Ανοσογνωσία στη σχιζοφρένεια
Βρηκα αυτο το αρθρο:
http://www.ncbi.nlm.nih.gov/pubmed/19081457
Δυστυχως το ολο κειμενο θελει συνδρομη για να διαβαστει. Να αυτα που λεει στην περιληψη ομως:
INTRODUCTION: Schizophrenia is the psychiatric disorder in which the awareness of pathology (or insight) is most frequently altered.
LITERATURE FINDINGS: A review of the literature shows that between 50 and 80% of patients with schizophrenia do not believe they have a disorder. Studies published on this subject over the two last decades stressed the specificity of this phenomenon in schizophrenic patients, taking into account both its prevalence and its clinical consequences comparatively to other mental disorders. If in bipolar disorders a lack of insight is linked with the intensity and acuteness of symptomatology, there is only a limited relationship between these factors in schizophrenia, thus making lack of insight a trait rather than a state-related symptom.
DISCUSSION: Though defined for a very long time as a dichotomic phenomenon, the recent interest on insight in psychosis and the development of assessment tools for its evaluation have made it possible to underline its multifactorial and dynamic characteristics. Although lack of insight related to pathologies may vary across time in bipolar disorders, the results of clinical studies suggest that this phenomenon remains stable in schizophrenia. CONCEPTUAL PROPOSALS: In this review, we will reconsider the evolution of this concept in psychiatry and its definition. The clinical characteristics, which are specifically associated with the lack of insight in schizophrenia will be outlined. We will describe more specifically the model of Amador and Strauss and their assessment tool: the Scale to Assess Unawareness of Mental Disorder (SUMD). This model developed since the 1990s takes into account the time-related evolution of insight, and can be applied both to bipolar and psychotic disorders. ASSESSMENT TOOLS: The SUMD has six general items and four subscales. The general items estimate the three most widely used definitions of insight: awareness of having a mental disorder, awareness of the achieved effects of medication and awareness of the social consequences of having a mental disorder, and include assessment of both current and past-time periods. Four other subscales, each composed of 17 items, assess awareness and attribution of specific current and retrospective symptoms as well as deficits associated with severe mental disorders. Insight, thus, appears as a multidimensional and continuous phenomenon, since patients' awareness may apply only to part of their symptoms and vary over time. In this article, we will review existing scales assessing insight in schizophrenia. The deficiency of available scales validated in French limits the number of scientific publications concerning this important aspect of the clinical evaluation of schizophrenic patients. THERAPEUTICAL ASPECTS: Finally, interventions to improve insight in patients with schizophrenia are presented. Recent studies have shown cognitive behavioural therapy (CBT) to be of benefit in the treatment of poor insight in schizophrenia.
CONCLUSION: Evidence suggests that early diagnosis and treatment of schizophrenia leads to better prognosis. An important suggestion from theses studies may be that psychosocial therapy needs to focus on explanations that are in tune with the culture, rather than focus on diagnostic labels
Αναφερει στην αρχη οτι το ποσοστο αυτων που δε θεωρουν οτι πασχουν απο κατι (ανοσογνωσια), γεγονος που οδηγει σε κακη προγνωση της ασθενειας, ειναι 50-80%, αρκετα υψηλο.
Η ανοσογνωσια, παρεπιπτοντως, ειναι ενας απο τους κυριους λογους για τους οποιους οι σχιζοφρενεις αρνουνται να παρουν φαρμακα η τα διακοπτουν στη μεση της θεραπειας, οταν οι ιδιοι θεωρουν, προφανως εσφαλμενα, οτι εχουν γινει καλα, και οποτε ακολουθει υποτροπη. Ισως η ανοσογνωσια να ειναι, ετσι, ενας απο τους κυριους λογους για τα σχετικα υψηλα ποσοστα αυτων που παγιδευονται σε ενα φαυλο κυκλο υποτροπων και νεων υποτροπων, ειδικα μαλιστα αν λαβουμε υποψη τις στατιστικες για τα ποσοστα αυτων που κανουν υποτροπη σε μικρο χρονικο διαστημα, πχ μεσα σε 2 χρονια, απο ενα ψυχωσικο επεισοδιο. Καπου διαβαζα οτι αυτο μπορει να αγγιξει σε αυτους που δεν παιρνουν φαρμακα το 80%, αλλα δεν εχω προχειρη αυτη τη στιγμη τη σχετικη μελετη. Ετσι, τα φαρμακα αποτελουν και για στατιστικους λογους μονοδρομο για τους σχιζοφρενεις καταναλωτες, απο τη στιγμη που θα επιλεγουν ως λυση για τη θεραπεια τους (χωρις αυτο να μειωνει βεβαια και τη σημασια του συνδυασμου με ψυχοθεραπεια και δραστηριοτητες βελτιωσης των κοινωνικων δεξιοτητων).
