Unawareness Of Mental Disorder Research Articles

Relationship Between Obsessional Beliefs and Insight in Patients with Obsessive-Compulsive Disorder

Introduction: OCD is a heterogenous entity in terms of symptoms and insight. Various models have been formed to explain the complexity of OCD and how obsessive beliefs play a vital role in the etiology and psychopathology of OCD. Evaluating the association between these beliefs and insight can be very advantageous.
 Method: aim: to determine the relation between obsessive beliefs and the level of insight in obsessive compulsive patients, Venue: The study was conducted at the institute of mental health and hospital, Agra, Design: The study is a hospital based cross sectional study. sampling: 80 ocd patients as per ICD-10 diagnostic criteria were selected through purposive sampling. Tools: Patients assessed using Obsessional belief questionnaire-44 (OBQ-44) and Scale to Assess Unawareness in Mental Disorder (SUMD).
 Result: the data was analysed with product moment correlation and it was found that OBQ-ICT has negative correlation (r = -0.36) with SUMD indicating controlling thought promote insight in patients. No significant correlation was found between OBQ-RT and OBQ-PC and insight.
 Conclusion: In this study importance of control of thought was the only variable which is significantly correlated with level of insight. Implications of these findings for conceptualising the relationship between obsessive beliefs and insight have been discussed.
 Key Words: OCD, Obsessional belief, Insight, SUMD.
 

A comparative study evaluating insight in different phase of illness among patients with bipolar disorder by using multiple scales

Aim This cross-sectional study aimed to evaluate insight and its correlates among patients with bipolar disorder (BD). Methodology 180 patients with BD were evaluated on Scale to Assess Unawareness of Mental Disorders (SUMD), Insight scale for affective disorders (ISAD), Mood Disorders Insight Scale (MDIS), and Beck Cognitive Insight Scale (BCIS). Results About half of the patients were in clinical remission (N = 94; 52.2%), one-fifth (N = 37; 20.55%) were in the phase of mania and one-fourth (N = 49; 27.2%) were in a depression. There was no significant difference in the level of insight between those in clinical remission and those in depression except for one of the domains of BCIS. Patients with mania had poorer insight compared to those in remission and depression. In terms of association of insight as assessed by different scales, in the whole sample and all the three subgroups, SUMD current and past scores had a significant positive correlation with the ISAD total score. In the whole sample, among patients currently in remission and those currently in depression, ISAD total score had significant negative correlation with MDIS total score. Poorer insight as assessed on SUMD (current and past), ISAD and MDIS was associated with poorer medication adherence. Conclusion The present study demonstrates that patients with mania have poor insight when compared to the patients in clinical remission and depression. The present study also demonstrates that the assessment of clinical insight is not affected much by the type of scale used.

The Effects of Bi-Anodal tDCS Over the Prefrontal Cortex Regions With Extracephalic Reference Placement on Insight Levels and Cardio-Respiratory and Autonomic Functions in Schizophrenia Patients and Exploratory Biomarker Analyses for Treatment Response.

BackgroundWe previously showed the efficacy of bi-anodal transcranial direct current stimulation (tDCS) over the prefrontal cortex (PFC) regions with extracephalic reference placement in improving negative symptoms in schizophrenia. In this ancillary investigation, the effects of this intervention on insight levels, other clinical outcomes, and cardio-respiratory and autonomic functions were examined and the potential of biomarkers for treatment response was explored.MethodsSchizophrenia patients were randomly allocated to receive 10 sessions of bi-anodal tDCS over the PFC regions with extracephalic reference placement (2 mA, 20 minutes, twice daily for 5 weeks) or sham stimulation. We examined, in 60 patients at baseline, immediately after stimulation and at follow-up visits, the insight levels, other clinical outcomes, blood pressure, respiratory rate, heart rate, and heart rate variability.ResultsInsight levels as assessed by the abbreviated version of the Scale to Assess Unawareness in Mental Disorder in schizophrenia awareness of the disease, positive and negative symptoms dimensions, and beliefs about medication compliance as assessed by Medication Adherence Rating Scale were significantly enhanced by active stimulation relative to sham. No effects were observed on cognitive insight, other clinical outcomes, or cardio-respiratory and autonomic functions. Heart rate variability indices as biomarkers were not associated with the clinical response to the intervention.ConclusionsOur results provide evidence for bi-anodal tDCS over the PFC regions with extracephalic reference placement in heightening the levels of insight into the disease and symptoms, as well as beliefs about medication compliance in schizophrenia, without impacting other clinical outcomes and cardio-respiratory/autonomic functions.

