Evaluation of insight and functional recovery in patients with schizophrenia

Objective: Despite the fact that functional remission is the most important goal for the treatment of schizophrenia, standard definitions have not yet been made due to differences in measurement methods, the variability in the course of the disease, cognitive levels of the patients, and psycho-social factors. Nevertheless, there exists an accumulation of knowledge regarding factors, which inşuence functional remission. Insight levels of patients inşuence their level of functionality, while causing problems in treatment adherence and social adaptation. The purpose of this study was to examine the factors which inşuence schizophrenia patients' levels of insight and functional remission.

Methods: In this cross-sectional descriptive study, 70 outpatients between the ages of 18-65, who applied to the Karadeniz Technical University, Psychiatry Clinic and were diagnosed with schizophrenia according to DSM-IV, were evaluated. The patients who reported they agree to take part in the study by signing the consent form were included in the study. The patients who had a history of traumatic brain injury and/or any disease which affects the central nervous system, whose Clinical Global Impression (CGI) disease severity low score was above four, who were taken as inpatients to the hospital in the last two months or whose treatment was changed were excluded from the study. The patients were evaluated by using respectively socio-demographic data collection form, clinical interview structured for DSM (SCID-I), the Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS), the Functional Remission of General Schizophrenia Scale (FROGS), Schedule for Assessing the Three Components of Insight (SAI-E), and cognitive test battery.

Results: Insight levels of the patients determined through the SAI-E, were found to be highly correlated with the PANSS positive, negative, and general psychopathology, Stroop Test, Controlled Word Association Test (FAS), and Trail Making Test A-B scores. In the regression analysis, PANSS total score, Stroop Test, and FAS scores were the predictors of insight.The FROGS functional levels of patients were found to be related with occupational status, sex, age of onset of illness, comorbid psychiatric illness, PANSS positive, negative, and general psychopathology, CDS, SAI-E, FAS, Trail Making Test, Stroop Test, and Wisconsin Card Sorting Test. In the regression analysis, occupational status, comorbid obsessive compulsive disorder, PANNS negative and general psychopathology, and FAS scores were the predictors of patients functional status.

Conclusion: Although insight levels of patients are basically related to cognitive functions, it has been reported in previous studies that clinical symptoms can cause changes in the levels of insight depending on the course of the disease. The relationship between insight and depression can vary depending on the severity of the depression, patients' defense mechanisms, and internalized stigma levels. The effects of clinical symptoms of schizophrenia, levels of cognitive function, and levels of insight and employment status on the patients' functionality levels are prominent.