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Effects on cognitive and clinical insight with the use of Guided Self-Determination in outpatients with schizophrenia: A randomized open trial

Published online by Cambridge University Press:  15 April 2020

R. Jørgensen ,
R.W. Licht ,
P.H. Lysaker ,
P. Munk-Jørgensen ,
K.D. Buck ,
S.O.W. Jensen ,
L. Hansson  and
V. Zoffmann
R. Jørgensen*
Affiliation:
Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
R.W. Licht
Affiliation:
Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
P.H. Lysaker
Affiliation:
Indiana University School of Medicine, Indianapolis, IN, USA Roudebush Veteran Affairs Medical Center, Indianapolis, IN, USA
P. Munk-Jørgensen
Affiliation:
Department M, Aarhus University Hospital, Risskov, Denmark
K.D. Buck
Affiliation:
Roudebush Veteran Affairs Medical Center, Indianapolis, IN, USA
S.O.W. Jensen
Affiliation:
Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
L. Hansson
Affiliation:
Department of Health Science, Lund University, Lund, Sweden
V. Zoffmann
Affiliation:
Research Unit Women's and Children's Health, the Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
*
⁎Corresponding author. Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark. Tel.: +45 22 72 69 77; fax: +45 97 64 37 54. E-mail address:rijo@rn.dk (R. Jørgensen).
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Abstract

Poor insight has a negative impact on the outcome in schizophrenia; consequently, poor insight is a logical target for treatment. However, neither medication nor psychosocial interventions have been demonstrated to improve poor insight. A method originally designed for diabetes patients to improve their illness management, Guided Self-Determination (GSD), has been adapted for use in patients with schizophrenia (GSD-SZ). The purpose of this study was to investigate the effect on insight of GSD-SZ as a supplement to treatment as usual (TAU) as compared to TAU alone in outpatients diagnosed with schizophrenia. The design was an open randomized trial. The primary hypothesis was cognitive insight would improve in those patients who received GSD-SZ + TAU as assessed by the BCIS. We additionally explored whether the intervention led to changes in clinical insight, self-perceived recovery, self-esteem, social functioning and symptom severity. Assessments were conducted at baseline, and at 3-, 6- and 12-month follow-up. Analysis was based on the principles of intention to treat and potential confounders were taken into account through applying a multivariate approach. A total of 101 participants were randomized to GSD-SZ + TAU (n = 50) or to TAU alone (n = 51). No statistically significant differences were found on the cognitive insight. However, at 12-month follow-up, clinical insight (measured by G12 from the Positive and Negative Syndrome Scale), symptom severity, and social functioning had statistically significantly improved in the intervention group as compared to the control group. “Improving insight in patients diagnosed with schizophrenia”, NCT01282307, http://clinicaltrials.gov/.

Keywords

SchizophreniaRCTComplex interventionPoor insightSymptoms
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 5 , July 2015 , pp. 655 - 663
Copyright
Copyright © Elsevier Masson SAS 2015