Insight and Associated Factors among Patients with Schizophrenia in Mental Specialized Hospital, Ethiopia, 2018.

Background Insight is the degree of the patient's awareness and understanding of their attributions, feelings, behavior and disturbing symptoms. Majority of the patients with schizophrenia have poor insight and insight is an important prognostic indicator in schizophrenia to enhance treatment compliances and reducing the risks of clinical deterioration. The main objective of this study was to assess insight and its associated factors among patients with schizophrenia at mental specialized hospital in Ethiopia. Methods Institutional based cross-sectional study was conducted from May to June 2018 Mental Specialized Hospital among 455 patients with schizophrenia. Insight was measured by an abridged version of Scale to assess unawareness of mental disorder. Positive and Negative Syndrome Scale, Calgary depressive scale, Oslo social support scale was used to identify factors associated with insight. Simple and multiple linear regression analysis were used to assess associated factors of insight in the participants. Results The mean score of insight was 13.66 (95% CI 13.27, 14.04). Age at first onset of illness, duration of treatments, depressive symptoms were inversely associated with mean insight score; whereas unemployed, positive and negative syndrome, previous hospitalization, >=2 episodes were positively associated with mean insight score. Conclusion Nearly half of the study participants were scored above the mean insight score so, the clinicians and psychotherapists should have to work together to improve insight among patients with schizophrenia.

Effective Factors of Non-Adherence and Admission in Bipolar Disorder

Bipolar disorder is a severe mental disorder that becomes chronic in about 40% of the cases and nearly 45% of the patients experience frequent relapses. The study population included all patients with bipolar disorder with a history of admission to psychiatric hospitals. Using a nonrandom sampling method, a total of 73 patients with bipolar I disorder were selected. The study data were collected using medical records, the Structured Clinical Interview (SCID), the Scale to Assess Unawareness in Mental Disorder (SUMD), the Drug Attitude Inventory-10 (DAI-10), the Liberman’s psycho-education protocol, and the checklist for patient’s adherence to behavioral and medication recommendations and the reasons for temporal or permanent stopping taking medications. It was found that female patients, patients with a high school degree or higher, and patients aged older than 30 years had better treatment adherence (p<0.01). Only 3.4% of participants had good treatment adherence. According to the results of Repeated measures ANOVA, participants in the experimental and control groups had significantly different post-test and follow-up scores on drug attitude, insight, and the reasons for stopping taking medication. We can conclude that the Liberman’s psycho-education protocol led to significant improvements in drug attitude, insight, and the reasons for stopping taking medication.

Does Perceived Social Support and Insight Influence Schizophrenic Patients Medication Adherence?

Background of the Study: Schizophrenia is a severe form of mental illness affecting most of the adult population. Though the incidence is low, the prevalence is high due to its chronicity. Most of the patients having schizophrenia tend to leave medication at some point of time. Social support and insight found to have influence over patients having schizophrenias' adherence towards medication. Aim: This study was aimed at finding the relationship of perceived social support and insight over medication adherence in patients having schizophrenia. Material and Methods: The study was conducted using descriptive, exploratory, cross-sectional study design on 60 patients having schizophrenia. The perceived social support, medication adherence and insight were assessed using MOS social support survey questionnaire, drug attitude inventory-10 and scale to assess unawareness in mental disorder respectively. Results: Non-adherence to medication was reported to be 25%. There is no significant relationship between perceived social support and insight over medication adherence. It was found that most of the participants had mild to moderate insight that might have had an influence on the findings of various tools. Conclusion: Findings highlight the importance of medication adherence interventions irrespective of the perceived social support and insight into the illness. Keywords: Schizophrenia, medication adherence, social support, insight, family support, peer support Cite this Article G. Srinivasan, Deepika C. Khakha. Does Perceived Social Support and Insight Influence Schizophrenic Patients Medication Adherence? Research and Reviews: Journal of Neuroscience . 2018; 8(3): 12–18p.

