Krankheitseinsicht – Eine Übersicht über das Konzept mit Fokus auf schizophrene Erkrankungen

Zusammenfassung

Anliegen Das Konzept zur Krankheitseinsicht (KHE) ist in den letzten 10 Jahren wieder zunehmend ins wissenschaftliche Interesse gerückt. Konzeptuelle Erweiterungen zur KHE sowie Befunde zur Ätiologie, den Bedingungsfaktoren, zur Erfassung sowie Techniken zur Herbeiführung von KHE sollen dargestellt werden. Methode In einem Literaturüberblick werden neuere Befunde zu KHE berichtet. Ergebnisse KHE ist ein komplexes, vieldimensionales, stark kulturell eingebettetes Phänomen, das durch multiple Faktoren beeinflusst und in seiner Ätiologie nur unzureichend verstanden ist. Schlussfolgerungen Weitere Studien, insbesondere zur therapeutischen Herbeiführung von KHE, sind erforderlich.

Abstract

Objective Insight into illness is key to successful treatment. Poor insight, especially in schizophrenia, is, however, quite a frequent phenomenon that is also associated with poor adherence to treatment and a variety of unfavorable outcome parameters. On that background, the concept of insight into illness has gained new reseach interest during the last 10 years. The present review aims to report new findings regarding conceptual changes of insight, findings on the etiology, contributing factors as well as the assessment and methods to develop insight. Methods Based on a review of the literature, results from more recent studies on insight into illness will be presented. Results Insight into illness is a complex, multidimensional, strongly culturally embedded phenomenon that is influenced by a variety of factors. The etiology of insight still remains poorly understood but is likely to be multifactorial including psychological, neuropsychological and organic reasons. Conclusions Further research is needed, in particularly regarding therapeutical techniques to improve insight into illness.

