Correlates, change and 'state or trait' properties of insight in schizophrenia

Background: The associations of insight into illness and clinical and socio-demographic variables in schizophrenia have been examined, yet little attention has been given to premorbid functioning, insight change and outcomes. Objectives: We examined these associations in a large cohort of recent onset schizophrenia spectrum disorder patients. Methods: This was a prospective 6-month, open-label, multicentre, phase IV trial in 303 subjects with recent onset (<= 2 years) schizophrenia treated with risperidone long-acting injection (RLAI). Insight (Schedule for the Assessment of Insight - Expanded), treatment efficacy (Positive and Negative Syndrome Scale, Clinical Global Impression) and quality of life (Short Form-36) were assessed at baseline and after 2, 4 and 6 months. The Premorbid Adjustment Scale was administered at baseline. Results: Insight was positively associated with better premorbid functioning, more education and schizoaffective disorder versus schizophrenia. Insight improved modestly, but significantly throughout treatment, particularly illness beliefs. Baseline insight was negatively correlated with quality of life and positive symptoms and positively correlated with anxiety/depression. It was not significantly associated with change in symptom severity or time in trial, but was positively associated with age. Conclusions: Insight, at least in this stable, comparatively high-insight sample, improved during treatment but this is not closely related to improvement in psychotic symptoms. Insight appears to have trait-like qualities demonstrated by association with premorbid factors. While insight is generally a favorable attribute and is associated with fewer psychotic symptoms, it is also associated with increased depression and lower perceived quality of life. Some components of insight are more amenable to improvement; particularly the ability to adopt less fixed illness attributions. (C) 2010 Elsevier B.V. All rights reserved.