Unawareness of the disease in patients with schizophrenia: diagnosis and insight-oriented psychotherapy

Relevance. Phenomenon of patients' unawareness of their illness (insight) is a pathognomonic diagnostic criterion that distinguishes schizophrenia from many other psychiatric disorders. More than half of patients with schizophrenia do not realize their illness that makes their treatment more difficult. Diagnosis of insight in patients with schizophrenia is an important issue. The volume and content of rehabilitation programs depends on it. The purpose of research is to study the structure of insight in patients with schizophrenia, its relationship with certain clinical, social and psychological indicators, and to assess the influence of insight-oriented psychotherapy on the outcomes of schizophrenia. Material and methods. 237 patients with schizophrenia were studied: 139 (58.6 %) men and 98 (41.4 %) women aged 18-35 years. Patients of the main group (122 people) received pharmacotherapy and were included in the program of insight-oriented psychotherapy. Patients of the comparison group (115 people) received standard treatment. Measurement of the insight level was carried out using the scale of unawareness of mental disorder (SUMD). To study social indicators the scale of social functioning in various spheres was used (Zaitsev, 1999). The quality of life level and social stigma were measured by WHOQOL-BREF and adapted version of the self-stigmatization scale (SSMIS). Evaluation of outcomes in schizophrenia was carried out using the IMR and RMQ scales. The level of cognitive functioning was assessed by the GACF-CogFu scale. The severity of depression was measured by the scale developed by Beck (BDI). The mechanisms of psychological defense were assessed using the scale of R. Plutchik, H. Kellerman (1979). Mathematical processing of the results was also carried out. Results. Correlations were found between a higher level of patient awareness of the disease and its better prognosis (r= -0.507; p<0.05), a higher level of social functioning (r= 0.478; p<0.05), quality of life (r= -0.311; p<0.05), cognitive functioning (r= -0.508; p<0.05) and a lower intensity of defensive psychological mechanisms (r= -0.401; p<0.05). A different predictive value of some insight components was found. There were detected correlations between a successful disease prognosis and a high degree of patient awareness of the disease symptoms (r = -0.318; p<0.05), the need for treatment (r = -0.603; p<0.05), the drug effect (r = -0.312; p<0.05) and a low awareness level of how people perceive the patient’s illness (r = 0.527; p<0.05) and its social consequences (r= 0.419; p<0.05). The highest association with the risk of depressive symptoms and self-stigmatization had the following insight components: awareness of the mental illness presence (r= -0.365 and r= -0.525, respectively; p<0.05) and perception by others (r= -0.654 and r= -0,417; p<0.05), awareness of the diagnosis (r= -0.312 and r= -0.45; p<0.05), social consequences of the disease (r= -0.3 and r= -0.621; p<0.05) and their perception by others (r= -0.531 and r= - 0.576; p<0.05). Conclusions. Insight-oriented psychotherapy has proven effective in patients with schizophrenia treatment. It is reasonable to increase the patients' awareness of the disease symptoms, their causes, the need for treatment and the effectiveness of medicines, while leaving intact those aspects of insight that increase the risk of depression, psychological distress and self-stigmatization.