Schlüsselwörter

Krankheitseinsicht - Schizophrenie - Ätiologie - Kultur

Keywords

insight into illness - schizophrenia - etiology - culture

Literatur

• 1 McEvoy J P, Freter S, Everett G. et al . Insight and the clinical outcome of schizophrenic patients.  J Nerv Ment Dis. 1989;  177 (1) 48-51
• 2 Schwartz R C, Cohen B N, Grubaugh A. Does insight affect long-term impatient treatment outcome in chronic schizophrenia?.  Comp Psychiatry. 1997;  38 (5) 283-288
• 3 Amador X F, Flaum M, Andreasen N C. et al . Insight into illness in schizophrenia, schizoaffective and mood disorders – results from the DSM IV field trials.  Schizophr Res. 1994;  11 (2) 180
• 4 Böker W. Störungswahrnehmung und Krankheitseinsicht schizophrener Patienten.  Fortschr Neurol Psychiatr. 1999;  67 237-248
• 5 Gilmer T P, Dolder C R, Lacro J P. et al . Adherence to treatment with antipsychotic medication and health care costs among medicaid beneficiaries with schizophrenia.  Am Journal Psychiatry. 2004;  161 (4) 692-699
• 6 AMDP .Das AMDP-System. Manual zur Dokumentation psychiatrischer Befunde (8., überarb. Aufl.). Göttingen; Hogrefe 2006
• 7 Lewis A. The psychopathology of insight.  Br J Med Psychology. 1934;  14 332-348
• 8 Jaspers K. Die Stellungnahme der Kranken zur Krankheit. In: Allgemeine Psychopathologie (8. Aufl.). Berlin; Springer 1965: 345-356
• 9 Surguladze S, David A. Insight and major mental illness: an update for clinicians.  Adv Psychiatr Treatment. 1999;  5 163-170
• 10 David A S. On insight and psychosis: discussion paper.  J Roy Soc Med. 1990;  83 325-329
• 11 Amador X F, Strauss D H, Yale S A. et al . Awareness of illness in schizophrenia.  Schizophr Bull. 1991;  17 (1) 113-132
• 12 Amador X F, Strauss D H, Yale S A. et al . Assessment of Insight in Psychosis.  Am J Psychiatry. 1993;  150 (6) 873-879
• 13 Cooke M A, Peters E R, Kuipers E. et al . Disease, deficit or denial? Models of poor insight in psychosis.  Act Psychiatr Scand. 2005;  112 4-17
• 14 Young D A, Zakzanis K K, Bailey C. et al . Further parameters of insight and neuropsychological deficit in schizophrenia and other chronic mental disease.  J Nerv Ment Dis. 1998;  186 (1) 44-50
• 15 Moore O, Cassidy E, Carr A. et al . Unawareness of illness and its relationship with depression and self-deception in schizophrenia.  Europ Psychiatry. 1999;  14 (5) 264-269
• 16 McGlashan T H, Carpenter W T. Post-psychotic depression in schizophrenia.  Arch Gen Psychiatry. 1976;  33 (2) 231-239
• 17 Karow A, Schäfer I, Hirdes F. et al . Positivsymptome und Lebensqualität aus der Sicht schizophrener Patienten.  Psychiat Prax. 2008;  35 286-293
• 18 Alloy L B, Abramson L Y. Judgement of contingency in depressed and nondepressed students – sadder but wiser.  J Exp Psych – Genera. 1976;  108 (4) 441-485
• 19 Lewisohn P M, Mischel W, Chaplin W. et al . Social competence and depression: The role illusory self-perceptions.  J Abnorm Psychol. 1980;  89 203-212
• 20 Sackheim H A, Wegner A Z. Attributional patterns in depression and euthymia.  Arch Gen Psychiatry. 1986;  43 553-560
• 21 McEvoy J P, Johnson J, Perkins D. et al . Insight in first-episode psychosis.  Psychol Med. 2006;  36 1385-1393
• 22 Mintz A R, Dobson K S, Romney D. Insight in schizophrenia: a meta-analysis.  Schizophr Res. 2003;  61 75-88
• 23 Ko N Y, Yeh M L, Hsu S T. et al . Investigation of insight formation using narrative analyses of people with schizophrenia in remission.  J Nerv Ment Dis. 2006;  194 124-127
• 24 Cooke M A, Peters E R, Kuipers E. et al . Disease, deficit or denial? Models of poor insight in psychosis.  Act Psychiatr Scand. 2005;  112 4-17
• 25 Cooke M, Peters E, Fannon D. et al . Insight, distress and coping styles in schizophrenia.  Schizophr Res. 2007;  94 12-22
• 26 Pia L, Tamietto M. Unawareness in schizophrenia: neuropsychological and neuroanatomical findings.  Psychiatr Clin Neurosc. 2006;  60 531-537
