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Lack of insight has been extensively studied and was found to be adversely correlated with impaired treatment compliance and worse long term clinical outcomes among patients with schizophrenia, while not much is known about this phenonmenon in patients with severe depression.To explore the correlates of insight and its relation to symptom changes among the most seriously ill patients with affective disorders, those who require hospitalization.Patients hospitalized in a large psychiatric hospital in south China with either major depressive disorder (MDD)(N=55) or bipolar depression (BD) (N=85) based on ICD-10 diagnostic criteria were assessed with the Insight and Treatment Attitudes Questionnaire (ITAQ) one week after admission and at the time of discharge. Clinical symptoms were measured at the same time with the Hamilton Rating Scale for Depression (HAMD-17) and the Depression subscale of the Symptom Check list-90 (SCL-90). Length of stay (LOS), duration of illness, duration of untreated mood disorder, number of previous episodes of depression and previous admissions for depression were documented during interviews with patients and their families and from a review of medical records. Bivariate correlations and multiple regression analysis were used to examine the relationship of sociodemographic characteristics, clinical symptomatology and clinical history, to insight at the time of admission. The relationships between change in clinical symptoms and change in insight from admission to discharge were also examined.Stepwise multiple regression models suggested that any previous admissions for depression and higher anxiety factor scores on the HAMD-17 are significant independent predictors of insight accounting for 22.9% of the variance. Multiple regression analysis residual change scores (change scores adjusted for baseline values) on the ITAQ showed that improved insight over average stays of 51 days were inversely related to the residual psychomotor retardation factor on the HAMD-17 accounting for 9.1% of the variance.More severe anxiety symptoms and previous hospitalization for depression were associated with greater insight into illness at admission. Reduction of motor retardation symptoms during treatment was associated with greater improvement in insight to the time of discharge. The patients who are sicker at admission and who show more improvement in psychomotor retardation show the greatest insight.自知力缺乏已经被广泛的研究并且发现与精神分裂症患者受损的治疗依从性和长期临床治疗效果较差相关，但是很少研究表明这种现象也存在于严重的抑郁症患者中。.探讨情感障碍、需要住院治疗的最严重的情感障碍患者的自知力及其与症状变化之间的关系。.根据 ICD-10 诊断标准从中国南部的一家大型精神科医院纳入了住院抑郁症患者（MDD）（N = 55）或双相抑郁症患者（BD）（N = 85），在他们住院一周和出院时采用自知力与治疗态度问卷（ITAQ）进行评估。同时也采用汉密尔顿抑郁量表（HAMD-17）和症状自评量表抑郁量表（SCL-90）测量临床症状。在对病人及其家属的访谈中，记录了住院时间、疾病持续时间、未治疗情绪紊乱的持续时间、既往抑郁发作次数、和以往的抑郁症入院记录。采用二分类相关分析和多元回归分析来研究社会人口学特征、临床症状、和临床病史与入院时自知力之间的相关性。对临床症状的变化和从入院到出院之间自知力的变化之间的关系也进行了研究。.多元逐步回归模型显示既往的抑郁症入院记录和HAMD-17 中较高的焦虑因子分都是自知力的显著独立预测因素，占方差的22.9%。ITAQ 的多元回归分析残差变化得分（基线值矫正后的评分变化）显示平均住院超过51 天对自知力的改善与精神发育迟滞因子负相关，占方差的9.1%。.较严重的焦虑症状和抑郁症的既往住院史与入院时自知力方面的疾病有关。治疗期间运动迟缓症状的减轻与出院时间对自知力较大的改善之间是相关的。入院时病情更严重并且精神发育迟滞改善更大的患者表现出最大的自知力。.

In the last decade, olanzapine became widely used in mental health service worldwide even after being criticized for its metabolic side effects. Patients with schizophrenia on olanzapine were usually found to stay on their medications longer than the other second-generation antipsychotics (SGAs) except clozapine. The reason for this is unknown.This prospective study compared the influences of olanzapine and other SGAs except clozapine on improving insight and medication discontinuation rate in schizophrenia.A total of 148 patients with schizophrenia medically indicated for initiation of treatment with olanzapine or other SGAs were evaluated for symptoms, insight, attitudes toward medication, side effects, body weight and fasting lipid and glucose parameters at admission and before discharge, and follow-up calls one-year after discharge documented whether they were regularly taking prescribed psychotropic medication or not.After an average of 72.8 days of inpatient treatment, the olanzapine and other SGAs group exhibited similar levels of symptom improvement with an average reduction of 28.7 in the Positive and Negative Syndrome Scale (PANSS) total score. The Olanzapine group exhibited better improvement in insight assessed using the G12 item of PANSS and Insight and Treatment Attitudes Questionnaire (ITAQ), more metabolic side effects indexed with total cholesterol, triglycerides levels and weight gain, and a lower medication discontinuation rate than the other SGAs group.Although general symptom improvement was similar, olanzapine significantly improved insight and presented less medication discontinuation compared to other SGAs, which might partially explain why patients on olanzapine stayed longer on their medications.在过去10 年中，奥氮平即使被指出具有代谢副 作用但依然被广泛应用于精神卫生服务中。服用奥氮 平的精神分裂症患者通常服药时间比除了氯氮平外的 其他二代抗精神病药物（SGAs）更长，而原因不明。.该前瞻性研究旨在比较奥氮平与其他除氯氮平 以外的二代抗精神病药物（SGAs）治疗对改善精神分 裂症患者自知力和药物停药率的影响。.共有148 例精神分裂症患者起始治疗就采用奥 氮平或其他SGAs，对他们进行评估入院前和出院前的 症状、自知力、用药态度、副作用、体重和空腹血脂 和血糖参数。出院后一年的随访电话包括是否定期服 用精神药物。.平均72.8 天的住院治疗后，奥氮平和其他SGA 组表现的症状改善水平相似，阳性和阴性症状量表 （PANSS）总分平均减少28.7。采用PANSS 的G12 项 目和自知力及治疗态度问卷（ITAQ）评估后奥氮平组 自知力方面有了更好的改善，总胆固醇、甘油三酯水平、 和体重增加引起的代谢副作用更多，而药物停药率比 其他二代抗精神病药物组低。.虽然奥氮平和其他二代抗精神病药物对一般症 状的改善相差不大，但是奥氮平比其他SGAs 明显改善 了自知力并且停药率也较低，这可能部分解释了为什 么患者服用奥氮平的时间会更长。.