The effects of illness severity, cognition, and estimated antipsychotic dopamine receptor occupancy on insight into the illness in schizophrenia: An analysis of clinical antipsychotic trials of intervention effectiveness (CATIE) data

Miracle Ozzoude, Shinichiro Nakajima, Eric Plitman, Jun Ku Chung, Julia Kim, Yusuke Iwata, Fernando Caravaggio, Hiroyoshi Takeuchi, Hiroyuki Uchida, Ariel Graff-Guerrero, Philip Gerretsen

Research output: Contribution to journalArticle

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Background: The relationship between dopamine D2 receptor (D2R) occupancy and impaired illness awareness (IIA) remains unclear. While IIA is associated with illness severity and cognitive dysfunction, antipsychotic medication, the principal treatment for schizophrenia, indirectly improves IIA, but may simultaneously contribute to cognitive dysfunction at supratherapeutic doses. Aim and methods: We investigated the influence of estimated D2R (Est.D2R) occupancy by antipsychotics on the relationships between IIA and illness severity, and IIA and cognition. IIA was assessed in 373 adult patients with schizophrenia (18−62 years) using data from CATIE. IIA was measured using the Positive and Negative Syndrome Scale (PANSS) item G12. D2R occupancy levels were estimated from plasma concentrations for risperidone, olanzapine, and ziprasidone. Correlation, regression, and path analyses were performed to examine IIA's relationship to illness severity, cognition, and Est.D2R. Results: Illness severity was predictive of IIA. However, premorbid IQ, cognition, and Est.D2R did not predict IIA, and Est.D2R did not serve either a moderating or mediating role in both regression and path analyses. Conclusions: Consistent with previous literature, our results suggest that IIA is a function of illness severity in adult patients with schizophrenia. Future studies should explore whether D2R occupancy mediates the relationships between IIA and illness severity, and IIA and cognitive dysfunction, in late-life schizophrenia (i.e. ≥60 years) given the effects of aging on cognition, IIA, and antipsychotic sensitivity.

Original languageEnglish
Pages (from-to)207-213
Number of pages7
JournalProgress in Neuro-Psychopharmacology and Biological Psychiatry
Publication statusPublished - 2019 Mar 8



  • D receptor occupancy
  • Illness severity, Cognition
  • Insight into illness
  • Schizophrenia
  • Structural Equation Modeling

ASJC Scopus subject areas

  • Pharmacology
  • Biological Psychiatry

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