The Association of Insight and Change in Insight with Clinical Symptoms in Depressed Inpatients

背景:自知力缺乏已经被广泛的研究并且发现与精神分裂症患者受损的治疗依从性和长期临床治疗效果较差相关,但是很少研究表明这种现象也存在于严重的抑郁症患者中。目的:探讨情感障碍、需要住院治疗的最严重的情感障碍患者的自知力及其与症状变化之间的关系。方法:根据ICD-10诊断标准从中国南部的一家大型精神科医院纳入了住院抑郁症患者(MDD)(N=55)或双相抑郁症患者(BD)(N=85),在他们住院一周和出院时采用自知力与治疗态度问卷(ITAQ)进行评估。同时也采用汉密尔顿抑郁量表(HAMD-17)和症状自评量表抑郁量表(SCL-90)测量临床症状。在对病人及其家属的访谈中,记录了住院时间、疾病持续时间、未治疗情绪紊乱的持续时间、既往抑郁发作次数、和以往的抑郁症入院记录。采用二分类相关分析和多元回归分析来研究社会人口学特征、临床症状、和临床病史与入院时自知力之间的相关性。对临床症状的变化和从入院到出院之间自知力的变化之间的关系也进行了研究。结果:多元逐步回归模型显示既往的抑郁症入院记录和HAMD-17中较高的焦虑因子分都是自知力的显著独立预测因素,占方差的22.9%。ITAQ的多元回归分析残差变化得分(基线值矫正后的评分变化)显示平均住院超过51天对自知力的改善与精神发育迟滞因子负相关,占方差的9.1%。结论:较严重的焦虑症状和抑郁症的既往住院史与入院时自知力方面的疾病有关。治疗期间运动迟缓症状的减轻与出院时间对自知力较大的改善之间是相关的。入院时病情更严重并且精神发育迟滞改善更大的患者表现出最大的自知力。

Background： Lack of insight has been extensively studied and was found to be adversely correlated with impaired treatment compliance and worse long term clinical outcomes among patients with schizophrenia, while not much is known about this phenonmenon in patients with severe depression. Aim： To explore the correlates of insight and its relation to symptom changes among the most seriously patients with affective disorders, those who require hospitalization. Methods： Patients hospitalized in a large psychiatric hospital in south China with either major depressive disorder （MDD）（N=55） or bipolar depression （BD） （N=85） based on ICD-10 diagnostic criteria were assessed with the Insight and Treatment Attitudes Questionnaire （ITAO.） one week after admission and at the time of discharge. Clinical symptoms were measured at the same time with the Hamilton Rating Scale for Depression （HAMD-17） and the Depression subscale of the Symptom Check list-90 （SCL-90）. Length of stay （LOS）, duration of illness, duration of untreated mood disorder, number of previous episodes of depression and previous admissions for depression were documented during interviews with patients and their families and from a review of medical records. Bivariate correlations and multiple regression analysis were used to examine the relationship of sociodemographic characteristics, clinical symptomatology and clinical history, to insight at the time of admission. The relationships between change in clinical symptoms and change in insight from admission to discharge were also examined. Results： Stepwise multiple regression models suggested that any previous admissions for depression and higher anxiety factor scores on the HAMD-17 are significant independent predictors of insight accounting for 22.9% of the variance. Multiple regression analysis residual change scores （change scores adjusted for baseline values） on the ITAO. showed that improved insight over average stays of 51 days were inversely related to the residual psychomotor retardation factor on the HAMD-17 accounting for 9.1% of the variance. Conclusions： More severe anxiety symptoms and previous hospitalization for depression were associated with greater insight into illness at admission. Reduction of motor retardation symptoms during treatment was associated with greater improvement in insight to the time of discharge. The patients who are sicker at admission and who show more improvement in psycho-motor retardation show the greatest insight.