• 27 McGlynn S M, Schacter D L. Unawareness of deficits in neuropsychological syndromes.  J Clin Exp Neuropsychol. 1989;  11 (2) 143-205
• 28 Lysaker P, Bell M. Insight and cognitive impairment in schizophrenia: performance on repeated administrations of the Wisconsin Card Sorting Test.  J Nerv Ment Dis. 1994;  182 (11) 656-660
• 29 Lysaker P H, France C M, Hunter N L. et al . Personal narratives of illness in schizophrenia: associations with neurocognition and symptoms.  Psychiatr. 2005 b;  68 (2) 140-151
• 30 Goodman G, Knoll G, Isakov V. et al . Insight into illness in schizophrenia.  Compr Psychiatr. 2005;  46 284-290
• 31 Lysaker P H, Whitney K A, Davis L W. Awareness of illness in schizophrenia: associations with multiple assessments of executive function.  J Neuropsychiatr Clin Neurosc. 2006;  18 (4) 516-520
• 32 Ritsner M S, Blumenkrantz H. Predicting domain-specific insight of schizophrenia patients from symptomatology, multiple neurocognitive functions, and personality related traits.  Psychiatr Res. 2007;  149 (1–3) 59-69
• 33 Jovanovski D, Zakzanis K K, Young D A. et al . Assessing the relationship between insight and everyday executive deficits in schizophrenia: A pilot study.  Psychiatr Res. 2007;  151 (1–2) 47-54
• 34 Lysaker P H, Carcione A, Dimaggio G. et al . Metacognition amidst narratives of self and illness in schizophrenia: associations with neurocognition, symptoms insight and quality of life.  Act Psychiatr Scand. 2005 a;  112 64-71
• 35 Gambini O, Barbieri V, Scarone S. Theory of mind in schizophrenia: first person vs. third person perspective.  Consciousness Cogn. 2004;  13 (1) 39-46
• 36 Startup M. Awareness of own and others schizophrenic illness.  Schizophr Res. 1997;  26 (2–3) 203-211
• 37 Amador X F, David A S. Insight and Psychosis. New York; Oxford University Press 1998
• 38 Keshavan M S, Rabinowitz J, DeSmedt G. et al . Correlates of insight in first episode psychosis.  Schizophr Res. 2004;  70 (2–3) 187-194
• 39 Debowska G, Grzywa A, Kucharska-Pietura K. Insight in paranoid schizophrenia – Its relationship to psychopathology and premorbid adjustment.  Comp Psychiatr. 1998;  39 (5) 255-260
• 40 Nakano H, Terao T, Iwata N. et al . Symptomatological and cognitive predictors of insight in chronic schizophrenia.  Psych Res. 2004;  127 (1–2) 65-72
• 41 Baier M, DeShay E, Owens K. et al . The relationship between insight and clinical factors for person with schizophrenia.  Arch Psych Nursing. 2000;  14 (6) 259-265
• 42 Kim Y, Sakamoto K, Kamo T. et al . Insight and clinical correlates in schizophrenia.  Comp Psychiatr. 1997;  38 (2) 117-123
• 43 Schwartz R C, Petersen S. The relationship between insight and suicidality among patients with schizophrenia.  J Nerv and Ment Dis. 1999;  187 (6) 376-387
• 44 Perkins R E, Moodley P. Perception of problems in psychiatric inpatients: denial, race and service usage.  Soc Psychiatr Epidemiol. 1993;  28 189-193
• 45 Johnson S, Orrell M. Insight and Psychosis: A social-perspective.  Psychol Med. 1995;  25 (3) 515-520
• 46 McCabe R, Priebe S. Explanatory models of illness in schizophrenia: comparison of four ethnic groups.  Br J Psychiatr. 2004;  185 25-30
• 47 Saravanan B, Jacob K S, Johnson S. et al . Belief models in first episode schizophrenia in South India.  Soc Psychiatr Epidemiol. 2007;  42 446-451
• 48 Goldberg R W, Green-Paden L, Lehman A F. et al . Correlates of Insight in Serious Mental Illness.  J Nerv Ment Dis. 2001;  189 (3) 137-145
• 49 Pote H L, Orrell M W. Perceptions of Schizophrenia in multi-cultural Britain.  Ethn Health. 2002;  7 (1) 7-20
• 50 Carter J H. Religion / spirituality in african-american culture: an assential aspect of psychiatric care.  J Nat Med Assoc. 2002;  94 (5) 371-375