S117. MODELLING THE RELATIONSHIP BETWEEN INSIGHT, PSYCHOPATHOLOGY AND GENDER IN SCHIZOPHRENIA USING STRUCTURAL EQUATIONS

BackgroundStudies about the problem of the lack of awareness of the illness in psychosis have a long trajectory of research (Amador and David, 2004). Previous reported articles exert their insidious negative effects in the evolution and managing of the illness both by the patients and professionals. Lack of insight have been related to a generally poor prognosis of schizophrenia, predisposing to non-adherence with antipsychotic and other negatives influences on outcomes. In the last years, previous analysis from the Insight Barcelona Research Group tried to develop a deeper view of insight dimensions in schizophrenia (Pousa et al., 2017).The impact of gender in schizophrenia and first-episode psychosis has been studied extensively in recent decades (Riecher-Rössler and Häfner, 2000; Ochoa et al., 2011). Previous studies about the role of gender in the deficit of insight in psychosis showed inconclusive results. These contradictory findings may be related to differences in the study populations as well as to the use of different instruments to assess insight and other related variables. In these sense, our group presented a previous analysis focused on insight and gender (Cobo et al., 2016) into specific psychotic symptoms. Using the Spanish complete version of the Scale of Unawareness of Mental Disorder - SUMD (Ruiz et al., 2008) and the Five-PANSS Lidenmayer’s Factors (1995) - Positive, Negative, Cognitive, Depressive and Excitement. No gender differences in the three main dimensions of insight in psychosis were found, neither in awareness and attribution of symptoms when assessed globally. However, gender differences appear in awareness and attribution of particular symptoms when assessed separately, with women showing higher levels of unawareness and misattribution than men. On the other hand, a different pattern of clinical, sociodemographic and functional variables seem to affect insight in men and women differently.AimThe aim of this study was to modelling the influence of psychopathological factors in the deficit of insight in psychosis, taking in account the difference of gender as a relevant variable.MethodsA multicenter sample of 305 patients with schizophrenia who agreed to participate was evaluated in four centers of the metropolitan area of Barcelona (Catalonia). Psychopathological assessment was performed using the Five-PANSS Wallwork’s Factors (2012). Insight and its dimensions were assessed by means of the SUMD. Structural Equation Models (SEM) was used to fix the model in the total sample and by gender.ResultsSEM models for the sample showed a moderate fix capacity. Insight SUMD Dimensions models in the schizophrenia sub-sample were related significantly to Positive, Excited and Depressed PANSS Wallwork’s Factors. Higher scores on Positive and Excited PANSS Wallwork’s Factors reduce de insight scores. Conversely, higher scores in Depressed PANSS Wallwork Factor were associated to greater awareness. In women affected of schizophrenia, SEM models fixed poorly and the lack of association for any isolated PANSS factor, probably due to the size of the subsample.DiscussionThere is a lack of studies in the area. In the previous SEM model of Xavier et al. (2017), disorganized symptoms had the strongest effect on insight. In addition, both in our study and in the study of Xavier et al. (2017), negative symptoms have no significative effect on either illness insight or treatment insight. In our opinion, the possible explanation of the principal differences between the studies is related to the instruments utilized and the sample characteristics. Our data also support gender differences in the influence of psychopatology factors on the insight dimensions.

F221. SELECTIVE ATTENTION BIAS FOR FEAR STIMULI AND HALLUCINATION IN PATIENTS WITH SCHIZOPHRENIA: A PRELIMINARY STUDY

BackgroundSeveral studies have shown the association between affective dysregulation and severity of psychotic symptoms in schizophrenic patients. Attentional biases, which operate automatically to favor the processing of emotionally negative information in early stages of information processing, are known to play a causal role in the etiology of anxiety and other negative affective states. This study was conducted to evaluate the association between selective attention bias for fear stimuli and psychotic symptoms in patients with schizophrenia.MethodsA total of 66 patients with schizophrenia were included in the study. Attentional biases were measured with the dot-probe task with facial expression of neutral and fear emotional. To measure the psychotic features of the participants, the Positive and Negative Symptom Scale (PANSS), Psychotic Symptom Rating Scale (PSYRATS), the Scale to Assess Unawareness of Mental Disorder (SUMD), and Clinical Global Impression–Severity scale (CGI-S) were used.ResultsAttentional vigilance scores were calculated by subtracting the median RT in congruent trials (dot at the position of the fear face) from the median RT in incongruent trials (dot at the position of the neutral face) Attentional vigilance scores was moderately correlated with the hallucination subscale of PSYTATS (r=0.268, p=0.029) in the participants. No correlation was found between selective attention bias and the scores of PANSS, PSYTATS-delusion, SUMD, and CGI-S. When the participants were divided into biased and non-biased groups by the attentional vigilance scores of +40 msec, no significant difference was found in the clinical measures. However, a statistical trend was found in hallucination severities between the biased and non-biased groups (p=0.092).DiscussionAs a pilot study, the results suggest that the emotional information processing might affect the subjective severity of psychotic features in schizophrenia. Further study would be needed to clarify this association.

