統合失調症者における病識の関連要因―精神障害者観，自尊感情，認知的洞察の関連から

Insight in Patients with Schizophrenia: Relationships among Self-Esteem, Perception of People with Mental Illness, and Cognitive Insight

要旨

　目的：統合失調症者の病気の認識に影響する要因間の関連を明らかにすることを目的とした．

　方法：入院中の統合失調症者に対面形式での質問紙調査を行った．各要因の関連はスピアマンの相関係数を用い，「自己の疾病についての意識」を従属変数として重回帰分析（変数減少法）を行った．

　結果：対象者104名のうち63名から有効回答を得た．病気の自覚尺度と「自己の疾病についての意識」において「自己内省性」と関連が認められた．また，精神疾患の自覚の程度により病気の認識，自尊感情，精神障害者観の関連が異なることが認められた．「自己の疾病についての意識」を従属変数とした重回帰分析では「陰性尺度」「自己内省性因子」「自己確信性因子」「自尊感情尺度」，精神障害者観因子「能力」で構成されるモデルを得た．

　結論：統合失調症者の病識の認識向上の支援には現実的認知の促進，精神障害者観と自己価値の改善の必要性が示唆された．

Abstract

　Purpose: The aim of this study was to investigate the relationships among insight, perception of people with mental illness, self-esteem, and reality testing in patients with schizophrenia.

　Method: We examined the responses of 63 patients to the Schedule for Assessment of Insight-Japanese version (SAI-J), Insight Scale (IS), Rosenberg Self Esteem Scale, Japanese version of the Beck Cognitive Insight Scale (BCIS-J), and perception of people with mental illness.

　Results: We found significant relationships among insight (SAI-J and IS), perception of people with mental illness, and self-esteem when we divided the participants according to degree of awareness of mental illness. We also found a significant correlation between insight (SAI-J and IS) and self-reflectiveness as well as a good model for predictive factors of “awareness of illness” by multiply regression analysis. The predictive factors were negative symptoms, self-reflectiveness, self-certainty, self-esteem, and one of the factors of perception of people with mental illness.

　Discussion: The findings of this study suggest that insight, perception of people with mental illness, and self-esteem are complexly related and that self-reflectiveness is an important cognitive ability for insight in people with schizophrenia. Although further study is needed, these results suggest that improving self-esteem, perception of people with mental illness, and ability of realistic cognition is important for improving insight in patients with schizophrenia.