title: A deeper view of insight in schizophrenia: Insight dimensions, unawareness and misattribution of particular symptoms and its relation with psychopathological factors.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain. Electronic address: epousa@parcdesalutmar.cat.
authors.forename: Esther
authors.initials: E
authors.lastname: Pousa
authors.affiliation: Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Ochoa
authors.affiliation: Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Cobo
authors.affiliation: Department of Research; Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz.Calzada México-Xochimilco 101. 14370 San Lorenzo Huipulco - Tlalpan, México D. F. México.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Nieto
authors.affiliation: Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Usall
authors.affiliation: Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Gonzalez
authors.affiliation: Servicio de Psiquiatría del Hospital de la Santa Creu i Sant Pau Barcelona, IIB-Sant Pau, Sant Quintí 89, 08025 Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Garcia-Ribera
authors.affiliation: Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Spain; Servicio de Psiquiatría del Hospital de la Santa Creu i Sant Pau Barcelona, IIB-Sant Pau, Sant Quintí 89, 08025 Barcelona, Spain; Centro de Investigación Biomédica En Red de Salud Mental, CIBERSAM, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Pérez Solà
authors.affiliation: Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Ada-I
authors.initials: AI
authors.lastname: Ruiz
authors.affiliation: Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain.
authors.forename: Iris
authors.initials: I
authors.lastname: Baños
authors.affiliation: Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain; Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Cobo
authors.affiliation: Servicio de Psiquiatría del Hospital de la Santa Creu i Sant Pau Barcelona, IIB-Sant Pau, Sant Quintí 89, 08025 Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: García-Ribera
authors.affiliation: Mental Health Department, Hospital Benito Menni, Sant Boi de Llobregat, Barcelona, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: González
authors.affiliation: Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain.
authors.forename: Carmina
authors.initials: C
authors.lastname: Massons
authors.affiliation: Department of Research; Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz.Calzada México-Xochimilco 101. 14370 San Lorenzo Huipulco - Tlalpan, México D. F. México.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Nieto
authors.affiliation: Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Monserrat
authors.affiliation: Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Ochoa
authors.affiliation: Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Salut Mental. Parc Taulí Sabadell, Hospital Universitari - UAB Universitat Autònoma de Barcelona, CIBERSAM, Campus d'Excel.lència Internacional. 08208 Sabadell, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Pousa
authors.affiliation: Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Ada-Inmaculada
authors.initials: AI
authors.lastname: Ruiz
authors.affiliation: Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Ruiz
authors.affiliation: Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Sanchez-Cabezudo
authors.affiliation: Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM Sant Boi de Llobregat, Barcelona, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Usall
mesh_terms: D000328:Adult; D001364:Awareness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011594:Psychometrics; D011599:Psychopathology; D011618:Psychotic Disorders / Q000209:etiology*; D012044:Regression Analysis; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D011795:Surveys and Questionnaires
keywords: Insight; Misattribution; Schizophrenia; Symptom dimensions; Unawareness of symptoms