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References

Amador, X., Flaum, M., Andreasen, N., Strauss, D.H., Yale, S.H., Clark, S.C., et al.Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry 1994;51:826–836.CrossRefGoogle ScholarPubMed
Beck, A.T., Baruch, E., Balter, J.M.. A new instrument for measuring insight: the Beck Cognitive Insight Scale. Schizophr Res 2004;68:319–329.CrossRefGoogle ScholarPubMed
Bell, M.D., Lysaker, P.H., Beam-Goulet, J.L., Milstein, R.M., Lindenmayer, J.P.. Five-component model of schizophrenia: assessing the factorial invariance of the positive and negative syndrome scale. Psychiatry Res 1994;52:295–303.CrossRefGoogle ScholarPubMed
Birchwood, M., Smith, V., Drury, V.. A self-report insight scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatr Scand 1994;89:62–67.CrossRefGoogle ScholarPubMed
Buck, K.D., Roe, D., Yanos, P., Buck, B., Fogley, R.L., Grant, M., et al.Challenges to assisting with the recovery of personal identity and wellness for persons with serious mental illness: considerations for mental health professionals. Psychosis 2013;5:134–143.CrossRefGoogle Scholar
Chan, S., Chan, K., Lam, M., Chiu, C., Hui, C., Wong, G., et al.Clinical and cognitive correlates of insight in first-episode schizophrenia. Schizophr Res 2012;135(1–3):40–45.CrossRefGoogle ScholarPubMed
Chue, P., Lalonde, J.K.. Addressing the unmet needs of patients with persistent negative symptoms of schizophrenia: emerging pharmacological treatment options. Neuropsychiatr Dis Treat 2014;10:777–789.CrossRefGoogle ScholarPubMed
Corrigan, P.W., Giffort, D., Rashid, F., Leary, M., Okeke, I.. Recovery as a psychological construct. Community Ment Health J 1999;35(3):231–239.CrossRefGoogle ScholarPubMed
Corrigan, P.W., Salzer, M., Ralph, R.O., Sangster, Y., Keck, L.. Examining the factor structure of the Recovery Assessment Scale. Schizophr Bull 2004;30(4):1035–1041.CrossRefGoogle ScholarPubMed
David, A.S.Chapter 18 – The clinical importance of insight: an overview. In: Amador, X.F., David, A.S., editors. Insight and psychosis. Oxford: Oxford University Press; 2004. p. 359–392.CrossRefGoogle Scholar
Endicott, J., Spitzer, R.L., Fleiss, J.L., Cohen, J.. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976;33:766–771.CrossRefGoogle ScholarPubMed
Erickson, M.A., Jaafari, N., Lysaker, P.H.. Insight and negative symptoms as predictors of functioning in a work setting in patients with schizophrenia. Psychiatry Res 2011;189:161–165.CrossRefGoogle Scholar
Francis, J.L., Penn, D.L.. The relationship between insight and social skill in persons with severe mental illness. J Nerv Ment Dis 2001;189:822–829.CrossRefGoogle ScholarPubMed
Granholm, E., McQuaid, J.R., McClure, F.S., Link, P.C., Perivoliotis, D., Gottlieb, J.D., et al.Randomised controlled trial of cognitive behavioural social skills training for older people with schizophrenia: 12-month follow-up. J Clin Psychiatry 2007;68:730–737.CrossRefGoogle ScholarPubMed
Henry, C., Ghaemi, S.N.. Insight in psychosis: a systematic review of treatment interventions. Psychopathology 2004;37:194–199.CrossRefGoogle ScholarPubMed
Husted, G.R., Esbensen, B.A., Hommel, E., Thorsteinsson, B., Zoffmann, V.. Adolescents developing life skills for managing type 1 diabetes: a qualitative, realistic evaluation of a guided self-determination-youth intervention. J Adv Nurs 2014;70(11):2634–2650.CrossRefGoogle ScholarPubMed
Husted, G.R., Thorsteinsson, B., Esbensen, B.A., Gluud, C., Winkel, P., Hommel, E., et al.Effects of guided self-determination youth intervention integrated into outpatients visits versus treatment as usual on glycemic control and life skills: a randomized clinical trial in adolescents with type 1 diabetes. Trials 2014;15:321.CrossRefGoogle Scholar
