Schizophrenia Research Trends

The Association of Verbal Learning Deficits with Unawareness of Mental Disorder 175Table 5. Significant Predictors of Improvement in SUMD General Items afterPsychological Intervention (n=26)Dependent variable Independent variables B SE Wald p (df=1) RImprovement of Constant 5.29 4.29 1.52 .217awareness of current Phase of treatment 3.80 1.73 4.81 .028 .28illnessLearning potential .81 .40 4.11 .043 .25Illness duration -.55 .31 3.20 .074 -.19Improvement of Constant 2.52 1.53 2.71 .10awareness of past Immediate recall -.29 .12 5.35 .02 -.31illness Learning potential .41 .25 2.70 .10 .14DiscussionBoth applied interventions improved patients' awareness of the illness. The influence wasmore prevalent in the psychoeducational group than in the cognitive training group.However, it must be noted that in the cognitive training group the sample size was smaller(n=14) than in psychoeducational group (n=19) and some comparable improvementsappeared not large enough to reach significance. It is possible that patients improved theirinsight scores not due to a change in their attitudes and beliefs about illness but ratherbecause they became more skilled in verbalizing and explaining their illness. However, webelieve that this change in patients' knowledge about mental illness is also a valuabletreatment effect which may contribute to improvements in patients' compliance or quality oflife. Our Study 2 lacked a group without any intervention, therefore it cannot be excludedthat improvement in insight was due to a spontaneous change, however this possibility seemsto be very improbable in chronic, clinically stable outpatients.The first logistic regression analysis showed that the improvement in awareness ofcurrent illness was more probable after participation in the second intervention and forpatients with higher learning potential, and shorter illness duration. The second analysisshowed that an improvement in awareness of past illness was predicted by higher learningpotential and worse immediate recall. Both analyses suggested that it was not important whatkind of intervention (psychoeducation vs. cognitive training) the patient received, the positiveand negative symptom severity also had no significant predictive value. These results ofmultiple-regression analyses we consider only preliminary because of inadequate sample size.However, they support our hypothesis that learning potential may be an important predictorof patients' ability to improve their insight after participation in psychological intervention.These results have some clinical implications. They suggest that poor learning potential,but not poor ability to retrieve information, may be a rate-limiting factor for interventionsaimed at insight improvement. This finding is consistent with results of Wiedl's [1999] study,which have shown that cognitive modifiability is an important predictor of readiness forrehabilitation. Moreover, it seems that various forms of rehabilitation may lead toimprovements in insight. Our study showed that psychoeducation and, to a lesser degree,cognitive training improve patients' awareness of illness, while Lysaker and Bell [1995] have