Comparison of clinician-rated and self-report insight in Korean patients with schizophrenia using VAGUS insight scale

This study was aimed to explore self-report auditory verbal hallucinations to provide unique and valuable information in addition to clinician-rated assessment in patients with schizophrenia. The VAGUS (http://www.vagusonline.com) is a recently developed insight scale that includes both clinician-rated (CR) and self-report (SR) versions. Insight measures obtained by the two versions of the VAGUS from the clinicians and the patients, respectively, in forty-one patients diagnosed with schizophrenia by DSM-IV-TR criteria were compared. Correlation coefficients for inter-scale convergence and 3-D biplots for multivariate relationship were derived from the subscales of the VAGUS. For external validation, correlation analyses with abridged version of Scale to Assess Unawareness in Mental Disorder (SUMD-A) and PANSS G12 item were conducted. Total scores of VAGUS-CR and –SR were 5.2 ± 2.6 and 4.9 ± 2.2, respectively. There was a strong correlation between them along with moderate pairwise correlations among the subscales. The 3-D biplots demonstrated that most subscales were clustered as a single factor apart from self-report Symptom Attribution separated as an independent factor. The VAGUS-CR, not -SR correlated significantly with the SUMD-A and PANSS G12. The utility of the VAGUS in reaching more overall understanding of the elusive phenomenon of insight in patients with schizophrenia is discussed.

An Investigation of the Psychometric Properties of Illness Perception Questionnaire for Schizophrenia (IPQS) in Iran

The present study has been carried out in order to evaluate psychometric characteristics of Illness Perception Questionnaire for Schizophrenia. This is a descriptive correlational research. The study population consisted of all patients with schizophrenia aging 19 to 70 years old who were hospitalized in the Psychiatric Ward of Shafa Hospital, Rasht (2016). Out of this population, a sample size of 95 people was obtained using purposive sampling, Demographic Questionnaire, Illness Perception Questionnaire for Schizophrenia (IPQS), Positive and Negative symptoms Scale (PNSS), Scale to Assess Unawareness in Mental Disorder (SUMD), Beck Depression Inventory (BDI), and Calgary Depression Scale for Schizophrenia (CDSS). Exploratory factor analysis revealed that this questionnaire is composed of 10 dimensions, the first of which explaining 24.402 percent of all of variance. Besides, concurrent validity showed that the total IPQS score had a significant correlation with SUMD equal to 0.579 at the level of 1 percent; this correlation was 0.29 at the level of 5 percent and 0.615 at the level of 1 percent in relation to BDI and CDSS, respectively. However, no correlation was observed between IPQS score and PANSS. Cronbach's alpha coefficients of reliability for IPQS scale were 0.705, and, for the subscales, between 0.599 and 0.865. This result suggests a good reliability for the Illness Perception Questionnaire for Schizophrenia. The Illness Perception Questionnaire for Schizophrenia has helpful psychometric properties that make it an appropriate analysis tool.

Tratamento em regime compulsivo ambulatório: estudo de follow-up após um ano em Portugal

Enquadramento: Não existem evidências suficientes relativamente ao impacto do tratamento em regime compulsivo ambulatório (TCA). Objetivos: Avaliámos o impacto do TCA ao longo de um ano em sintomas, funcionamento pessoal e social, insight e cognição. Métodos: Análise naturalística, longitudinal, no início e no follow-up após um ano, de 15 pacientes seguidos numa consulta especializada de TCA. Os pacientes foram submetidos a avaliação estandardizada com o Positive and Negative Syndrome Scale (PANSS) (Escala Positiva e Negativa do Síndroma), Personal and Social Performance Scale (PSP) (Escala de Desempenho Pessoal e Social), Berrios-Markova Scale to Assess Unawareness in Mental Disorder (SUMD) (Escala de Avaliação da Falta de Consciência no Distúrbio Mental), Trails A e B, Digit Span, e o Controlled Oral Word Association Test (COWA) (Teste de Associação Verbal Controlada). Resultados: No follow-up houve melhorias significativas no funcionamento pessoal e social (PSP inicial total: média=46,9; follow-up: média=59,3), e nomeadamente nas atividades socialmente úteis incluindo trabalho e estudos (p=0,012) e relações pessoais e sociais (p=0,033). Três pacientes (20%) pontuaram =&gt;69 no PSP, um bom nível de funcionamento. Porém, não verificámos melhorias significativas nos sintomas (PANSS=56,8), insight subjetivo ou objetivo (Berrios-Markova=10,0 e SUMD=11,0), ou desempenho cognitivo. Conclusões: No follow-up após um ano, os pacientes em TCA revelaram melhorias significativas no funcionamento pessoal e social, especificamente nas atividades socialmente úteis incluindo trabalho e estudos e nas relações pessoais e sociais, mas não registaram melhorias nos sintomas, insight e funcionamento cognitivo.

