Hope, awareness of illness, and coping in schizophrenia spectrum disorders: Evidence of an interaction

Roudebush VA Medical Center, Indianapolis, Indiana 46202, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.81). 05/2005; 193(5):287-92. DOI: 10.1097/01.nmd.0000161689.96931.0f
Source: PubMed

ABSTRACT Controversy exists regarding whether awareness of schizophrenia is linked with healthier or poorer psychosocial function. This study examined whether hope might interact with insight to affect function at the level of active versus avoidant coping preferences among 96 persons with schizophrenia spectrum disorders. Factorial multivariate analysis of variance comparing groups classified on the basis of hope and insight scores revealed a significant interaction between hope and insight (Wilks lambda = 2.7; p< 0.05). Post hoc analyses indicated that persons with high insight and high hope demonstrated the most adaptive coping preferences, whereas those with high insight and lower hope demonstrated the least.

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Available from: Paul H Lysaker, Jun 08, 2015
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    • "For instance, Hasson-Ohayon et al. (2009) have found that hope increases the strength of association between insight and positive QoL. Lysaker et al. (2005) found that patients with high Psychiatry Research 189 (2011) 190–194 ⁎ Corresponding author at: School of Psychology, Campus de Somosaguas, 28223 Madrid, "
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    ABSTRACT: In schizophrenia, poor insight has been associated with negative outcome. In fact, some studies have found insight to be associated with greater treatment adherence and lower levels of symptomatology, as well as better psychosocial functioning. However, others have found that insight into illness is associated with an increase in depression, low self-esteem, and possibly higher risk of suicide. We investigated the relationship between insight and well-being in a sample of 40 people presenting paranoid symptoms and diagnosed with schizophrenia or other psychotic disorder. Independent-samples t-tests revealed that compared to a paranoid group with high insight, paranoid participants with low insight had more self-acceptance, higher sense of autonomy and personal growth, and greater orientation towards gratification. Moderation analyses showed that when experiential avoidance was high, insight into paranoia had a detrimental effect on self-acceptance. Overall, our results support the need to explore which psychological variables moderate insight in patients with persecutory beliefs. We discuss the implications of these results for the research of paranoia.
    Psychiatry Research 03/2011; 189(2):190-4. DOI:10.1016/j.psychres.2011.02.018 · 2.68 Impact Factor
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    • "Lysaker et al. (2006) argued that negative outcome of insight depends on the internalization of stigmatic beliefs, on the meaning that patients attach to their illness. While some patients believe that they no longer have the ability to achieve valued social roles, others disagree, remain hopeful and engage in active coping (Lysaker et al., 2005). A similar idea was published by Williams (2008) who based a description of postdiagnostic identities for patients with schizophrenia on two dimensions: (1) the amount of identification with the community of people with severe mental illness, and (2) the amount of stigma that is internalized in the self-narrative. "
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    ABSTRACT: Good insight into illness in patients with schizophrenia is related not only to medication compliance and high service engagement, but also to depression, low self-esteem, and low quality of life. The detrimental effects of insight pose a problem for treatment. To investigate whether the negative associations of good insight are moderated by perceived stigma. Respondents were 114 patients with schizophrenia spectrum disorders. We used Analyses of Variance (ANOVA) and Structural Equation Modeling (SEM) to test moderation. Good insight was associated with high service engagement and high compliance. Also, good insight was associated with depressed mood, low quality of life, and negative self-esteem. This association was strong when stigma was high and weak when stigma was low. SEM showed that the constrained model performed significantly worse than the unconstrained model, in which detrimental associations of insight were free to vary across stigma groups (chi(2)=19.082; df=3; p<.001). Our results suggest that the associations of insight with depression, low quality of life, and negative self-esteem are moderated by stigma. Patients with good insight who do not perceive much stigmatization seem to be best off across various outcome parameters. Those with poor insight have problems with service engagement and medication compliance. Patients with good insight accompanied by stigmatizing beliefs have the highest risk of experiencing low quality of life, negative self-esteem, and depressed mood. A clinical implication is that when it is attempted to increase insight, perceived stigma should also be addressed.
    Schizophrenia Research 08/2009; 115(2-3):363-9. DOI:10.1016/j.schres.2009.06.015 · 4.43 Impact Factor
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    • "However, alternative interpretations cannot be ruled out. Individuals with more adaptive coping become generally more hopeful, and thus, perhaps the combination of adaptive coping and insight leads to hope and not vice versa (Lysaker et al., 2005). There is clearly a need to understand hopelessness in schizophrenia more clearly. "
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    ABSTRACT: Risk factors for the development of hopelessness in schizophrenia remain poorly understood. This study investigated how psychiatric symptom levels and beliefs about illness might be linked to hopelessness in 100 patients with DSM-IV schizophrenia. Participants were assessed on the Beck Hopelessness Scale (BHS), the Calgary Depression Scale for Schizophrenia (CDSS), the Personal Beliefs about Illness Questionnaire (PBIQ), the Brief Psychiatric Rating Scale (BPRS), and the Scale for the Assessment of Negative Symptoms (SANS). Severe levels of hopelessness were found in 25% of the sample. There were significant differences between the hopeless and nonhopeless participants on the PBIQ subscales, SANS and BPRS. Differences on the PBIQ subscales remained significant when depression scores were controlled for. The total CDSS score, the "humiliating need to be marginalized" PBIQ subscale, and total BPRS score contributed significantly to a model accounting for 60% of the variance in hopelessness scores. Processes potentially implicated in the emergence of hopelessness in schizophrenia are discussed.
    The Journal of nervous and mental disease 01/2008; 195(12):968-75. DOI:10.1097/NMD.0b013e31815c1a1d · 1.81 Impact Factor
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