Insight and neurocognition in first-episode psychosis : Effects of insight and baseline IQ on remission at 1-year follow-up

Abstract

Background: The present study has focused on IQ and insight as potential predictors for remission in a group of first-episode psychosis patients. Lack of insight is a prevalent feature of patients with psychosis, and is clinically relevant as it is associated with psychosocial dysfunction, poorer treatment adherence and an increased number of rehospitalizations. Previous studies have found general intelligence represented by IQ to be a sensitive and reliable cognitive predictor of later social and clinical outcome in the early stages of schizophrenia. In this study we have investigated to what degree insight in a group of first–episode psychosis patients changes from baseline to 1–year follow–up. In addition, we have explored the relationship between insight, baseline IQ and remission. Methods: 24 adults above 18 years diagnosed with a first episode of psychosis were assessed on insight using the G12 item of the Structured Clinical Interview for the Positive and Negative Syndrome Scale (SCI–PANSS). Intellectual functioning was measured using the Norwegian version of the Wechsler Abbbreviated Scale of Intelligence (WASI). Remission was assessed using the criteria defined by the Remission in Schizophrenia Working Group. For the statistical analyses we used data collected at baseline, 6 and 12 months. Results: The results from our study show a statistically significant increase in insight after one year. A small, non-significant correlation was found between degree of insight and IQ. At 1–year follow–up, 21 of a total of 24 patients were in remission. IQ is found to be moderately correlated with remission at 6 months and at 1 year. This correlation also failed to attain statistical significance. Results indicate small, non–significant correlations between insight and remission measured at the different time points. Conclusions: Support was found for the main hypothesis that insight is improved and maintained throughout the first year after a first episode of psychosis for our group of patients. Regarding remission as an outcome variable, results concerning the contribution of insight and IQ were inconclusive.