Decreases in retinal nerve fiber layer and ganglion cell-inner plexiform layer thickness in schizophrenia, relation to insight: a controlled study

Objective: The present study aimed to examine retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) thicknesses in schizophrenia patients according to the control group and in schizophrenia patients with good and poor insight. Methods: Sixty-three patients with schizophrenia recruited from the outpatient clinic of psychiatry and 39 healthy controls were included in the study. Patients were separated to two groups: good insight (n=31) and poor insight (n=32) schizophrenia. Group with schizophrenia were evaluated by using Positive and Negative Symptoms Scale (PANSS), Scale to Assess Unawareness of Mental Disorder. Changes in RNFL and GCIPL of all participants were analyzed with spectral optical coherence tomography (OCT). Results: Schizophrenia patients with good and poor insight were similar according to mean age of onset for illness, mean duration of illness, mean number of hospitalizations and mean daily used antipsychotic doses equivalent to chlorpromazine. There was no difference between the schizophrenia patients and the control group in terms of age and gender. In patients with schizophrenia all quadrants of RNFL, superior temporal (ST), superior (S), and inferior (I) quadrants of GCIPL were thinner than the controls. Inferior, inferior nasal quadrants of GCIPL and all quadrants of RNFL except nasal quadrant in schizophrenia patients with poor insight was found to be thinner than the schizophrenia patients with good insight and controls. Discussion: OCT can be used to detect neurodegeneration in schizophrenic patients. It can be argued that the GCIP layer may be a more sensitive biomarker than other retinal layers, requiring further investigation in this area.

Clinical variables and factors affecting duration of hospitalization in a sample of patients with affective and nonaffective psychoses

Backgrounds Duration of hospitalization (DOH) and length of stay in psychiatric hospitals are important factors affecting psychiatric patients and their families, in addition to their impact on the healthcare system policy and budget. Objectives The aims of this study were to identify the sociodemographic and clinical factors implicated in determining DOH and to study the effect of global functioning and insight on length of stay in psychiatric hospitals. Patients and methods A total of 129 inpatients diagnosed with affective and nonaffective psychoses were recruited from Minia Psychiatry Hospital. Data regarding their demographic and clinical manifestations were collected, including previous and current admissions. Their severity of illness was assessed with Positive and Negative Syndrome Scale, the level of initial functioning was evaluated by Clinical Global Impression Scale, and the details of their insight were measured by Scale to assess Unawareness of Mental Disorder. Results Female participants tended to have longer DOH than males, whereas males tended to have higher number of previous hospitalizations than females. Divorced and single patients had significantly longer DOH than married patients. DOH of current admission was found to increase with increasing severity of mental illness, decreased awareness of mental disorders, deceased awareness of achieved effects of medications, and decreased awareness of social consequences of mental illness. Number of hospitalizations was found to significantly increase with younger age at onset, longer duration of illness, higher number of previous episodes, whereas it was found to decrease with higher total number of received electroconvulsive therapies. Conclusion Sex and marital status have an effect on DOH. Increased severity of mental illness and disturbance of insight increase DOH and so does the initial decrease in global functioning.

