Is clinical insight a determinant factor of subjective recovery in persons living with schizophrenia or schizoaffective disorders ?

Is clinical insight a determinant factor of subjective recovery in persons living with schizophrenia or schizoaffective disorders ?

Auteurs : G. Gal­liot, R. San­chez-Rodri­guez, A. Bel­loc, H. Phul­pin, A. Icher, P. Birmes, K. Faure, T. Gozé

Réfé­rence : Psy­chia­try Research (Vol. 316, Octo­ber 2022, 114726)

Abs­tract

Good cli­ni­cal insight is pre­dic­tive of cli­ni­cal reco­ve­ry in schi­zo­phre­nia (i.e. symp­to­ma­tic remis­sion and func­tio­nal impro­ve­ment). Howe­ver, the recent sub­jec­tive reco­ve­ry para­digm (i.e. the self-iden­ti­ty recons­truc­tion pro­cess with and beyond psy­cho­sis) ques­tio­ned the rele­vance of see­king patients’ awa­re­ness of their medi­cal­ly-defi­ned ill­ness. This stu­dy aimed to assess the rela­tion­ship bet­ween cli­ni­cal insight and sub­jec­tive reco­ve­ry in indi­vi­duals with psy­cho­tic disor­ders. Six­ty-seven out­pa­tients diag­no­sed with schi­zo­phre­nia or schi­zoaf­fec­tive disor­der were asses­sed for cli­ni­cal insight using the Scale to assess Una­wa­re­ness of Men­tal Disor­der (SUMD) and for self-rated sub­jec­tive reco­ve­ry using the Reco­ve­ry Assess­ment Scale (RAS). Among all dimen­sions of insight, only the una­wa­re­ness of cur­rent symp­toms was signi­fi­cant­ly asso­cia­ted with RAS total score, with ill­ness dura­tion as the only mode­ra­ting fac­tor. On the final regres­sion model, una­wa­re­ness of cur­rent symp­toms was confir­med as the stron­gest of six fac­tors explai­ning all toge­ther 44% of the sub­jec­tive reco­ve­ry variance, whe­reas cli­ni­cal insight taken as an inde­pendent mul­ti­di­men­sio­nal construct did not signi­fi­cant­ly par­ti­ci­pate in explai­ning sub­jec­tive reco­ve­ry. Our stu­dy high­lights the weak and only par­tial impli­ca­tion of cli­ni­cal insight in sub­jec­tive reco­ve­ry, and invites cli­ni­cians to consi­der the patients’ mea­ning making pro­cess of mor­bid expe­riences in order to build a self-direc­ted and medi­cal­ly-sup­por­ted recovery.