Insight and subjective measures of quality of life in chronic schizophrenia

Abstract

Lack of insight is a well-established phenomenon in schizophrenia, and has been associated with reduced rater-assessed functional performance but increased self-reported well-being in previous studies. The objective of this study was to examine factors that might influence insight (as assessed by the Insight and Treatment Attitudes Questionnaire [ITAQ] or PANSS item G12) and subjective quality-of-life (as assessed by Lehman QoL Interview [LQOLI]), using the large National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset. Uncooperativeness was assessed by PANSS item G8 (“Uncooperativeness”). In the analysis, we found significant moderating effects for insight on the relationships of subjective life satisfaction assessment to symptom severity (as assessed by CGI-S score), objective everyday functioning (as assessed by rater-administered Heinrichs–Carpenter Quality of Life scale), clinically rated uncooperativeness (as assessed by PANSS G8), and discontinuation of treatment for all causes (all P > 0.05 for statistical interaction between insight and subject QoL). Patients with chronic schizophrenia who reported being "pleased" or "delighted" on LQOLI were found to have significantly lower neurocognitive reasoning performance and poorer insight (ITAQ total score). Our findings underscore the importance of reducing cognitive and insight impairments for both treatment compliance and improved functional outcomes.

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

“…Sui et al 34 examined the link of insight with non-adherence in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, a nationwide public health-focused clinical trial of antipsychotic medication, and found that patients with poor insight who were most likely to discontinue treatment also had relatively more severe levels of psychopathology.…”

Lurasidone Effects on Cognition and Functional Capacity in Schizophrenia

“…The large-scale CATIE study showed that correlation between PANSS item G12 and insight as assessed by Insight and Treatment Attitudes Questionnaire (ITAQ) total score was 0.49: [30];(p<0.001, N=1099) and that the PANSS G12 had a number of functional correlates in that sample. In these analyses, impairment was defined as a score of 4 or greater on PANSS item 12.…”

“…Treatmentrelated improvement in insight from baseline to the 6-month endpoint was significantly correlated with better scores for measures of neurocognitive performance (p<0.05), functional capacity (p<0.05) and quality of well-being (p<0.05) across treatment groups and study periods. Poor insight contributing to deficits in illness awareness and objective measures of cognitive and functional performance is prevalent in schizophrenia [30,[32][33][34][35]. Lack of insight was associated with inability to complete neurocognitive testing and provide valid scores at baseline visit in acute study phase.…”

“…Lack of insight was associated with inability to complete neurocognitive testing and provide valid scores at baseline visit in acute study phase. Previous studies have found better insight and greater illness awareness are associated with worse subjective, patient-assessed quality-of-life outcomes [30]. Longitudinal analyses of insight improvement from baseline in treatment studies are therefore crucial to gain further insight into the inter-relationships among these important clinical outcomes over time.…”

“…Most research has found that cognitive impairments in general are not strongly correlated with reduced awareness other than in the domains of executive functioning [30,36]. The modest correlation between cognitive deficits and unawareness of cognitive limitations may be due to the unidirectional nature of the relationship in schizophrenia: most patients have significant limitations and only some are aware of them.…”