Persistent negative symptoms (PNS) are an important factor of first episode of psychosis (FEP) that present early on in the course of illness and have a major impact on long-term functional outcome. Lack of clinical insight is consistently associated with negative symptoms during the course of schizophrenia, yet only a few studies have explored its evolution in FEP. We sought to explore clinical insight change over a 24-month time period in relation to PNS in a large sample of FEP patients. Clinical insight was assessed in 515 FEP patients using the Scale to assess Unawareness of Mental Disorder. Data on awareness of illness, belief in response to medication, and belief in need for medication were analyzed. Patients were divided into 3 groups based on the presence of negative symptoms: idiopathic (PNS; n = 135), secondary (sPNS; n = 98), or absence (non-PNS; n = 282). Secondary PNS were those with PNS but also had clinically relevant levels of positive, depressive, or extrapyramidal symptoms. Our results revealed that insight improved during the first 2 months for all groups. Patients with PNS and sPNS displayed poorer insight across the 24-month period compared to the non-PNS group, but these 2 groups did not significantly differ. This large longitudinal study supported the strong relationship known to exist between poor insight and negative symptoms early in the course of the disorder and probes into potential factors that transcend the distinction between idiopathic and secondary negative symptoms.

中文翻译：

---

精神病首发中洞察力与持续负面症状之间的动态相互作用：一项纵向研究

持续性阴性症状 (PNS) 是首发精神病 (FEP) 的一个重要因素，它在疾病过程的早期出现并对长期功能结果产生重大影响。缺乏临床洞察力始终与精神分裂症过程中的阴性症状相关，但只有少数研究探讨了其在 FEP 中的演变。我们试图在大量 FEP 患者中探索与 PNS 相关的 24 个月期间的临床洞察力变化。使用量表评估了 515 名 FEP 患者的临床洞察力，以评估对精神障碍的无意识。对疾病意识、对药物反应的信念和对药物需求的信念的数据进行了分析。根据阴性症状的存在将患者分为 3 组：特发性（PNS；n = 135）、继发性（sPNS；n = 98）、或缺席（非 PNS；n = 282）。继发性 PNS 是那些患有 PNS 但也具有临床相关水平的阳性、抑郁或锥体外系症状的患者。我们的结果显示，在前 2 个月内，所有组的洞察力都有所改善。与非 PNS 组相比，PNS 和 sPNS 患者在 24 个月期间的洞察力较差，但这两组没有显着差异。这项大型纵向研究支持了已知在疾病早期洞察力差和阴性症状之间存在的密切关系，并探讨了超越特发性和继发性阴性症状之间区别的潜在因素。我们的结果显示，在前 2 个月内，所有组的洞察力都有所改善。与非 PNS 组相比，PNS 和 sPNS 患者在 24 个月期间的洞察力较差，但这两组没有显着差异。这项大型纵向研究支持了已知在疾病早期洞察力差和阴性症状之间存在的密切关系，并探讨了超越特发性和继发性阴性症状之间区别的潜在因素。我们的结果显示，在前 2 个月内，所有组的洞察力都有所改善。与非 PNS 组相比，PNS 和 sPNS 患者在 24 个月期间的洞察力较差，但这两组没有显着差异。这项大型纵向研究支持了已知在疾病早期洞察力差和阴性症状之间存在的密切关系，并探讨了超越特发性和继发性阴性症状之间区别的潜在因素。