Jónsdóttir, H., Opjordsmoen, S., Birkenaes, A.B., Simonsen, C., Engh, J.A., Ringen, P.A., et al.Predictors of medication adherence in patients with schizophrenia and bipolar disorder. Acta Psychiatr Scand 2013;127:23–33.CrossRefGoogle ScholarPubMed
Jørgensen, R.En ny begyndelse med skizofreni — et interventionsstudie bygget på metoden Guidet Egen-Beslutning [No. 134 ; master thesis]. Department of Nursing Science, University of Aarhus; 2007.Google Scholar
Jørgensen, R., Hansson, L., Zoffmann, V.. Changes in persistent delusions in schizophrenia using guided self-determination: a single case study. Issues Ment Health Nurs 2012;33:293–300.CrossRefGoogle ScholarPubMed
Jørgensen, R., Munk-Jørgensen, P., Lysaker, P.H., Buck, K.D., Hansson, L., Zoffmann, V.. Overcoming recruitment barriers revealed high readiness to participate and low drop-out rate among people with schizophrenia in a randomized controlled trial testing the effect of a guided self-determination intervention. BMC Psychiatry 2014;14:28.CrossRefGoogle Scholar
Kay, S.R., Fiszbein, A., Opler, L.A.. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–276.CrossRefGoogle Scholar
Lincoln, T.M., Lüllmann, E., Rief, W.. Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophr Bull 2007;33(6):1324–1342.CrossRefGoogle ScholarPubMed
Linden, M., Godderman, F.. The differentiation between lack of insight and dysfunctional health believes in schizophrenia. Psychopathology 2007;40(4):236–241.CrossRefGoogle Scholar
Lysaker, P.H., Buck, K.D., Salvatore, G., Popolo, R., Dimaggio, G.. Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches. Expert Rev Neurother 2009;9(7):1035–1043.CrossRefGoogle ScholarPubMed
Lysaker, P.H., Dimaggio, G., Buck, K.D., Callaway, S.S., Salvatore, G., Carcione, A., et al.Poor insight in schizophrenia: links between different forms of metacognition with awareness of symptoms, treatment need, and consequences of illness. Compr Psychiatry 2011;52:253–260.CrossRefGoogle Scholar
Lysaker, P.H., Vohs, J., Hillis, J.D., Kukla, M., Popolo, R., Salvatore, G., et al.Poor insight into schizophrenia: contributing factors, consequences and emerging treatment approaches. Expert Rev Neurother 2013;13(7):785–793.CrossRefGoogle ScholarPubMed
Lysaker, P.H., Wilkniss, S.M., Glynn, S.M., Silverstein, S.M.. Psychotherapy and recovery from schizophrenia: a review of potential applications and need for future study. Psychol Serv 2010;7(2):75–91.CrossRefGoogle ScholarPubMed
Martin, J.L.R., Pérez, V., Sacristán, M., Rodríguez-Artalejo, F., Martínez, , Álvarez, E.. Meta-analysis of drop-out rates in randomized clinical trials, comparing typical and atypical antipsychotics in the treatment of schizophrenia. Eur Psychiatry 2006;21:11–20.CrossRefGoogle ScholarPubMed
Martin, J.M., Warman, D.M., Lysaker, P.H.. Cognitive insight in non-psychiatric individuals and individuals with psychosis: an examination using the Beck Cognitive Insight Scale. Schizophr Res 2012;121(1–3):39–45.CrossRefGoogle Scholar
Millan, M.J., Fone, K., Steckler, T., Horan, W.P.. Negative symptoms of schizophrenia: clinical characteristics, pathophysiological substrates, experimental models and prospects for improved treatment. Eur Neuropsychopharmacol 2014;24:645–692.CrossRefGoogle ScholarPubMed
Olfson, M., Marcus, S.C., Wilk, J., West, J.C.. Awareness of illness and nonadherence to antipsychotic medications among persons with schizophrenia. Psychol Serv 2006;57:205–211.CrossRefGoogle ScholarPubMed
Penn, D.L., Meyer, P.S., Evans, E., Wirth, R.J., Cai, K., Burchinal, M.. A randomized controlled trial of group cognitive-bahavioral therapy vs. enhanced supportive therapy for auditory hallucinations. Schizophr Res 2009;109:52–59.CrossRefGoogle Scholar
