Method. Males, consecutively hospitalized with diagnosed first-episode schizophrenia (according to ICD 10), who provided written informed consent, and were reassessed at the 1-year follow-up were included. The psychopathology was evaluated using the Positive and Negative Syndrome Scale (PANSS) prior to acute treatment – on admission; at the end of the acute treatment – at discharge; at the 1-year follow-up. Insight was measured using item G12 from the PANSS. Results. Ninety-three patients (mean age 23 years, mean duration of illness 0.77 years) were reassessed after 1 year. A total of 73/93 patients (78%) fulfilled the criteria for remission. When compared, remitters and nonremitters showed no significant difference in impaired judgement and insight on admission. The mean value of this item was significantly lower at discharge even in nonremitters; however, a significantly higher value was found after 1 year in nonremitters. In remitters the impaired insight decreased significantly at discharge and there was a significant additional decrease after 1 year. In nonremitters there was a significant decrease at discharge; however, a significant increase was observed after 1 year. In the 73 remitters the rate of insight impairment was 79.4% on admission, 46.6% at discharge and 10.9% after 1 year; the same values were 90, 20 and 70% in the 20 nonremitters. In both remitters and nonremitters the lack of judgement and insight was the first or second most frequently observed item at all three time points. The impaired insight on admission was strongly associated with the overall symptomatology, including positive, negative and general psychopathology on admission in both remitters and nonremitters. Only in remitters was the impaired insight at discharge associated with symptoms at discharge, on admission and also after 1 year. The impaired insight at the 1-year follow-up was associated with some symptoms after 1 year in both remitters and nonremitters. Conclusion. Insight may be state dependent, especially in patients with a good outcome. Attitudes towards treatment and insight into the illness may vary during the course of the illness. However, more longitudinal prospective studies are needed to verify such state-related change, and the factors that may underlie the acquisition of insight.