BACKGROUND: How insight, paranoia and depression evolve in relation to each other during and after the first episode of schizophrenia is poorly understood but of clinical importance. METHOD: Serial assessments over 18 months were made using multiple instruments in a consecutive sample of 257 patients with first episode DSM-IV non-affective psychosis. Repeated measures of paranoia, insight, depression and self-esteem were analysed using structural equation modelling, to examine the direction of relationships over time after controlling for confounds. RESULTS: Depression was predicted directly by greater insight, particularly at baseline, and by greater paranoia at every stage of follow-up. Neither relationship was mediated by self-esteem, although there was a weak association of lower self-esteem with greater depression and better insight. Paranoia was not strongly associated with insight. Duration of untreated psychosis and substance use at baseline predicted depression at 18 months. CONCLUSIONS: In first-episode psychosis, good insight predicts depression. Subsequently, paranoia is the strongest predictor. Neither effect is mediated by low self-esteem. Effective treatment of positive symptoms is important in preventing and treating low mood in early schizophrenia.
BACKGROUND: How insight, paranoia and depression evolve in relation to each other during and after the first episode of schizophrenia is poorly understood but of clinical importance. METHOD: Serial assessments over 18 months were made using multiple instruments in a consecutive sample of 257 patients with first episode DSM-IV non-affective psychosis. Repeated measures of paranoia, insight, depression and self-esteem were analysed using structural equation modelling, to examine the direction of relationships over time after controlling for confounds. RESULTS:Depression was predicted directly by greater insight, particularly at baseline, and by greater paranoia at every stage of follow-up. Neither relationship was mediated by self-esteem, although there was a weak association of lower self-esteem with greater depression and better insight. Paranoia was not strongly associated with insight. Duration of untreated psychosis and substance use at baseline predicted depression at 18 months. CONCLUSIONS: In first-episode psychosis, good insight predicts depression. Subsequently, paranoia is the strongest predictor. Neither effect is mediated by low self-esteem. Effective treatment of positive symptoms is important in preventing and treating low mood in early schizophrenia.
Authors: Colin A Depp; Alexandrea L Harmell; Gauri N Savla; Brent T Mausbach; Dilip V Jeste; Barton W Palmer Journal: J Affect Disord Date: 2013-10-02 Impact factor: 4.839
Authors: Jason R Randall; Randy Walld; Greg Finlayson; Jitender Sareen; Patricia J Martens; James M Bolton Journal: Can J Psychiatry Date: 2014-10 Impact factor: 4.356
Authors: Laura Giusti; Donatella Ussorio; Adele Tosone; Chiara Di Venanzio; Valeria Bianchini; Stefano Necozione; Massimo Casacchia; Rita Roncone Journal: Community Ment Health J Date: 2014-07-27
Authors: Balasubramanian Saravanan; K S Jacob; Shanthi Johnson; Martin Prince; Dinesh Bhugra; Anthony S David Journal: Br J Psychiatry Date: 2010-06 Impact factor: 9.319
Authors: Michael Cooke; Emmanuelle Peters; Dominic Fannon; Anantha P P Anilkumar; Ingrid Aasen; Elizabeth Kuipers; Veena Kumari Journal: Schizophr Res Date: 2007-06-11 Impact factor: 4.939