Insight into illness in patients and caregivers during early psychosis: a pilot study

Background: Impaired insight into illness is common during early psychosis and has been associated with treatment delays and poorer long-term outcomes. The relationship between patients' insight into illness and their caregivers' knowledge about psychosis is putatively associated with treatment outcome but there is limited research about this. This pilot study was designed to test the hypothesis that caregivers' levels of insight into illness is associated with patients' insight into illness in early psychosis and would be related to caregivers' levels of critical, rejecting attitudes toward patients.

Methods: Patients with schizophrenia or schizoaffective disorder within 5 years of psychosis onset (n=14) and caregivers (n=14) of the patients' choosing were studied. Insight into illness was assessed in patients using the Scale to assess Unawareness of Mental Disorder (SUMD). Caregiver insight into illness was assessed with a modified version of the SUMD with questions rephrased to probe caregivers' understanding of the patients' illness. Caregivers' critical attitudes toward patients were assessed with the Patient Rejection Scale (PRS).

Results: Significant correlations were found between patients' and caregivers' awareness of need for treatment (r=.55, p=.02), awareness of symptoms (r=.48, p=.04) and between caregivers' awareness of illness and critical attitudes toward patients (r=.65, p=.01).

Conclusions: These findings suggest that caregivers' emotional characteristics and levels of insight into illness may be related to insight into illness in patients. Implications for family psychoeducational approaches to impairments of insight into illness during early psychosis are discussed.