• 51 Phillips M R, Li Y, Stroup T S. et al . Causes of schizophrenia reported by patients' family members in China.  Br J Psychiatr. 2000;  177 20-25
• 52 White R, Bebbington P, Pearson J. et al . The social context of insight in schizophrenia.  Soc Psychiatr Epidemiol. 2000;  35 500-507
• 53 Kulhara P, Avasthi A, Sharma A. Magico-religious beliefs in schizophrenia: a study from North India.  Psychopathol. 2000;  33 62-68
• 54 Saravanan B, Jacob K S, Prince M. et al . Culture and insight revisited.  Br J Psychiatr. 2004;  184 107-109
• 55 Patel V, Kleinman A. Poverty and common mental disorders in developing countries.  Bull World Health Org. 2003;  81 (8) 609-615
• 56 Beck-Sander A. Is insight into psychosis meaningful?.  J Ment Health. 1998;  7 25-34
• 57 Sanz M, Constable G, Lopez-Ibor I. et al . A comparative study of insight scales and their relationship to psychopathological and clinical variables.  Psychol Med. 1998;  28 437-446
• 58 Saravanan B, David A, Bhugra D. et al . Insight in people with psychosis: The influence of culture.  Int Rev Psychiatr. 2005;  17 (2) 83-87
• 59 Amador X F, Strauss D H. The Scale to assess Unawareness of Mental Disorder. Columbia University and New York Psychiatric Institute 1990
• 60 McEvoy J P, Freter S, Everett G. et al . Insight and the clinical outcome of schizophrenic patients.  J Nerv Ment Dis. 1989;  177 (1) 48-51
• 61 Kemp R, David A. Psychosis – Insight and Compliance.  Curr Op Psychiatr. 1995;  8 (6) 357-361
• 62 Markova I S, Berrios G E. The assessment of insight in clinical psychiatry: a new scale.  Act psych Scand. 1992;  86 (2) 159-164
• 63 Birchwood M, Smith J, Drury V. et al . A self-report insight scale for psychosis: reliability, validity and sensitivity to change.  Act psych Scand. 1994;  89 62-67
• 64 Beck A T, Baruch E, Balter J M. et al . A new instrument for measuring insight: the Beck Cognitive Insight Scale.  Schizophr Res. 2004;  68 319-329
• 65 Turkington D, Kongdon D, Turner T. Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia.  Br J Psychiatr. 2002;  180 523-527
• 66 Bell M, Bryson G, Greig T. et al . Neurocognitive enhancement therapy with work therapy.  Arch Gen Psychiatr. 2001;  58 763-768
• 67 Hogarty G E, Flesher S. Practice principles of cognitive enhancement therapy for schizophrenia.  Schizophr Bull. 1999;  25 (4) 693-708
• 68 Pekkala E, Merinder L. Psychoeducation for schizophrenia. Cochrane Database Syst Rev 2 CD002831 2002
• 69 Kilian R, Holzinger A, Angermeyer M C. „Das ist zwar ein bisschen anstrengender manchmal, aber auch interessanter” – Psychiaterinnen und Psychiater beurteilen die Wirkung von Psychoedukation auf die ambulante Schizophreniebehandlung.  Psychiat Prax. 2001;  28 209-213
• 70 Rusch N, Corrigan P W. Motivational interviewing to improve insight and treatment adherence in schizophrenia.  Psychiatr Rehab J. 2002;  26 (1) 23-32
• 71 Bustillo J R, Lauriello J, Horan W P. et al . The psychosocial treatment of schizophrenia: an update.  Am J Psychiatr. 2001;  158 163-175
• 72 Kemp R, Kirov G, Everitt B. Randomised controlled trial of compliance therapy. 18 month follow-up.  Br J Psychiatr. 1998;  172 413-419
• 73 O'Donnell C, Donohoe G, Sharkey L. et al . Compliance therapy: a randomised controlled trial in schizophrenia.  BMJ. 2003;  327 834-836
• 74 Hofer E, Wancata J, Amering M. „Ich bin ein unverstandenes Wesen auf Erden” – Krankheitskonzepte von PatientInnen mit der Diagnose Schizophrenie vor und nach Psychoedukation.  Psychiat Prax. 2001;  28 287-291
• 75 Kilian R, Lindenbach I, Angermeyer M C. „(…) manchmal zweifle ich an mir, wenn es mir nicht gut geht” – Die Wirkung eines ambulanten psychoedukativen Gruppenprogramms aus der subjektiven Perspektive von Patienten mit schizophrenen Erkrankungen.  Psychiat Prax. 2001;  28 168-173
