Self knowledge refers to the cognitive ability of patients to their own mental state, that is, whether they can detect or recognize their own illness and whether their mental state is normal, whether they can analyze, judge and point out which of their past and present states and performances are normal and which are pathological.Patients with complete insight are usually able to recognize that they are ill, know that they need treatment, and actively cooperate with doctors for treatment.Psychiatric patients generally have different degrees of insight defects. At different stages of the disease, the integrity of insight is also different and changes with the condition.[1]
A patient with complete insight can usually recognize his illness, know which symptoms are pathological, and request treatment.asNeurosisMost patients have complete self-awareness. They take the initiative to seek medical advice, tell the doctor about their discomfort, ask for treatment, and actively cooperate with the doctor.
Disease characteristics
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mental diseasePeople generally have different degrees of insight defects.At different stages of the disease, insight also changes, which has certain regularity.In the early stage of psychosis, some patients' self-awareness is still preserved, and they can be aware of changes in their mental state.With the development and aggravation of the disease, patients tend toMental symptomsHe lost his judgment, denied that he was abnormal, and even refused treatment.This is called insight defect.
Lack of insight or incomplete insight refers to the patient's wrong response to their own state, or“Self cognition”The loss of unity with "self reality".
Evaluation criteria
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At present, the commonly used foreign and domesticSchizophreniaThe assessment of insight can be roughly summarized into the following five categories:
Assessment of 7 grades
Ganjingli et alSchizophreniaThe clinical value and related factors of insight were studied in 118 patients with schizophreniaConcise Psychiatric Rating Scale(BPRS) scoring method, 1~7 points in 7 grades, the higher the scoreObstacle of insightThe heavier.The results showed that 11% of the patients had complete insight. The higher the insight score, the BPRSnegativeSymptom Scale (SANS)positiveSymptom Rating Scale (SAPS), General Clinical Efficacy Rating Scale (CGI-GI) and treatmentComplianceThe higher the score;Self knowledge is also significantly correlated with some symptom factor scores in BPRS, SANS, and SAPS, as well as years of education, but not with age, course of disease, number of hospitalizations, and total length of stay.Prompt insight and othersMental symptomsThe severity, changes, efficacy and treatment compliance ofSchizophreniaIt has important clinical value.
Evaluation of 4 grades
Zheng Chengchou et alMental symptomsSelf knowledge is divided into four grades: existence, basic existence, partial existence and loss.They compared 45 casesSchizophreniaThe insight of patients was analyzed.The results show that:
Insight
(1) Only 11.1% of patients with complete insight, indicating thatObstacle of insightIt is a high incidence symptom of schizophrenia and has diagnostic value.The degree of insight impairment is related to the duration of the disease. Most patients with short duration and acute stage lose insight completely, while those with long duration tend to have partial insight;Age, number of hospitalizations, length of stay and other factors had no effect on insight, and there was no difference between first and multiple hospitalizations.It shows that the existence of insight is mainly related to the onset period of the patient.（2）Lack of insightThe patient's condition was more serious, and the difference of insight in different degrees between the three factor scores of BPRS: lack of vitality, activation and hostile suspicionSignificance。It suggests that insight is related to other mental symptoms.
(3) Self knowledge and efficacycorrelation analysis, there is a significant difference between the twopositive correlation。Visible insight level andMental symptomsThere is a good consistency between the severity, which can be used as a reliable indicator to evaluate the condition and judge the efficacy.
Evaluation of ITAQ
Insight
Liu Huaqing and others took ITAQ and medicineComplianceThe evaluation criteria ofvaliditydetermination;And to the first roundSchizophreniaPatients were assessed on BPRS, ITAQ and medication compliance to understand the relationship between the three.The ITAQ consists of 11 items, which mainly evaluate the schizophrenic patients' understanding of the disease and their attitude to taking medicine. Each item is divided into three levels according to the completeness of the answers to the questions. The patients also have to answer two questions for each item, that is, the patients' general views on each question and give further explanation to each question.They compared 34 casesSchizophreniaThe patient has carried out self insight andmental diseaseAssessment of the relationship between physical symptoms.The data showed that the level of insight of first-episode schizophrenic patients was not closely related to the severity of psychopathological symptoms. In hospitalized schizophrenic patients, the change of insight did not change with the change of psychopathological symptoms.From the use process of the scale, it can reflect the patient'sMental illnessAnd treatment needs.For clinical psychiatry, ITAQ is a valuable test tool for insight of schizophrenic patients.Hu RenminIn order to understand the effect of insight education on restoring insight of schizophrenic patients, 95 schizophrenics were randomly divided into drug group and insight education combined with drug treatment group. BPRS and ITAQ were measured at admission and discharge respectively.The results suggest that insight education is recoverySchizophreniaEffective methods of patient insight.The results also showed that there was no significant correlation between ITAQ and BPRS scores.It shows that the change of insight of schizophrenic patients does not change with the change of mental symptoms, which is consistent with the research results of Liu Huaqing and others.
