Insight into illness in patients with schizophrenia: Associations with clinical symptoms, executive functions, and...

To evaluate the level of insight into illness in patients with schizophrenia and its associations with demographic factors, clinical symptoms, executive functions, and selected metabolic parameters.

This cross-sectional study included 60 outpatients diagnosed with schizophrenia according to DSMIV criteria. Participants were divided into two groups based on the median score of the Self-Appraisal of Illness Questionnaire (SAIQ): preserved insight (n=30) and impaired insight (n=30). Positive symptoms were assessed with the Positive Symptoms Rating Scale (PSRS), negative symptoms with the Brief Negative Symptom Assessment (BNSA), executive functions with the Wisconsin Card Sorting Test (WCST) and Wechsler-Bellevue Intelligence Scale-II (WB-II) subscales. Metabolic parameters included body mass index (BMI), systolic and diastolic blood pressure, and waist circumference. Statistical analysis was performed using t-tests, ANOVA, Pearson correlation, and multiple linear regression (p<0.05).

Patients with impaired insight exhibited significantly higher positive (PSRS: 28.5±4.2 vs 18.3±3.1; p<0.001) and negative symptoms (BNSA: 35.2±5.6 vs 22.1±4.0; p<0.001), poorer executive performance (WCST total score: 45.6±8.9 vs 68.4±7.2; p<0.001), higher BMI (28.7±3.4 vs 24.5±2.8; p<0.01), and elevated blood pressure values. SAIQ total score negatively correlated with positive (r=-0.62; p<0.001) and negative symptoms (r=-0.58; p<0.001), illness duration (r=-0.45; p<0.01), and positively with years of education (r=0.48; p<0.01) and WCST score (r=0.52; p<0.001). Regression analysis showed that negative symptoms (β=-0.41; p<0.001) and executive dysfunction (β=-0.35; p<0.01) were the strongest independent predictors of poor insight (R²=0.62).

Impaired insight in schizophrenia is strongly associated with greater psychopathological burden, neurocognitive deficits (especially executive dysfunction), and metabolic disturbances. These findings support the implementation of integrated therapeutic strategies targeting insight, cognition, and cardiometabolic health to improve long-term outcomes.