Relationship between self-reflection and insight in early psychosis patients using guided illness model questionnaire (GIM) / y Kong Po Ying, Cathy

Abstract

Insight impairment is commonly reported in psychosis patients and such impairment leads to poor outcome and it also causes burden to the family and caregivers. It is as yet unclear what causes unawareness of illness therefore it is essential to find out the key element to form this fundamental correlation.

Wiffen and David proposed that self-reflective processing may have similar cognitive mechanisms as theory of mind processing, but this does not imply that the processes cannot be affected independently. Lysaker et al. demonstrated that better meta-cognitive skills, such as the ability to think about one’s own thoughts were related to better insight in schizophrenia patients. An increasing number of studies suggest that patients lacking insight into their own illness, were fully capable of recognizing the illness and symptoms in other patients. This indicated that insight impairment only happened at the self-recognition level.

The ability of integrating information from outside world to the self is seen as a factor in gaining insight, therefore self-reflection ability are commonly seen as key features of awareness of mental illness. Previous studies of chronic schizophrenia patients show that their ability to accept the biological model of their own psychotic symptoms, assessed with Guided Illness Model Questionnaire (GIM) questionnaire, has a positive association with their neuropsychological function and awareness of illness However, it has not been common to use GIM questionnaire in early stage psychosis patients.

This study aims are (1) use Guided Illness Model Questionnaire (GIM) to assess the self-reflection ability of early stage psychosis patients (2) explore the relationship between self-reflection and insight (3) Cognitive functions, particular executive functions, will be evaluated with self-reflection ability and insight. Insight will be measured by scale to assess unawareness of mental disorder (SUMD). Results show self-reflection ability is related with insight impairment and executive function, especially processing speed and attention contributes to self-reflection ability and poor insight. Further investigation reveals that self-reflection ability acts as a mediator for poor insight. This study concludes that executive functioning is the basic-order process for gaining insight and self-reflection could act as higher-order process as mediator for provoking insight for psychosis patients.