SYNOPSIS
Rajiv Gandhi University of Health Sciences, Karnataka
Bangalore
‘‘COMPARATIVE STUDY OF THE DEGREE OF INSIGHT IN
PATIENTS WITH SCHIZOPHRENIA AND BIPOLAR AFFECTIVE
DISORDER.’’
Name of the candidate
:
Dr. D. ARCHANAA
Guide
:
Dr. DENZIL A. PINTO
Course and Subject
:
M.D. (PSYCHIATRY)
Department of Psychiatry
Father Muller Medical College
Kankanady, Mangalore- 575002
AUGUST- 2011
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1
Name of the Candidate
Dr. D. ARCHANAA
And address
DEPARTMENT OF PSYCHIATRY
(In Block letters)
FATHER MULLER MEDICAL
COLLEGE , KANKANADY,
MANGALORE -575 002
2.
Name of Institution
FR. MULLER MEDICAL COLLEGE
KANKANADY,
MANGALORE – 575 002
3.
Course of study and Subject
M.D. PSYCHIATRY
4.
Date of admission to Course
31 – 05 – 2011
5.
TITLE OF THE TOPIC
‘‘COMPARATIVE STUDY OF THE DEGREE OF INSIGHT IN PATIENTS
WITH SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDER’’
1
6.
BRIEF RESUME OF THE INTENDED WORK :
6.1
NEED FOR STUDY:
Poor insight in psychosis has been described as a lack of awareness of
having an illness, of the deficits caused by the illness, the consequences
of the disorder, and the need for treatment .
Evidence suggests that poor insight is a manifestation of the illness itself,
rather than a coping strategy. It may be comparable to the lack of awareness of
neurological deficits seen in stroke, termed anosognosia.
This symptom predisposes the individual to noncompliance with
treatment and has been found to be predictive of an increased number of
involuntary hospital admissions, poorer psychosocial functioning, and a poorer
course of illness
Expecting insight from a psychiatrically ill person is asking for a great
deal but not the impossible . When a patient accepts mental illness of the past
he is said to have retrospective insight. There are various degrees of insight of
which the retrospective insight plays an integral part in the recovery process .
Assessment of insight, as well as its relationships with prognosis,
compliance, neuropsychological impairment and severity of psychopathology
in schizophrenia as well as mania have been studied. Different dimensions of
insight have been found to be related to different aspects of disease outcome.
The present investigator has come across only few published Indian
studies on insight and this study is being done to find correlation between
varying degree of insight and various sociodemographic and clinical
determinants in patients with schizophrenia and mania.
2
6.2
REVIEW OF LITERATURE :
Awareness of illness was assessed in 57 consecutively enrolled patients
with bipolar I or bipolar II disorder. These results suggest that a lower level of
awareness of illness was responsible for the social maladaptation and increase
in previous episodes of illness and mood alterations seen in patients with
bipolar II .1
A study was done on 173 patients with bipolar disorder – mania to
determine the clinical correlate of aggressive behaviour in manic patients.
Forty percent of patients displayed aggressive behaviour and lack of insight
was found to be one of the
predictors of aggressive behaviour in these
patients. The study also concluded that the severity of the psychopathology,
involuntary admissions and lack of insight appears to be related with the
severity of aggressive behaviour.2
A cross sectional study with a sample of 59 patients diagnosed to have
Schizophrenia with a mean duration of illness of 41.88 months found out that
the degree of insight was found to have significant positive association with
number of previous episodes of illness and treatment taken in the past.3
A
prospective,
longitudinal
cohort
study
on
insight
and
psychopathology in patients with schizophrenia for a period of one year
showed that improvement in the level of insight predicted good outcome and
patients with a longer duration of untreated psychosis were less likely to
achieve full remission. There was a significant inverse correlation between
degree of insight and psychopathology.4
A study of 334 patients with schizophrenia and duration of untreated
psychosis in relation to insight showed that patients with lower insight had a
longer duration of untreated psychosis and hence poor quality of life.5
3
6.3 OBJECTIVES OF THE STUDY :

To evaluate the degree of insight in patients with schizophrenia and
bipolar affective disorder current episode mania

To study the degree of insight in relation to sociodemographical
variables

To study the degree of insight in relation to clinical variables –duration
of illness, previous episodes, response to treatment and severity of
psychosis
7
MATERIALS AND METHODS :
7.1
Source of Data :
The study will be conducted in the department of psychiatry, Father
Muller Medical College, Kankanady, Mangalore from 2011-2014. All
inpatients admitted in the family psychiatry wards of the department of
psychiatry during the study period will constitute the study population.
7.2
Methods of Collection of data :
The study sample will consist of 2 groups. A consecutive method of
sampling with 30 consecutive patients who satisfied the ICD-10 DCR criteria
for schizophrenia will be compared with 30 consecutive patients who satisfied
the ICD-10 DCR criteria for bipolar affective disorder current episode mania.
Both groups must satisfy the inclusion and exclusion criteria.
INCLUSION CRITERIA :

Inpatients.

