A deeper view of insight in schizophrenia: Insight dimensions, unawareness and misattribution of particular symptoms and its relation with psychopathological factors

• Published in: Schizophrenia research Vol. 189; pp. 61 - 68
• Main Authors: Pousa, Esther, Ochoa, Susana, Cobo, Jesús, Nieto, Lourdes, Usall, Judith, Gonzalez, Beatriz, Garcia-Ribera, Carles, Pérez Solà, Victor, Ruiz, Ada-I, Baños, Iris, García-Ribera, Carles, González, Beatriz, Massons, Carmina, Monserrat, Clara, Ruiz, Ada-Inmaculada, Ruiz, Isabel, Sanchez-Cabezudo, Dolores
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.11.2017
• Subjects: Adult; Awareness; Female; Humans; Insight; Male; Middle Aged; Misattribution; Prospective Studies; Psychiatry; Psychometrics; Psychopathology; Psychotic Disorders - etiology; Regression Analysis; Schizophrenia; Schizophrenia - complications; Schizophrenic Psychology; Surveys and Questionnaires; Symptom dimensions; Unawareness of symptoms; Misattribution; Schizophrenia; Insight; Unawareness of symptoms; Symptom dimensions
• ISSN: 0920-9964; 1573-2509
• DOI: 10.1016/j.schres.2017.02.016

Abstract Objective 1. To describe insight in a large sample of schizophrenia subjects from a multidimensional point of view, including unawareness of general insight dimensions as well as unawareness and misattribution of particular symptoms. 2. To explore the relationship between unawareness and clinical and socio-demographic variables. Methods 248 schizophrenia patients were assessed with the Positive and Negative Syndrome Scale (PANSS, five factor model of Lindenmayer) and the full Scale of Unawareness of Mental Disorder (SUMD). Bivariate associations and multiple linear regression analyses were used to investigate the relationship between unawareness, symptoms and socio-demographic variables. Results Around 40% of the sample showed unawareness of mental disorder, of the need for medication and of the social consequences. Levels of unawareness and misattribution of particular symptoms varied considerably. General unawareness dimensions showed small significant correlations with positive, cognitive and excitement factors of psychopathology, whereas these symptom factors showed higher correlations with unawareness of particular symptoms. Similarly, regression models showed a small significant predictive value of positive symptoms in the three general unawareness dimensions while a moderate one in the prediction of particular symptoms. Misattribution showed no significant correlations with any symptom factors. Conclusions Results confirm that insight in schizophrenia is a multi-phased phenomenon and that unawareness into particular symptoms varies widely. The overlap between unawareness dimensions and psychopathology is small and seems to be restricted to positive and cognitive symptoms, supporting the accounts from cognitive neurosciences that suggest that besides basic cognition poor insight may be in part a failure of self–reflection or strategic metacognition.