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

Benjamin D.R. Wiffen, Jonathan Rabinowitz, Alice Lex, Anthony S. David

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


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.

Original languageEnglish
Pages (from-to)94-103
Number of pages10
JournalSchizophrenia Research
Issue number1-3
StatePublished - Sep 2010

Bibliographical note

Funding Information:
ASD and BDRW acknowledge support from the Department of Health via the National Institute for Health Research (NIHR) Specialist Biomedical Research Centre for Mental Health award to South London and Maudsley NHS Foundation Trust (SLaM) and the Institute of Psychiatry at King's College London .

Funding Information:
The study was sponsored by Janssen-Cilag EMEA a division of Janssen Pharmaceutica NV. Prof. Rabinowitz has received research support, and/or consultancy fees and/or travel support from Janssen-Cilag, JNJ, Eli Lilly, Pfizer, BiolineRx, Newron Pharmaceuticals and Novartis Pharmaceuticals. Dr. Lex is an employee of Janssen-Cilag. Prof. David has received honoraria from Eli Lilly, Astra Zeneca and Janssen-Cilag and was a paid consultant for this study.

Funding Information:
This study was sponsored by Janssen-Cilag Medical Affairs EMEA , a division of Janssen Pharmaceutica NV. The authors wish to acknowledge the following physicians, their patients, co-workers and institutions for taking part in this study: Belgium : B. Delatte, T. Festjens, D. Volcke; France : V. Adnet-Markovitch, F. Bayle, G. Durelle, E. Lombertie, P. Meyer, J. Pon, P. Princet, M.A. Zimmermann; Greece : V. Fotopoulos, A. Karavatos, M. Tzanakaki-Melissari, E. Tzebelikos, A. Vidalis; Israel : Z. Fishel, C. Meodovnik, H. Szor, A. Teitelbaum; Italy : G. Corrivetti, L. Sartore, E. Smeraldi; Lithuania : B. Burba, L. Dembinskiene, V. Diktanas, M. Janulioniene, R. Jasaite; Netherlands : J. Hovens, H. De Keyzer; Portugal : M. Osorio; Romania: G. Badescu, L. Becheanu, L. Don, E. Ionescu-Mihaita, V. Irimia, G. Marian, D. Marinescu, B. Pacala; Russia : A. Avedisova, L. Bardenshtein, M. Ivanov, S. Mosolov, N. Neznanov, A. Smulevich, V. Tochilov; Turkey : H. Savas, H. Soygur; Ukraine : V. Abramov, V. Bitenskiy, V. Demchenko, V. Kozidubova, N. Maruta, O. Napryeyenko, V. Samokhvalov.


  • Antipsychotic
  • Functioning
  • Insight
  • Premorbid adjustment
  • Schizophrenia


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