Male and female patients.
4

Age group between 18 to 65 years

Patients diagnosed with schizophrenia using ICD-1O DCR criteria

Patients diagnosed with bipolar affective disorder mania using ICD-1O
DCR criteria
EXCLUSION CRITERIA:

Patients with co- morbid medical or neurological disorders

Substance use ( except nicotine)

Schizoaffective disorder

Depressive episode
SCALES FOR ASSESSMENT :

Scale to assess unawareness of mental disorder

Brief psychiatric rating scale

Global assessment of functioning
TYPE OF THE STUDY :
This study is a observational analytical cross sectional clinical study.
Procedure : The study sample will consist of clinically diagnosed patients with
schizophrenia or bipolar affective disorder current episode mania obtained by
consecutive sampling. Study sample must meet the inclusion and exclusion
criterias. A written informed consent will be obtained from all patients. The
sociodemographic and clinical variables will be recorded in a specific proforma
prepared for the study.
The degree of insight , severity of psychotic symptoms and the quality
of life and level of functioning will be assessed in all patients belonging to both
5
the groups using the Scale to assess unawareness of mental disorder ,Brief
psychiatric rating scale and the Global assessment of functioning scales
respectively.
These scales will be applied twice to each patient in both groups once at
time of admission and then again on day of discharge. The treatment given to
the patients will not be interfered with during the study.
STATISTICS:
The results obtained will be analyzed using the following statistical
methods.
7.3

Chi-square test

Paired and unpaired ‘t’ test

Carl Pearson correlation coefficient
Does the study require any investigations or interventions to be
conducted on patients or the humans or animals ? If so, please describe
briefly.
– No –
7.4 Has ethical clearance been obtained from your institution in case of
7.3?
- Yes -
6
8.
LIST OF REFERENCES:
1. Pallanti S , Quercioli L, Pazzagli A, Rossi A, Dell’Osso L, Pini S, Cassano GB,
Awareness of Illness and Subjective Experience of Cognitive Complaints in
Patients With Bipolar I and Bipolar II Disorder, American Journal of Psychiatry
1999; 156:1094–1096.
2. Ortega IG, Mosquera F, Echeburúa E ,Pinto AG , Insight, psychosis and
aggressive behaviour in mania, European Journal of Psychiatry 2010; 24(2) :
70 – 77.
3. Aga VM, Agarwal AK, Gupta SC, The relationship of insight to
psychopathology in schizophrenia : A Cross sectional study, Indian Journal of
Psychiatry 1995;37(3): 129-135 .
4. Saravanan B, Jacob KS, Johnson S, Prince M, Bhugra D, David AS, Outcome
of first-episode schizophrenia in India: longitudinal study of effect of insight
and psychopathology. British Journal of Psychiatry 2010; 196(6): 454-459.
5. Pek E, Mythily S, Chong SA, Clinical and social correlates of duration of
untreated psychosis in first episode psychosis patient, Annals Academy of
Medicine Singapore 2006; 35: 24-26.
7
9.
SIGNATURE OF THE CANDIDATE:
10.
REMARKS OF THE GUIDE:
This study is feasible
11.
NAME AND DESIGNATION OF THE
11.1 GUIDE:
DR. DENZIL A. PINTO
PROFESSOR
DEPARTMENT OF PSYCHIATRY
FATHER MULLER MEDICAL COLLEGE ,
MANGALORE - 575002
11.2 SIGNATURE :
11.3 CO-GUIDE ( IF ANY) :
11.4 SIGNATURE:
11.5 HEAD OF THE DEPARTMENT:
11.6 SIGNATURE:
12.
12.1 REMARKS OF THE CHAIRMAN
& PRINCIPAL:
12.2 SIGNATURE:
8
DR. P. JOHN MATHAI
PROFESSOR & HOD
DEPARTMENT OF PSYCHIATRY
FATHER MULLER MEDICAL COLLEGE
MANGALORE – 575002.