Pijnenborg, G.H.M., van Donkersgoed, R.J.M., Davis, A.S., Aleman, A.. Changes in insight during treatment for psychotic disorders: a meta-analysis. Schizophr Res 2013;144(1–3):109–117.CrossRefGoogle ScholarPubMed
Pijnenborg, H.G., Van der Gaag, M., Bockting, C.L., Van der Meer, L., Aleman, A.. REFLEX, a social-cognitive group treatment to improve insight in schizophrenia: study protocol of a multi-center RCT. BMC Psychiatry 2011;11:161.CrossRefGoogle ScholarPubMed
Pedersen, G., Hagtvet, K.A., Karterud, S.. Generalizability studies of the Global Assessment of Functioning-Split version. Compr Psychiatry 2007;48(1):88–94.CrossRefGoogle ScholarPubMed
Rathod, S., Kingdon, D., Smith, P., Turkington, D.. Insight into schizophrenia: the effects of cognitive behavioural therapy on the components of insight and association with sociodemographics – data on a previously published randomised controlled trial. Schizophr Res 2005;74(2–3):211–219.CrossRefGoogle ScholarPubMed
Riggs, S.E., Grant, P.M., Perivoliotis, D., Beck, A.T.. Assessment of cognitive insight: a qualitative review. Schizophr Bull 2012;38(2):338–350.CrossRefGoogle ScholarPubMed
Rosenberg, M.Society and the adolescent self image. Princeton, NJ: Princeton University Press; 1965.CrossRefGoogle Scholar
Schennach, R., Meyer, S., Seemüller, F., Jäger, M., Schmauss, M., Laux, G., et al.Insight in schizophrenia-course and predictors during the acute treatment phase of patients suffering from a schizophrenia spectrum disorder. Eur Psychiatry 2012;27(8):625–633.CrossRefGoogle ScholarPubMed
Schwartz, R.C.. The relationship between insight, illness and treatment outcome in schizophrenia. Psychiatr Q 1998;69:1–22.CrossRefGoogle Scholar
Startup, M.. Awareness of own and others’ schizophrenic illness. Schizophr Res 1997;29:203–211.CrossRefGoogle Scholar
Tarrier, N.. Cognitive behaviour therapy for schizophrenia – a review of development, evidence and implementation. Psychother Psychosom 2005;74(3):136–144.CrossRefGoogle ScholarPubMed
Villeneuve, K., Potvin, S., Lesage, A., Nicole, L.. Meta-analysis of rates of drop-out from psychosocial treatment among persons with schizophrenia spectrum disorder. Schizophr Res 2010;121:266–270.CrossRefGoogle ScholarPubMed
Wang, Y., Xiang, Y., Wang, C., Chlu, H.F.K., Zhao, J.P., Chen, Q., et al.Insight in Chinese schizophrenia patients: a 12-month follow-up. J Psychiatr Ment Health 2011;18(9):751–757.CrossRefGoogle ScholarPubMed
Zoffmann, V.Guided self-determination: a life skills approach developed in difficult type 1 diabetes [thesis]. Department of Nursing Science, University of Aarhus; 2004.Google Scholar
Zoffmann, V., Harder, I., Kirkevold, M.A person-centered communication and reflection model: sharing decision-making in chronic care. Qual Health Res 2008;18(5):670–685.CrossRefGoogle ScholarPubMed
Zoffmann, V., Kirkevold, M.Life versus disease in difficult diabetes care: conflicting perspectives disempower patients and professionals in problem-solving. Qual Health Res 2005;15(6):750–765.CrossRefGoogle ScholarPubMed
Zoffmann, V., Kirkevold, M.Relationships and their potential for change developed in difficult type 1 diabetes. Qual Health Res 2007;17(5):625–638.CrossRefGoogle ScholarPubMed
Zoffmann, V., Kirkevold, M.Realizing empowerment in difficult diabetes care: a guided self-determination intervention. Qual Health Res 2011;22(1):103–118.CrossRefGoogle ScholarPubMed
Zoffmann, V., Lauritzen, T.Guided self-determination improves life skills with type 1 diabetes and A1C in randomized controlled trial. Patient Educ Couns 2006;64(1–3):78–86.CrossRefGoogle ScholarPubMed
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