Validation study of the Medication Adherence Rating Scale. Results from the FACE-SZ national dataset

ObjectiveThe Medication Adherence Rating Scale (MARS) is one of the most widely used measurements of adherence in schizophrenia (SZ). However, the data available regarding its psychometric properties are scarce. The aim of this study was to provide new data regarding the psychometric properties of the MARS in a multicenter community-dwelling sample of SZ patients. MethodsThis study was conducted in the French National network of the 10 FondaMental Expert Centers for SZ. The MARS was tested for construct validity, reliability, external validity and acceptability. In addition, data pertaining to sociodemographic information, clinical characteristics using the Positive and Negative Syndrome Scale (PANSS), the Scale to Assess Unawareness in Mental Disorder (SUMD), the Calgary Depression Scale for Schizophrenia (CDRS) and therapeutic adherence using the Brief Adherence Rating Scale (BARS) were collected. ResultsThree hundred and nineteen patients were included. The 3-factor structure of the MARS was confirmed using confirmatory factor analysis: RMSEA=0.05, CFI=0.95, and WRMR=0.88. The unidimensionality of each factor was supported by the satisfactory INFIT statistics. Item internal consistencies were all higher than 0.15 and the Kuder–Richardson were close to 0.6, except for factor 2, which was close to 0.5. Significant associations with BARS, PANSS, CDRS showed satisfactory external validity. The acceptability was excellent as all patients complete the MARS, without missing values. ConclusionThe MARS is a short self-administered instrument with acceptable psychometric properties that yields important information about adherence to pharmacological treatment. Some improvements might be considered to enhance its validity and reliability.

Insight, self-stigma and depressive symptoms among patients with schizophrenia

Depressive symptoms are rather prevalent among patients with schizophrenia and various factors can influence them. Insight and self-stigma shows complex and contradictory relationship, both are among most important features of schizophrenia with strong impact on depressive symptoms. We wanted to test hypothesis that preserved insight is related to depressive symptoms only when self-stigma is also high. Our cross-sectional research comprised 149 patients with diagnosis of schizophrenia, both gender, age span 25-45 years. Rating scales used were Calgary Depression Scale (CDS), Scale to assess Unawareness of Mental Disorder (SUMD) and Internalized Stigma in Mental Illness (ISMI) which are specifically designed for patients with schizophrenia. Majority of patients were male (72%), single or separated (85%). Relation between selfstigma and depressive symptoms was statistically significant ( b =0.12, 95% CI=[0.06, 0.19], β=0.32, t (135)=3.89, P b =–0.01, 95% CI=[–0.02,–0.001], β=–0.17, t (135)=–2.20, P =0.029). Post-hoc analysis showed that among patients with extremely high selfstigma (more than 90 centile), higher insight was related to more depressive symptoms (b=–0.22, 95% CI=[–0.42,–0.02], β=–0.34, t =–2.23, P =0.028). These results are important for tailoring specific antistigma programs for patients with high level of insight in order to prevent deleterious impact of depressive symptoms on course of schizophrenia.

Clinical and socio-demographic characteristics of a sample of outpatients with long-acting injectable antipsychotic treatment

IntroductionThere are relatively few studies of Long-acting injectable antipsychotics (LAI), although poor adherence to treatment is one of the main problems in patients with psychotic disorders.ObjectivesThe aim of the study is to describe socio-demographic and clinical characteristics of a sample of outpatients with LAI treatment.MethodsThis is a cross-sectional study. A randomized sampling was performed among the outpatients that were receiving LAI in an outpatient clinic in Barcelona (Spain). For each patient, socio-demographic, clinical and pharmacotherapeutic data were collected through interviews and clinical history.ResultsThe sample consisted of 30 subjects (50% men, average age 48 years). Most of the patients in the sample have basic education (50%) and are unemployed, receiving permanent disability pension (39.3%). In addition, 44.8% of the subjects were living with family members and were not married (56.7%). Of the patients, 70% were diagnosed with schizophrenia, 13.3% schizoaffective, 10% bipolar and 6.7% delusional disorder. The main reason to initiate LAI treatment was due to non-compliance of the prescribed oral treatment (85.7%). The 40% of patients were also with oral antipsychotic treatment. Average punctuation in the 3 first items of the Scale to Assess Unawareness of Mental Disorder: 11. Average punctuation in the short version of the Simpson-Angus Scale: 1.68.ConclusionsIn our sample, the outpatients with LAI treatment had a low functioning and disease awareness. Although the main reason to start LAI is the non-compliance, 40% of the patients were concurrently treated with oral antipsychotics. The extrapyramidal side effects are mild.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effect of empathy on the insight in patients with first-episode schizophrenia

