A Schandrin1, J Norton2, S Raffard3, B Aouizerate4, F Berna5, L Brunel6, I Chereau-Boudet7, T D'Amato8, H Denizot7, C Dubertret9, J Dubreucq10, C Faget11, G Fond12, F Gabayet10, P M Llorca7, J Mallet9, D Misdrahi4, C Passerieux13, R Rey8, F Schurhoff6, M Urbach13, S Bonnet14, D Capdevielle15. 1. Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, University Hospital of Nimes, Nimes, France. Electronic address: aurelie.schandrin@chu-nimes.fr. 2. Inserm 1061, Montpellier, France. 3. Inserm 1061, Montpellier, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHRU Montpellier, University of Montpellier 1, Montpellier, France. 4. Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Charles Perrens Hospital, F-33076 Bordeaux, France; University of Bordeaux, Inserm, Magendie Neurocenter - Pathophysiology of neural plasticity, U862, F-33000 Bordeaux, France. 5. Fondation FondaMental, Créteil, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France. 6. Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94000 Créteil, France. 7. Fondation FondaMental, Créteil, France; Clermont-Ferrand University Hospital, EA 7280 Auvergne University, BP 69 63003 Clermont-Ferrand Cedex 1, France. 8. Fondation FondaMental, Créteil, France; University Claude Bernard Lyon 1, Le Vinatier Hospital, Pole Est BP 300 39 - 95 bd Pinel, 69678 BRON Cedex, France. 9. Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894 Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France. 10. Fondation FondaMental, Créteil, France; Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France. 11. Fondation FondaMental, Créteil, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France. 12. Fondation FondaMental, Créteil, France. 13. Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, UFR Health Sciences Simone Veil, Université de Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France. 14. University Department of Adult Psychiatry, La Colombiere Hospital, CHRU Montpellier, University of Montpellier 1, Montpellier, France. 15. Fondation FondaMental, Créteil, France; Inserm 1061, Montpellier, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHRU Montpellier, University of Montpellier 1, Montpellier, France.
Abstract
BACKGROUND: Aggressiveness is a stigma frequently associated with schizophrenia. The role of insight as a risk factor of aggressiveness remains contradictory; mainly because single measures of these states mask their complexity and heterogeneity. METHODS: This study was conducted on 666 patients aged 15 and above with a DSM-IV-TR diagnosis of schizophrenia spectrum disorder, drawn from the French national network of schizophrenia expert center database. Collected data comprised socio-demographics and standardized psychiatric assessments. Aggressiveness was evaluated using the Buss-Perry Aggression Questionnaire and insight using the Scale to assess Unawareness of Mental Disorder (SUMD) and Birchwood Insight Scale (BIS). RESULTS: Hostility was the aggressiveness dimension the most strongly associated with SUMD insight dimensions. Patients aware of their illness were nearly twice as likely to show hostility than those seriously unaware (OR = 1.95, 95% CI.: 1.08-3.5), but not when further adjusting for depression. Similarly, those aware of the consequences of their illness and of their symptoms were more hostile. Patients moderately aware of illness consequences had a higher risk of both anger and physical aggressiveness than those unaware (OR = 2.63, 95% CI.: 1.42-4.86, OR = 2.47, 95% CI.: 1.33-4.60, respectively), even when adjusting for depression for anger. CONCLUSION: Our study confirms that a multi-dimensional approach to insight and aggressiveness is essential to understand the types of links between these clinical states. Insight may trigger the expression of an underlying hostile tendency, maybe via depression and self-stigmatisation. This should be taken into account in therapeutic approaches to improve insight.
BACKGROUND:Aggressiveness is a stigma frequently associated with schizophrenia. The role of insight as a risk factor of aggressiveness remains contradictory; mainly because single measures of these states mask their complexity and heterogeneity. METHODS: This study was conducted on 666 patients aged 15 and above with a DSM-IV-TR diagnosis of schizophrenia spectrum disorder, drawn from the French national network of schizophrenia expert center database. Collected data comprised socio-demographics and standardized psychiatric assessments. Aggressiveness was evaluated using the Buss-Perry Aggression Questionnaire and insight using the Scale to assess Unawareness of Mental Disorder (SUMD) and Birchwood Insight Scale (BIS). RESULTS: Hostility was the aggressiveness dimension the most strongly associated with SUMD insight dimensions. Patients aware of their illness were nearly twice as likely to show hostility than those seriously unaware (OR = 1.95, 95% CI.: 1.08-3.5), but not when further adjusting for depression. Similarly, those aware of the consequences of their illness and of their symptoms were more hostile. Patients moderately aware of illness consequences had a higher risk of both anger and physical aggressiveness than those unaware (OR = 2.63, 95% CI.: 1.42-4.86, OR = 2.47, 95% CI.: 1.33-4.60, respectively), even when adjusting for depression for anger. CONCLUSION: Our study confirms that a multi-dimensional approach to insight and aggressiveness is essential to understand the types of links between these clinical states. Insight may trigger the expression of an underlying hostile tendency, maybe via depression and self-stigmatisation. This should be taken into account in therapeutic approaches to improve insight.