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RESEARCH WEEKLY: 2 New Studies on Insight in Schizophrenia
By Elizabeth Sinclair Hancq
(January 11, 2023) Lack of insight into one’s illness is a key characteristic of severe psychiatric disorders, and research indicates that up to half of people with schizophrenia may have this symptom. Reduced insight and general unawareness of illness is associated with a host of negative outcomes, including more severe symptoms, worse psychosocial functioning and lower overall prognosis.
Two research studies on insight into schizophrenia were published in the November edition of Schizophrenia Bulletin, an academic journal associated with Oxford University Press and the University of Maryland School of Medicine. The first examines the effect of early intervention services on insight in individuals with first episode psychosis. The second reports on the efficacy of transcranial direct current stimulation, an innovative interventional psychiatry treatment, on improving insight in patients with schizophrenia.
Insight in first episode psychosis
Insight in individuals experiencing a first episode of psychosis is of particular importance, because research has shown that it predicts overall prognosis of the individual’s illness. While early intervention service programs for individuals experiencing first episode psychosis have shown positive results in improving symptoms and their overall illness course, none of those research studies have examined the impact of early intervention programs on insight, despite its importance.
The study published in Schizophrenia Bulletin is a randomized-controlled trial of the effects of early intervention services on insight in first episode psychosis. A total of 404 participants were included in the study, and they were followed for two years.
The researchers found a larger improvement in insight among individuals in an early intervention program versus those in usual care. Most of the gains in insight occurred during the first six months of being enrolled in the program, although there continued to be improvement in the remaining 18 months studied.
Just like in previous research, this study showed that, at baseline, individuals with higher levels of insight had less severe psychosis symptoms and higher social functioning. However, higher insight is also associated with more severe depression in individuals with schizophrenia and in the first episode psychosis patients of this study. Importantly, while individuals enrolled in early intervention services showed improved insight, this did not lead to more severe depression in these individuals. These results suggest earlier intervention service programs can improve insight without worsening depression in individuals with first episode psychosis.
tDCS improves insight in individuals with schizophrenia
tDCS is a safe and low-cost interventional treatment that works by applying weak electrical stimulation to targeted regions of the brain to modulate brain activity and connectivity. Research shows that repeated sessions over a treatment course has positive results in alleviating hallucination and delusion symptoms, as well as cognition, in individuals with schizophrenia.
This new research by study authors from research centers from around the world is a systematic review and meta-analysis of randomized-controlled trials, the gold standard in clinical research. By combining results from multiple different trials, researchers have a better understanding of the true effects of a given treatment.
Thirteen studies with a total of 587 patients with schizophrenia were included in the analysis. Levels of insight were measured utilizing a widely used psychiatric assessment scale, the Positive and Negative Syndrome Scale, and specifically, item G12, which assesses lack of judgement and insight into illness.
Patients with schizophrenia who received at least ten sessions of tDCS showed improved insight into their illness compared to those that did not, according to the results. The authors suggest that the improvement in insight among patients who receive this treatment might underlie the efficacy of the treatment itself on other outcomes like hallucination and delusion symptoms, because the increased insight may lead to better medication adherence and compliance with treatment.
Targeting insight
As the authors of the tDCS study note, “impaired insight is a transdiagnostic construct, since it is found in many psychiatric disorders, and it is underpinned by several commonalities among them. It is therefore important to focus on insight because it represents a therapeutic target that can affect many patients.” These two studies show promising results on ways to improve insight in individuals with schizophrenia at different stages of the illness; however, more research is needed given the critical importance of insight on an individual’s prognosis and overall well-being.
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