Relationships between selfreflectiveness and clinical symptoms in individuals during pre-morbid and early clinical stages of psychosis

作     者：Lihua Xu Huiru Cui Yanyan Wei Zhenying Qian Xiaochen Tang Yegang Hu Yingchan Wang Hao Hu Qian Guo Yingying Tang Tianhong Zhang Jijun Wang Lihua Xu;Huiru Cui;Yanyan Wei;Zhenying Qian;Xiaochen Tang;Yegang Hu;Yingchan Wang;Hao Hu;Qian Guo;Yingying Tang;Tianhong Zhang;Jijun Wang

作者机构：Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research CenterShanghai Key Laboratory of Psychotic DisordersShanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina Department of PsychiatryShanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina Department of Early Psychotic DisordersShanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina Center for Excellence in Brain Science and Intelligence Technology(CEBSIT)Chinese Academy of ScienceShanghaiChina Brain Science and Technology Research CenterShanghai Jiao Tong UniversityShanghaiChina 

出 版 物：《General Psychiatry》 (综合精神医学（英文）)

年 卷 期：2022年第35卷第3期

页      面：163-172页

核心收录：

学科分类：1002[医学-临床医学] 100205[医学-精神病与精神卫生学] 10[医学] 

基　　金：supported by the Ministry of Science and Technology of China,National Key R&D Program of China(2016YFC1306800) National Natural Science Foundation of China(81671332,81971251,81671329,81871050,81901832,81971251,82001406,82101582,82151314,and 82171497) Shanghai Municipal Science and Technology Major Project(2018SHZDZX01,2018SHZDZX05)and ZJLab Science and Technology Commission of Shanghai Municipality(16JC1420200,16ZR1430500,19410710800,19411950800,19411969100,19441907800,19ZR1445100,19ZR1477800,20ZR1448600,21ZR1481500,and 21S31903100) Shanghai Municipal Health Commission(202040361) Project of the Key Discipline Construction,Shanghai 3-Year Public Health Action Plan(GWV10.1-XK18) Shanghai Clinical Research Center for Mental Health(19MC1911100) Clinical Research Plan of SHDC(SHDC2020CR4066) Clinical Research Center at Shanghai Jiao Tong University School of Medicine(DLY201817,20190102) Shanghai Jiao Tong University Foundation(ZH2018ZDB03,ZH2018QNB19) The Clinical Research Center at Shanghai Mental Health Center(CRC2018ZD01,CRC2018ZD04,CRC2018YB01,CRC2019ZD02,and 2020-FX-02) Shanghai Mental Health Center(2019-zd01). 

主　　题：clinical symptoms morbid 

摘      要：Background Self-reflectiveness,one dimension of cognitive insight,plays a protective role in an individual’s mental state.Both high and low levels of self-reflectiveness have been reported in patients with schizophrenia and individuals at clinical high risk for the illness.Aims This study aimed to explore the relationship patterns between self-reflectiveness and clinical symptoms in individuals during the pre-morbid and early clinical stages of psychosis.Methods A total of 181 subjects,including individuals with attenuated positive symptoms(APS,n=122)and patients with first-episode psychosis(FEP,n=59),completed the Beck Cognitive Insight Scale and were evaluated using the Schedule of Assessment of Insight and Positive and Negative Syndrome Scale.All subjects were classified into three groups according to their level of selfreflectiveness:low level(LSR,n=59),medium level(MSR,n=67)and high level(HSR,n=55).Both linear and nonlinear relationships between self-reflectiveness and clinical symptoms were explored.Results More individuals with APS were classified into the MSR group,while more patients with FEP were classified into the LSR group.The LSR group demonstrated less awareness of illness than the MSR and HSR groups,more stereotyped thinking and poorer impulse control but less anxiety than the MSR group,and lower levels of blunted affect and guilt feelings than the HSR group.The MSR group demonstrated lower stereotyped thinking than the HSR group.Compared to the LSR group,the MSR group had increased selfreflectiveness,improved awareness of illness,decreased stereotyped thinking,and better impulse control,but increased feelings of guilt.The HSR group showed increased stereotyped thinking when compared to the MSR group,but the other variables did not change significantly between these two groups.Overall,self-reflectiveness demonstrated an approximately inverse S-shaped relationship with the awareness of illness,a U-shaped relationship with stereotyped thinking and poor impulse control,and an almost linear relationship with anxiety and guilt feelings.Conclusions Self-reflectiveness demonstrates complex relationships with clinical symptoms and fails to exert significant positive effects when reaching a certain high level.