Şizofreni Hastalarında Öznel İyileşme İle Bilişsel İçgörü Arasındaki İlişkinin Araştırılması

Year 2018, , 1 - 4, 31.01.2018

Kübra İpçi , Aysel İncedere , Fatma Kiras Mustafa Yıldız

https://doi.org/10.30934/kusbed.337808

Cited By: 5

Abstract

Amaç: Çalışmamızda şizofreni hastalarının öznel iyileşme duygularının klinik şiddet ve bilişsel içgörü ile ilişkisini incelemek amaçlanmıştır.

Yöntem: DSM-5 tanı ölçütlerine göre şizofreni ve şizoaffektif bozukluk tanısı alan ve sürdürüm tedavisi devam eden 151 hasta çalışmaya dahil edildi. Hastalar araştırmacılar tarafından hazırlanan sosyodemografik ve klinik veri formu, Pozitif ve Negatif Sendrom Ölçeği, Klinik Global İzlenim, İşlevselliğin Genel Değerlendirmesi, Öznel İyileşmeyi Değerlendirme Ölçeği ve Beck Bilişsel İçgörü Ölçeği ile değerlendirildi.

Bulgular: Çalışmaya katılan 151 hastanın yaş ortalaması 37.2, ortalama eğitim süresi 10.4 yıl ve ortalama hastalık süresi 14.2 yıl idi. Grubun %77’sini erkekler oluşturmakta, %71’i bekâr, %68’i ailesi ile birlikte yaşamakta ve %62’si herhangi bir işte çalışmamakta idi. Çalışmamızda öznel iyileşme duygusu klinik durum ve bilişsel içgörü ile ilişkili bulundu.

Sonuç: Bu çalışmanın bulguları öznel iyileşme duygusunun klinik durum ve bilişsel içgörü düzeyinden etkilendiğini göstermektedir. İyileştirim çalışmalarında başetme becerileri, umut, özgüven ve bilişsel içgörü geliştirmeye yönelik girişimlere yer verilmesinin hastaların öznel iyileşme duygularının artmasına yardımcı olacağı düşünülmektedir.

Keywords

Şizofreni, öznel iyileştirme, bilişsel içgörü

Examination Of The Relationship Between Subjective Recovery And Cognitive Insight In Patients With Schizophrenia

Abstract

Objective: The aim of this study was to examine the relationship between subjective feeling of recovery, clinical severity and cognitive insight of the patients with schizophrenia.

Methods: One hundred and fifty one patients who were diagnosed with schizophrenia or schizoaffective disorder according to DSM-5 diagnostic criteria and receiving maintenance treatment were included in this study. Patients were evaluated with Positive and Negative Syndrome Scale, Clinical Global Impression, Global Assessment of Functioning, Subjective Recovery Assessment Scale, Beck Cognitive Insight Scale and a sociodemographic and clinical data form prepared by the researchers.

Results: Mean age of the patients participated in the study was 37.2, average level of education was 10.4 years, and mean duration of illness was 14.2 years. Seventhy seven percent of the participants were males, 71% were single, 68% were living with family and 62% were unemployed. Subjective feeling of recovery was found to be associated with clinical condition and cognitive insight.

Conclusion: The results of this study shows that subjective feeling of recovery is affected by clinical condition and cognitive insight. It is suggested that inclusion of interventions to improve coping abilities, hope, self-confidence, and cognitive insight in rehabilitation programs would be beneficial for the patients in terms of improving their subjective feeling of recovery.

