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Is Living With Psychosis Demoralizing?: Insight, Self-stigma, and Clinical Outcome Among People With Schizophrenia Across 1 Year
Open accessAbstract
Lack of insight is a major target in the treatment of schizophrenia. However, insight may have undesirable effects on self-concept and motivation that can hinder recovery. This study aimed to examine the link between insight, self-stigma, and demoralization as predictors of symptoms and functioning. Insight, self-stigma, depressive and psychotic symptoms, and functioning were assessed among 133 outpatients with schizophrenia at baseline and 12 months later. The data were analyzed by hierarchical multiple linear regressions. More insight at baseline and an increase in self-stigma over 12 months predicted more demoralization at follow-up. Insight at baseline was not associated with any outcome variable, but self-stigma at baseline was related to poorer functioning and more positive symptoms at follow-up. More demoralization at baseline predicted poorer functioning 12 months later. Demoralization did not mediate the relationship between self-stigma at baseline and functioning after 1 year. Given the decisive role of self-stigma regarding recovery from schizophrenia, dysfunctional beliefs related to illness and the self should be addressed in treatment. Different psychotherapeutical approaches are discussed.
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“Studying interpersonal elements of treatment, Lincoln et al 37 reported that lack of insight predicted drop out from cognitive behavior therapy in patients with psychosis.”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [39]
In the citing paper
“Examining this relationship over time, research has also suggested that insight may cause depression.Evidence of this includes findings that good insight prospectively predicted higher levels of demoralization and that increased depressive symptoms were linked to improvements in insight in both first-episode psychosis and acute schizophrenia 39,56 .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [39]
In the citing paper
“As reviewed above, stigma may result in insight leading to despair, and individuals may consider a meaningful life no longer a viable possibility 39,81 .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [39]
In the citing paper
“As reviewed above, stigma may result in insight leading to despair, and individuals may consider a meaningful life no longer a viable possibility 39,81 .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [39]
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Metadata
- Authors
- Cavelti, M., Rüsch, N., & Vauth, R.
- Affiliations
- Universität Ulm (DE)
- Corresponding author
- Cavelti, Marialuisa
- Venue
- Journal of Nervous & Mental Disease
- Published
- 2014-07
- Volume
- 202
- Issue
- 7
- Pages
- 521-529
- ISSN
- 0022-3018 (ISSN-L)
- OpenAlex
- W2029059351
- Cited by
- 60
- References
- 58
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 1 · 2023: 5 · 2022: 5 · 2021: 1 · 2020: 6 · 2019: 4 · 2018: 9 · 2017: 7 · 2016: 9 · 2015: 5
- FWCI
- 5.35
- Type
- journal article
- Language
- en
- Open access
- green
- boris.unibe.ch
- Licence
- other-oa
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion, other-oa)
- Open Access CRIS of the University of Bern
- Funders
- National Science Foundation
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (120673)
- 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 › Mental Health Treatment and Access
- Keywords
- schizophrenia, insight, self-stigma, demoralization, self-concept, motivation, functioning, depressive symptoms, psychotic symptoms, recovery, psychotherapy
- MeSH terms
- Adult, Depression, Female, Follow-Up Studies, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Morale, Predictive Value of Tests, Psychiatric Status Rating Scales, Psychotic Disorders, Schizophrenia, Schizophrenic Psychology, Self Concept, Time Factors, Social Stigma, Patient Outcome Assessment
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