Improved insight affects social outcomes in involuntarily committed psychotic patients: A longitudinal study in the Netherlands

Background Lack of insight in schizophrenia is associated with negative social outcomes mediated by symptom severity, but longitudinal studies show contradicting findings. Method After commencement of court-ordered admission, adult patients were enrolled in a prospective study. A relatively homogeneous group of 133 patients with schizophrenia or related psychotic disorders was selected to evaluate the impact of illness insight and symptom severity on social outcomes. Interviews at baseline and after 6 and 12 months included objective and subjective indicators of insight and social outcomes. Multilevel analyses were used to estimate the effect of insight and change in social outcomes controlling for symptom severity. Results In 12-month follow-up, patients involuntarily hospitalized showed improvement in illness insight, symptom level, and social functioning, and had stable quality of life scores. Illness insight was associated with change in outcomes, independent from symptom severity. Results of the change analyses suggest that in time the association between insight and functioning becomes stronger. In contrast, insight scores were negatively associated with self-report quality of life ratings and markedly ill patients had a more negative perception of their quality of life. Conclusions Improvement in illness insight was associated with improvement in social functioning, but this was not reflected in improved self-perceived quality of life. Illness insight could result in worrying about relationships, living situation, health and finances. For severely mentally ill patients additional strategies must be found to improve social outcomes. Researchers should be more aware of varying effects for researcher-rated versus self-report indicators of insight and social outcome.

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