Insight and clinical correlates in schizophrenia

It is not clear to what extent poor insight is inherent in schizophrenic psychopathology or is related to clinical factors. It is clinically important to elucidate this point to know how some insight remains intact in schizophrenia. Sixty-three ICD-10 schizophrenics were recruited. Insight was measured by David's three-dimensional scale, which deals with the awareness of the need for treatment, of the illness, and of psychotic experiences. Clinical factors that may influence insight were grouped into objective psychopathology, subjective experience, and treatment settings, according to the normal development of insight starting from objective illness, through subjective perception of it, to seeking treatment. Psychopathology was measured by the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS), and the subjective experience was measured by a checklist of our own. Positive symptoms, especially disordered thought, hallucinations, and delusions, had a modest inverse correlation with awareness of illness and of psychotic experiences, but these were not correlated with alogia or other negative symptoms. Later age at the first onset was significantly correlated with poor awareness of psychotic experience, but no correlation of subjective experience with insight emerged. Awareness of the need for treatment was significantly higher in outpatient than in inpatient groups, and was not correlated with any other variables. Poor awareness of illness and of psychotic experience seems to be a trait of the acute rather than the chronic psychopathology of schizophrenia. Poor awareness of psychotic experience was related to later onset. Awareness of the need for treatment seems to improve, even in the absence of awareness of illness or of psychotic experience, in outpatient settings--the effects of social interaction may be relevant to this.