An article from TrygFonden
New method helps schizophrenics become self-aware
New treatment helps schizophrenia patients deal with their everyday experiences, and might result in long-term behavioural change.
Many people who suffer from schizophrenia find it difficult to accept that they are ill.
Up to three quarters of them are estimated to have a poor understanding of their illness and this lack of insight often inhibits effective treatments, and in severe cases causes the patient to resist treatment all together.
Traditionally, doctors have focused on convincing patients that they are ill and need treatment. But unfortunately, neither therapy nor medical treatment has proved particularly effective at increasing their insight into their own illness.
Now a group of researchers, funded by TrygFonden, have tested a new method that develops patients' ability to understand and respond to the impact that the disease has on their daily lives.
The researchers intend to improve the patients’ cognitive insight by helping them to reflect on their own personal experiences and to view it from multiple perspectives. It can gradually improve their ability to see the consequences of the disease and ultimately get them to change their problematic behaviour.
No scientific evidence it works
Feedback from therapists and patients is positive, but actual scientific proof of the method’s efficacy has so far been elusive.
"The feedback indicates that the program has made a difference,” says co-author Rikke Jørgensen, from Aalborg University Hospital, Denmark.
“Patients and nurses working on the project told us that patients have become more reflective. And patients have even been able to change their behaviour after the procedure," she says.
But the results of a randomized trial, where only one of two groups of patients followed the treatment, are inconclusive. The results changed, depending on when they tested the patients.
Patients’ cognitive insight improved immediately after the test. But when Jørgensen followed up six months later, this positive effect had apparently disappeared.
Needs a new assessment tool
Jørgensen does not have a definitive explanation as to why the positive feedback from therapists and patients is not reflected in the final assessment.
"Colleagues in the Netherlands have worked with a similar scenario, and their data show the same trend: They see the effect immediately after the course ends, but it's gone in the follow-up," says Jørgensen.
She used the Beck Cognitive Insight Scale (BCIS), an assessment tool to measure patients' cognitive insight.
Now, she has teamed up with colleagues in the Netherlands to understand why this tool may not work in this situation.
"As an example, the tool asks patients whether they agree with the statement 'I have drawn hasty conclusions', because the assumption behind the [tool] is that people with a psychotic disorder tend to jump to conclusions,” says Jørgensen.
“The patients will answer no, because they themselves are not able to see it, and it’ll then indicate that they have poor cognitive insight," says Jørgensen.
But this may not mean that they have slipped back into their old ways. It could reflect a genuine, long lasting change in behaviour, which the BCIS tool was incapable of identifying.
"If the course gives them a better cognitive insight, then immediately after the course they will say yes, because they now have a better understanding of themselves and the consequences of the disease, and it may cause them to change inappropriate behaviour,” she says.
“When we then ask them six months later, they might again answer no, but it’s not just because they’ve started to jump to conclusions again. Rather, their behaviour has now changed, and the [BCIS] tool doesn’t identify this change in behaviour."
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Read the Danish version of this story on Videnskab.dk
Translated by: Catherine Jex