• 76 Henry C, Ghaemi S N. Insight in psychosis: a systematic review of treatment interventions.  Psychopathol. 2004;  37 194-199
• 77 Macpherson R, Jerrom B, Hughes A. A controlled study of education about drug treatment in schizophrenia.  Br J Psychiatr. 1996;  168 709-717
• 78 Kemp R, Hayward P, Applewhaite G. et al . Compliance therapy in psychotic patients: Randomised controlled trial.  BMJ. 1996;  312 345-349
• 79 Owens D G, Carroll A, Fattah S. et al . A randomized, controlled trial of a brief interventional package for schizophrenic out-patients.  Act Psych Scand. 2001;  103 362-369
• 80 Ascher-Svanum H, Whitesel J. A randomized controlled study of two types of group patient education about schizophrenia.  Psychiatr Serv. 1999;  50 926-930
• 81 Carroll A, Fattah S, Clyde Z. et al . Correlates of insight and insight change in schizophrenia.  Schizophr Res. 1999;  35 247-253
• 82 Merinder L B, Viuff A G, Laugesen H D. et al . Patient and relative education in community psychiatry: A randomized controlled trial regarding its effectiveness.  Soc Psychiatry Psychiatr Epidemiol. 1999;  354 287-294
• 83 Modestin J. Psychotherapeutischer Einfluss auf Einsicht und Therapie-Compliance.  Schweizer Arch Neurol Psychiatr. 2008;  159 (3) 112-118
• 84 Klimitz H. Psychoedukation bei schizophrenen Störungen – Psychotherapie oder „Unterwanderung”?.  Psychiat Prax. 2006;  33 372-397
• 85 May P RA. Treatment of Schizophrenia A Comparative Study of Five Treatment Methods. New York; Science House 1968
• 86 Gunderson J G, Frank A F, Katz H M. et al . Effects of psychotherapy in schizophrenia. Comparative outcome of two forms of treatment.  Schizophr Bull. 1984;  10 564-598
• 87 Drury V, Birchwood M, Cochrane R. et al . Cognitive therapy and recovery from acute psychosis: A controlled trial. Impact on psychotic symptoms.  Br J Psychiatr. 1996;  169 593-601
• 88 Drury V, Birchwood M, Cochrane R. Cognitive therapy and recovery from acute psychosis: A controlled trial. Five-year follow-up.  Br J Psychiatr. 2000;  177 8-14
• 89 Muzekari L H. Videotape self-confrontation among chronic schizophrenics.  J Clin Psychol. 1974;  30 99-100
• 90 Davidoff S A, Forester B P, Ghaemi S N. et al . Effect of video self-observation on development of insight in psychotic disorders.  J Nerv Ment Dis. 1998;  186 697-700
• 91 McEvoy J P, Aland J, Wilson W H. et al . Measuring chronic schizophrenic patients' attitudes toward their illness and treatment.  Hosp Community Psychiatry. 1981;  32 856-858
• 92 Lin I F, Spiga R, Fortsch W. Insight and adherence to medication in chronic schizophrenics.  J Clin Psychiatr. 1979;  40 430-432
• 93 Lysaker P H, Lancaster R S, Davis L W. et al . Patterns of neurocognitive deficits and unawareness of illness in schizophrenia.  J Nerv Ment Dis. 2003;  191 (1) 38-44
• 94 Subotnik K L, Nuechterlein K H, Irzhevsky V. et al . Is unawareness of psychotic disorder a neurocognitive or psychological defensiveness problem?.  Schizophr Res. 2005;  75 (2–3) 147-157
• 95 Sandyk R. Biological determinants and risk factors for tardive dyskinesia in schizophrenia.  Int J Neurosc. 1993;  69 (1–4) 35-51
• 96 Arango C, Adami H, Sherr J D. et al . Relationship of awareness of dyskinesia in schizophrenia to insight into mental illness.  Am J Psychiatr. 1999;  156 1097-1099
• 97 Kleinmann A. The Illness Narratives: Suffering, Healing and the Human Condition. New York; Basic Books 1988
• 98 Lysaker P H, Lancaster R S, Davis L. et al . Patterns of neurocognitive deficits and unawareness of illness in schizophrenia.  J Nerv Ment Dis. 2003;  1 38-45
• 99 Freudenreich O, Deckersbach T, Goff D C. Insight into current symptoms of schizophrenia. Association with frontal cortical function and affect.  Act Psych Scand. 2004;  110 14-20
• 100 Lewis L. Mourning, insight, and reduction of suicide risk in schizophrenia.  Bull Menninger Clin. 2004;  68 (3) 231-244