title: Is insight in schizophrenia multidimensional? Internal structure and associations of the Greek version of the Schedule for the Assessment of Insight-Expanded.
abstract: Despite the general agreement that insight is a multidimensional phenomenon, the studies on the factorial structure of the scales for its assessment have yielded rather inconsistent results. The present study aimed to assess the internal structure of the Schedule for the Assessment of Insight (SAI-E). Seventy-two chronic patients with schizophrenia were assessed with SAI-E. Hierarchical cluster analysis and multidimensional scaling (MDS) were used to identify insight components and assess their inter-relationships. The associations of the extracted components with demographic, clinical and cognitive characteristics were also examined. The SAI-E demonstrated good psychometric properties. Three subscales of SAI-E were identified measuring awareness of illness, relabeling of symptoms, and treatment compliance. Moreover, the MDS disclosed two underlying dimensions--degree of 'specificity' and 'spontaneity'--within the insight construct. Treatment compliance was more strongly correlated with symptom relabeling than illness awareness. Excitement symptoms, global functioning and general intelligence were correlated with all the components of insight. Depressive symptoms were more strongly correlated with illness awareness. Impaired relabeling ability was linked to cognitive rigidity and greater severity of disorganization and positive symptoms. Education and severity of negative symptoms specifically affect treatment compliance. Our results support the hypothesis that insight is a multidimensional construct.
authors.affiliation: Athens University Medical School, First Department of Psychiatry, Greece; King's College, London, Institute of Psychiatry, Section of Cognitive Neuropsychiatry, UK. Electronic address: gekonst@otenet.gr.
authors.forename: George
authors.initials: G
authors.lastname: Konstantakopoulos
authors.forename: Dimitris
authors.initials: D
authors.lastname: Ploumpidis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Oulis
authors.forename: Aggeliki
authors.initials: A
authors.lastname: Soumani
authors.forename: Stavrina
authors.initials: S
authors.lastname: Nikitopoulou
authors.forename: Konstantina
authors.initials: K
authors.lastname: Pappa
authors.forename: George N
authors.initials: GN
authors.lastname: Papadimitriou
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
mesh_terms: D000328:Adult; D001364:Awareness; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012559:Schizophrenia / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D012565:Schizophrenic Psychology
keywords: Cognition; Psychopathology; Psychosis; Treatment compliance; Unawareness of illness