Background and Hypothesis Impaired insight into one’s illness is common in first episode psychosis (FEP), is associated with worse symptoms and functioning, and predicts a worse course of illness. Despite its importance, little research has examined the effects of early intervention services (EIS) on insight. Designs This paper evaluated the impact of EIS (NAVIGATE) on insight compared to usual community care (CC) in a large cluster randomized controlled trial. Assessments were conducted at baseline and every 6 months for 2 years. Results A multilevel regression model including all time points showed a significant time by treatment group interaction (P < .001), reflecting greater improvement in insight for NAVIGATE than CC participants. Impaired insight was related to less severe depression but worse other symptoms and functioning at baseline for the total sample. At 6 months, the same pattern was found within each group except insight was no longer associated with depression among NAVIGATE participants. Impaired insight was more strongly associated with worse interpersonal relationships at 6 months in NAVIGATE than in CC, and changes in insight from baseline to 6 months were more strongly correlated with changes in relationships in NAVIGATE than CC. Conclusions The NAVIGATE program improved insight significantly more than CC. Although greater awareness of illness has frequently been found to be associated with higher depression in schizophrenia, these findings suggest EIS programs can improve insight without worsening depression in FEP. The increased association between insight and social relationships in NAVIGATE suggests these 2 outcomes may synergistically interact to improve each other in treatment.

中文翻译：

---

早期干预服务对首发精神病患者洞察力影响的随机对照试验

背景和假设 对疾病的洞察力受损在首发精神病 (FEP) 中很常见，与更糟糕的症状和功能相关，并预示着更糟糕的病程。尽管它很重要，但很少有研究检查早期干预服务 (EIS) 对洞察力的影响。设计 本文在一项大型整群随机对照试验中评估了 EIS (NAVIGATE) 与常规社区护理 (CC) 相比对洞察力的影响。在基线和每 6 个月进行一次评估，为期 2 年。结果 包括所有时间点的多级回归模型显示治疗组交互时间显着（P < .001），反映 NAVIGATE 的洞察力比 CC 参与者有更大的改善。洞察力受损与不太严重的抑郁症有关，但总体样本的基线时其他症状和功能更差。在 6 个月时，除了洞察力不再与 NAVIGATE 参与者的抑郁症相关之外，每组中都发现了相同的模式。与 CC 相比，在 NAVIGATE 中，洞察力受损与 6 个月时的人际关系更差，并且从基线到 6 个月的洞察力变化与 NAVIGATE 中人际关系的变化比 CC 更密切相关。结论 NAVIGATE 程序比 CC 更能提高洞察力。尽管经常发现对疾病的更高认识与精神分裂症患者的抑郁程度较高有关，但这些研究结果表明，EIS 计划可以在不加重 FEP 抑郁症的情况下提高洞察力。