The relationship between clinical symptoms and level of insight in patients with paranoid schizophrenia

Abstract

Background. Insight in schizophrenia has traditionally been considered primarily in relation to awareness of illness and overall illness severity. However, the potential for assessing insight using clinical psychological methods and the relationship of this measure to specific domains of psychopathology remain insufficiently studied. Objective. To examine the association between insight level and clinical symptoms in patients with paranoid schizophrenia. Hypothesis. Insight is a metacognitive process related to behavioral regulation, error recognition, and the use of feedback and may be associated with the profile of clinical symptoms. Methods and materials. The study included 100 psychiatric inpatients diagnosed with paranoid schizophrenia (mean age 33.6 ± 8.0 years), divided into groups with relatively higher (n = 61) and lower (n = 39) insight. A clinical psychological assessment of insight and the Positive and Negative Syndrome Scale (PANSS) were used. Both the conventional PANSS subscales and the five-factor PANSS model scores were analyzed. Results. Patients with lower insight had higher scores on the positive, negative, and general psychopathology subscales of PANSS. In the five-factor model, group differences were found in the positive and negative factors, the disorganized/concrete factor, and the excited/hostility factor; the most statistically robust differences concerned the disorganized/concrete factor. Adjustment for hostility indicated that hostility accounted for only part of the associations between insight and clinical symptoms. Conclusions. Lower insight was not associated with a uniform increase in all clinical manifestations, but primarily with disorganization of thinking, negative symptoms, and impaired behavioral regulation.