Lack of insight is present in 50-80% of schizophrenic patients and is associated with poorer prognosis and negative outcome. The aim of our study was to evaluate possible differences in symptomatology and functioning between schizophrenic patients with poor or good insight.

One undred twenty one patients with a DSM-IV-TR diagnosis of schizophrenia in a stable phase were evaluated with PANSS, CDSS, GAF, and QLS. The Scale for the Assessment of Unawareness of Mental Disorder, SUMD, was used to assess three domains: awareness of mental illness, the need for treatment, the social consequences of illness. SUMD cut-off of 3 was used to differentiate patients with good insight from those with impaired insight. Independent sample t-test was performed to compare these two groups on clinical profile, quality of life and global functioning.

No significant differences were found between poor and good insight groups on socio-demographic variables. Significant differences (p< .01) were observed between patients with poor and good insight, for all the three dimensions of SUMD, in GAF, PANSS positive and PANSS general symptomatology. Patients with worse awareness of illness presented more severe negative symptoms (p= .001) and less depressive symptomatology (p= .008). Patients with impaired awareness of need for treatment and the social consequences of disorder presented lower scores in QLS occupational role (p< .02).

These findings suggest a link between insight, symptomatology and outcome that can be explained by a clinical model which considers insight related to how a particular symptom is created.