Content area
Abstract
Given that some individuals with schizophrenia are capable of possessing insight into their prodromal/relapse symptoms, and that the literature fails to clearly resolve the issue of whether or not specific interventions can eliminate unawareness of illness, a logical question would be “Is it possible to develop insight in individuals through the course of treatment?” Specifically, “Is it possible to develop through the course of treatment the first step of insight, which is engagement in the treatment process?” In addition, “Can an awareness of prodromal/relapse symptoms be developed through treatment?”
The purpose of this study was to answer these questions using the following approaches. First, this study explored the clinical use of the Prodromal Symptom Assessment Scale (PSA; Tapley, 1992), a newly developed measure which assessed patient insight. Secondly, this study explored the impact and efficacy of an intensive rehabilitation program on patient insight. Specifically, did an intensive rehabilitation program increase patient insight into prodromal symptoms, signs of impending relapse, and the need for treatment? Thirdly, this study examined the impact and efficacy of a new cognitive therapy on patient insight (Brenner, 1987; Brenner, Hodel, Kube, & Roder, 1987). Specifically, did the cognitive therapy increase patient insight into prodromal symptoms, signs of impending relapse, and the need for treatment?
Subjects were individuals diagnosed with schizophrenia or schizoaffective disorder who were or had been residents at one of three Nebraska State inpatient psychiatric hospitals. Longitudinal and cross-sectional analyses were performed. Subjects were tested on the following measures: (1) The Pre-Morbid Adjustment and Onset Inventory (Whiteside, 1992), (2) Insight and Treatment Attitudes Questionnaire (ITAQ; McEvoy et al., 1989), (3) The Schedule for Assessing the Three Components of Insight (SAI; David, 1990), (4) The Prodromal Symptom Assessment Scale (PSA; Tapley, 1992), (5) The Rater's Impression of Patient Insight Measure (RIPI, Tapley, 1992), (6) The Medication Management Module (MMM; Liberman, 1988a), and (7) The Symptom Management Module (SMM; Liberman, 1988b). Several conclusions can be drawn from this study. First, the Prodromal Symptom Assessment Scale (PSA) has adequate interrater and test/re-test reliability. This measure also did a better job at detecting insight than other commonly used measures (i.e., ITAQ, SAI). Secondly, this study failed to support the hypothesis that a high intensity rehabilitation program is associated with greater insight as compared to a low intensity rehabilitation program. Thirdly, and probably the main conclusion of the present study, is the finding that individuals who participated in the cognitive therapy did indeed perform better on some measures related to insight. It appears each of the measures used had adequate interrater reliability. Thus, there can be some confidence in the findings. Limitations of the study and directions for future research are discussed.