The relationship between insight profile and clinical practice
Jin Jiqing studied the relationship between three different aspects of insight and clinical practice, including: (1) the necessity of treatment;(2) Knowmental disease；(3) The ability to distinguish between hallucinations and delusions.Clinical indicators include:Mental symptomsObjective severity, own subjective abnormal experience, treatment environment (inpatient or outpatient treatment).The results show that,positiveThe severity of mental symptoms was negatively correlated with the patients' recognition of psychosis and their discrimination of hallucinations and delusions, but not with the necessity of treatment.There was no correlation between negative mental symptoms, patients' own subjective abnormal experience and the three aspects of insight.The age of first onset was positively correlated with the patient's discrimination of hallucinations and delusions, and the treatment environment was significantly correlated with the patient's understanding of the need for treatment.
Assessment of SAUMD
Insight
SAUMD has 20 questions in total, the first three areMental disordersThe understanding of drug therapy and the social consequences caused by mental disorders, including current and past two aspects;The remaining 17 items were used to evaluate the patients' understanding of current symptoms, past symptoms, current symptoms attribution and past symptoms attribution respectively, which constituted four subscales.The scoring range is 1-5 points, and high scores suggest poor understanding and attribution.Li Yiyun et al. used this table to analyze 111 hospitalized patientsSchizophreniaPatients were assessed for insight before and after treatment.
The results show that:
(1) There was significant difference in the score of SAUMD before and after treatment, mainly in the difference of symptom score, especially the change of symptom score at present was obvious, while the change of attribution score before and after treatment was not significant;
(3) There was no significant difference between the patients with chronic schizophrenia before and after treatment, suggesting that the insight of chronic schizophrenia was not significantly improved during short-term treatment.
influence factor
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Insight
Self knowledge is a concept widely used in clinical psychiatrySchizophreniaAn important part of the inspection.The complete insight of patients should include: recognizing their own disease, knowing exactly the nature and symptoms of the disease, analyzing and criticizing the causes and symptoms of the disease, seeking urgent treatment, and having reasonable plans for work and life after the disease is cured.In the process of insight assessment, factors such as test tools, study sample size, treatment environment and patient education level all affect the research results.
1. The impact of test tools and research samples on the assessment of insight: some scholars began toObstacle of insightThe degree is quantified, and some quantitative grades are drawn between "lack of insight" and "perfect insight". These methods can be used to evaluate insight more simply and superficially in clinical practice.Although the quantitative level of insight has some clinical significance, its quantitative degree is not high（Semiquantitative）The application in scientific research is limited;Some grades are too many or poorly defined, and there is no progressive relationship between grades, which makes it difficult for clinicians to make accurate classification.Therefore, some scholars began to create a scale of self-knowledge to improve the assessment of self-knowledge.Previous research and clinical practice habits all believe that the disappearance of psychopathological symptoms can easily improve insight.But in applicationITAQIt was found that the disappearance of psychopathological symptoms was not consistent with the improvement of insight.This may be because the number of research samples is too small to show the true situation of both;It may also be that the insight test tool we use fails to fully and truly reflect the patient's insight level. If the patient admits that he or she is mentally ill, it would be easier to let the patient tell that he or she is not the same as before.Because patients who have recovered their insight well may be mixed with many psychological and other factors mentioned above in the assessment process due to their worries about their future, work and future social environment discrimination, which affects the acquisition of the true level of insight.
2. Influence of treatment environment on insight assessment: treatment environment (hospitalization orOutpatient treatment）It is significantly related to the patients' understanding of the necessity of treatment.Lack of insightThe natural abscission of patients and the outpatient treatment environment are conducive to the establishment and recovery of insight, which may be the reason for the above results.acuteSchizophreniaEven if patients deny being ill, they do not completely refuse treatment, and 85% of chronic schizophrenics are admitted to hospital voluntarily, admit that they are ill and willing to receive treatment.The reason may be related to the patientHypovolemia, lack of assertiveness.
3. The influence of cultural level on the assessment of insight: The ability to correctly assess the type and severity of disease depends on intelligence and cultural level.Patients with "intelligent insight" have a high level of education, despite their existenceMental symptoms, but can still describe their own morbid state according to their previous illness experience,Obstacle of insightLight performance.Although the patients with low educational level have mild mental symptoms, they have difficulty in expressing and analyzing the pathological experience, which leads to severe insight disorder.For some patients whose intelligence is lower than normal, the lack of self-awareness is regarded as the loss of personality rather thanLack of insightIs more appropriate.Xu YouxinIt is believed that there are two kinds of insight: symptom insight and personality insight.Symptomatic insight（Mental disordersSelf knowledge) is not just about whether there is a problem or not. Patients often have multiple symptoms, and their self knowledge can be different.Even for a single symptom, because the symptom is multi-dimensional, complex in structure and rich in content, the insight is not engraved on a linear scale.Some typical symptoms themselves contain a lack of insight, such as hallucinations, delusions, etc.Some typical symptoms themselves contain insight, such as the insight of various neurosis patients.SchizophreniaThe patient's insight is as colorful and changeable as the symptoms of schizophrenia, which indicates its complexity.Therefore, the assessment of insight in schizophrenia needs to develop a perfect standard assessment method in our country to eliminate the influencing factors as far as possible, so as to improve its clinical value.
