Clinical characteristics and insight in a group of severely ill schizophrenics

Abstract

The aim of this cross-sectional study was to describe the mental disablement in a group of 30 outpatients with chronic schizophrenia or schizoaffective disorders. The relationships between ?insight in illness?, symptoms, side effects, and disablement were studied. The patient's insight in illness, positive and negative symptoms, side effects, level of functioning (GAF), and social well-being under neuroleptic treatment were rated. Two psychiatrists independently rated insight in illness and the most prominent clinical characteristic (symptom or side effects). Patient-adapted versions of psychiatric rating scales were used to investigate the patient's opinion of his/her side effects and level of functioning. Symptoms of illness were noticeable in 37% of the patients, and side effects in 40%. Patients having depot neuroleptics had significantly more extrapyramidal symptoms than patients taking peroral, conventional, or atypical neuroleptics. Whether this is a pharmacokinetic (plasma level) or a pharmacodynamic effect could not be concluded from the present study. In 30% of the patients there was disagreement between the clinician's (low) and the patient's (high) ratings of the level of functioning. These patients showed lack of insight and significantly lower level of functioning and were to a greater extent unmotivated for medication. The agreement between the patient's and the psychiatrist's ratings of side effects was generally high. The results indicated that outpatients with a chronic schizophrenic or schizoaffective disorder are disabled due to both schizophrenic symptoms and side effects and that insight-increasing interventions should be included in the treatment.