The evolution of insight, paranoia and depression during early schizophrenia
Abstract
BACKGROUND: How insight, paranoia and depression evolve in relation to each other during and after the first episode of schizophrenia is poorly understood but of clinical importance. METHOD: Serial assessments over 18 months were made using multiple instruments in a consecutive sample of 257 patients with first episode DSM-IV non-affective psychosis. Repeated measures of paranoia, insight, depression and self-esteem were analysed using structural equation modelling, to examine the direction of relationships over time after controlling for confounds. RESULTS: Depression was predicted directly by greater insight, particularly at baseline, and by greater paranoia at every stage of follow-up. Neither relationship was mediated by self-esteem, although there was a weak association of lower self-esteem with greater depression and better insight. Paranoia was not strongly associated with insight. Duration of untreated psychosis and substance use at baseline predicted depression at 18 months. CONCLUSIONS: In first-episode psychosis, good insight predicts depression. Subsequently, paranoia is the strongest predictor. Neither effect is mediated by low self-esteem. Effective treatment of positive symptoms is important in preventing and treating low mood in early schizophrenia.
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Depression has been associated with longer duration of untreated psychosis.
“longer duration of untreated psychosis (Drake et al., 2003)”
From A parallel group randomised open blinded evaluation of A cceptance and Commitment Therapy for d epression a fter p sychosis: Pilot t rial outcomes (ADAPT) (2017) · cites this paper as Drake et al., 2003
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- Authors
- DRAKE, R. J., PICKLES, A., BENTALL, R. P., KINDERMAN, P., HADDOCK, G., TARRIER, N., & LEWIS, S. W.
- Affiliations
- University of Manchester (GB)
- University of Liverpool (GB)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2004-01-28
- Volume
- 34
- Issue
- 2
- Pages
- 285-292
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2056061093
- Cited by
- 204
- References
- 15
- Citations by year
- 2025: 1 · 2023: 3 · 2022: 5 · 2021: 6 · 2020: 4 · 2019: 7 · 2018: 8 · 2017: 5 · 2016: 7 · 2015: 10 · 2014: 18 · 2013: 12 · 2012: 19
- FWCI
- 8.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- schizophrenia, first-episode psychosis, insight, paranoia, depression, self-esteem, duration of untreated psychosis, substance use, depressive mood
- MeSH terms
- Adult, Awareness, Depression, Female, Humans, Male, Paranoid Disorders, Predictive Value of Tests, Surveys and Questionnaires, Schizophrenia, Self Concept, Severity of Illness Index, Comorbidity, Incidence, Diagnostic and Statistical Manual of Mental Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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