Objective To investigate the effects of empathy on the insight of first-episode schizophrenia. Methods Empathy with the interpersonal reactivity index-C (IRI-C) was applied to 71 patients with first-episode schizophrenia and 69 healthy controls. In addition, schizophrenic patients were evaluated with scale of unawareness of mental disorder (SUMD) for the scores of clinical insight and positive and negative syndrome scale (PANSS) for clinical symptoms. Results Compared with the control group, the schizophrenic patients showed lower scores in the perspective taking ((13.85±1.86) vs (6.74±2.56), P<0.01), empathic concern ((14.28±2.16) vs (17.49±2.73), P<0.01) of IRI-C, but higher subscale score ((10.28±2.78) vs (8.93±1.93), P<0.01) in personal distress. Pearson correlation analysis showed that, there were negatively significant correlations between insight score and perspective taking (r=-0.429, P<0.01), empathic concern (r=-0.709, P<0.01) subscores of IRI-C respectively. In addition, the insight total score was positively correlated with the positive symptoms subscores (r=0.545, P<0.01) of PANSS. Conclusion Patients with first-episode schizophrenia have significant empathy defects. And the empathic deficits are associated with the insight impairment among the schizophrenic patients, suggesting that patients' insight level can change by improving their empathy ability. Key words: First-episode schizophrenia; Empathy; Symptom; Insight

The Insight Paradox: is Better Insight Associated with Depression Among Patients with Schizophrenia?

Introduction The insight paradox posits that among patients with schizophrenia, better insight is associated with depressive symptoms. However, available studies are characterized by conflicting results. Methods First, we conducted a systematic review, a meta-analysis and a meta-regression based on 59 available correlational studies. Second, we examined a cross-sectional examination on 80 patients diagnosed with schizophrenia in stable phase of the illness. Measures of depressive dimension were based on the Calgary Depression Scale for Schizophrenia (CDSS) and Beck Depression Inventory (BDI), for insight the Scale to assess Unawareness of Mental Disorder (SUMD). Furthermore, we assessed self-stigma, self-esteem and psychotic symptoms to test mediating and moderating models (Preacher and Hayes models). Results In the meta-analysis, global insight was associated weakly, but significantly with depression (effect size r=0.14), as were the insight into the mental disorder (r=0.14), insight into symptoms (r=0.14) and symptoms’ attributions (r=0.17). Whereas, insight into the social consequences of the disorder or into the need for treatment were not associated with symptoms of depression. Better cognitive insight was associated with higher levels of depression. Methodological and clinical factors moderated the magnitude of the association between insight and depression. Similar results were observed in the clinical sample, where self-stigma significantly mediated the association between insight and depression. Conclusions In conclusion, both literature and clinical findings indicate that better insight is associated with higher levels of depressive symptoms among patients with schizophrenia: interventions that are aimed at improving insight need to take into account the implications of these findings

EPA-0044 - The clinical correlations of unawareness of mental disorder in psychotic patients

Purpose the objective of the present study was to examine the clinical correlations of unawareness of mental disorder in psychotic patients. Method The clinical symptoms using the Positive and Negative Symptoms Scale (PANSS), demographic data and unawareness of mental disorder (SUMD) for the 120 psychotic patients was evaluated. Results the psychotic patients were significantly different in insight quality. Data analysis revealed that unawareness of mental disorder has significant correlations with positive symptoms and thought disturbance. There was no significant correlation between depression and unawareness of mental disorder. Investigation of dimensions of unawareness of mental disorder with all clinical variables in psychotic patients separately, show different results. Conclusion the results show that quality of unawareness of mental disorder is different in psychotic patients. Subcomponents of unawareness of mental disorder are influenced by different factors (such as positive and negative symptoms) emphasizing the need to consider insight as multidimensional.