The Causal Model of Insight in Schizophrenia Based on the Positive and Negative Syndrome Scale Factors and the Structural Equation Modeling

Abstract

We used structural equation modeling to formulate a causal model of insight in schizophrenia patients that explains the inconsistent results of the studies on the relationship between insight and psychopathology. The Positive and Negative Syndrome Scale was used to assess 342 patients with acute stage schizophrenia and 5 factors were identified through factor analysis with which a causal model of insight was constructed. Our model, where positive, negative, and autistic preoccupation (cognitive) factors were the primary predictors of insight with the activation factor mediating between positive and autistic preoccupation factors and insight, was found to show a perfect fit by most goodness-of-fit indices and to be superior to other alternative models. Specifically, positive, negative, and autistic preoccupation factors each had some predictive power for insight and the activation factor played a partial mediating role for the positive factor and a moderating role for the autistic preoccupation factor.