Keywords

Schizophrenia, subjective recovery, cognitive insight

References

• Zipursky RB, Reilly TJ, Murray RM. The myth of schizophrenia as a progressive brain disease. Schizophr Bull. 2013; 39(6):1363–1372.
• Liberman RP. Recovery from disability. Manual of Psychiatric Rehabilitation. American Psychiatric Publishing Inc. Washington. 2008.
• Tsuang D, Coryell W. An 8-year follow-up of patients with DSM-III-R psychotic depression, schizoaffective disorder, and schizophrenia. Am J Psychiatr. 1993; 150:1182-8.
• Rosen K, Garety P. Predicting recovery from schizophrenia: A retrospective comparison of characteristics at onset of people with single and multiple episodes. Schizophr Bull. 2005; 31:735-50.
• Leucht S, Lasser R. The concepts of remission and recovery in schizophrenia. Pharmacopsychiatry 2006; 39:161-70.
• San L, Ciudad A, Alvarez E et al. Symptomatic remission and social/vocational functioning in outpatients with schizophrenia: prevalence and associations in a cross-sectional study. Eur Psychiatr. 2007; 22:490-98.
• Schrank B, Slade M. Recovery in psychiatry. Psychiatr Bull. 2007; 31: 321-325.
• Beck AT, Baruch E, Balter JM et al. A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophr Res. 2004; 68(2–3):319–329.
• Burton CZ, Vella L. Clinical and cognitive insight in a compensatory cognitive training intervention. Am J Psychiatr Rehabil. 2011; 14:307–326.
• David AS, Bedford N, Wiffen B et al. Failures of metacognition and lack of insight in neuropsychiatric disorders. Philos Trans R Soc Lond B Biol Sci. 2012; 367(1594):1379–1390.
• Lincoln TM, Lullmann E, Rief W. Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophr Bull. 2007; 33(6):1324–1342.
• Mohamed S, Rosenheck R, McEvoy J et al. Crosssectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia. Schizophr Bull. 2009; 35(2):336–346.
• Barrett EA, Sundet K, Faerden A et al. Suicidality in first episode psychosis is associated with insight and negative beliefs about psychosis. Schizophr Res. 2010; 123(2–3):257–262.
• Cooke MA, Peters ER, Greenwood KE et al. Insight in psychosis: Influence of cognitive ability and self-esteem. Br J Psychiatry. 2007; 191:234–237.
• Drake RJ, Pickles A, Bentall RP et al. The evolution of insight, paranoia and depression during early schizophrenia. Psychol Medic. 2004; 34(2):285–292.
• Hasson-Ohayon I, Kravetz S, Meir T et al. Insight into severe mental illness, hope, and quality of life of persons with schizophrenia and schizoaffective disorders. Psychiatr Res. 2009; 167(3):231–238.
• Lysaker PH, Roe D, Yanos PT. Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and selfesteem among people with schizophrenia spectrum disorders. Schizophr Bull. 2007; 33(1):192–199.
• Valiente C, Provencio M, Espinosa R et al. Predictors of subjective well-being in patients with paranoid symptoms: is insight necessarily advantageous? Psychiatr Res. 2011; 189(2):190–194.
• Fıstıkçı N, Keyvan A, Cesur E. Psikiyatrik hastalıklarda içgörü kavramı: bir gözden geçirme. Yeni Symposium. 2016; 54(2):25-29.
• Kay SR, Fiszbein A, Opler La et al. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987; 13:261-76.
• Kostakoğlu AE, Batur S, Tiryaki A ve diğ. Pozitif ve negative sendrom ölçeğinin (PANSS) Türkçe uyarlamasının geçerlilik ve güvenilirliği. Türk Psikoloji Derg. 1999; 14:23-34.
• Guy W. ECDEU Assessment Manual for Psychopharmacology. US Department of Health and Human Services Publication. Rockville. 1976.
• Luborsky L. Clinicians' judgments of mental health. Arch Gen Psychiatr. 1962; 7:407-417.
• Aslan S, Türkçapar H, Güney E ve diğ. Beck bilişsel içgörü ölçeği Türkçe formunun şizofrenik hastalar için güvenilirlik ve geçerlik çalışması. Klinik Psikiyatri Derg. 2005; 8:186-196.
• Yıldız M, Erim R, Soygür H ve diğ. Development of the subjective recovery scale for the patients with schizophrenia. Npj Schizophrenia. 2016; 2. Article number: 16008; doi:10.1038/ npjschz.2016.8
• Chino B, Nemoto T, Fuji C et al. Subjective assessments of the quality of life, well-being and self-efficacy in patients with schizophrenia. Psych and Clin Neuroscie. 2009; 63:521–528
• Roe D, Mashiach-Eizenberg M, Lysaker PH. The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders. Schizophr Res. 2011; 131:133–138.
• Jørgensen R, Zoffmann V, Munk-Jørgensen P et al. Relationships over time of subjective and objective elements of recovery in persons with schizophrenia. Psychiatr Res. 2015; 228:14–19.
• Phalen PL, Viswanadhan K, Lysaker PH et al. The relationship between cognitive insight and quality of life in schizophrenia spectrum disorders: Symptom severity as potential moderator. Psychiatr Res. 2015; 230:839–845.
• Lien YJ, Chang HA, Yu Chen Kao YC et al. The impact of cognitive insight, self stigma, and medication compliance on the quality of life in patients with schizophrenia. Eur Arch Psychiatr Clin Neurosci. 2017; DOI 10.1007/s00406-017-0829-3.
• De Vos AE, Pijnenborg GH, Aleman A et al. Implicit and explicit self-related processing in relation to insight in patients with schizophrenia. Cogn Neuropsychiatry. 2015; 20(4):311–329.