The impact of cognitive insight, self-stigma, and medication compliance on the quality of life in patients with schizophrenia.

Impaired quality of life (QoL) is a common and clinically relevant feature of schizophrenia. In the present study, we attempted to formulate a model of QoL in the chronic stage of schizophrenia by including key variables-namely cognitive insight, self-stigma, insight into treatment, and medication compliance-that were proposed as its significant predictors in previous studies. We employed structural equation modeling (SEM) to simultaneously test the associations between these variables. A total of 170 community-dwelling patients with schizophrenia participated in this study. Cognitive insight, self-stigma, insight into treatment, medication compliance, and QoL were assessed through self-reporting. Symptoms were rated by interviewers. The influences of cognitive insight, stigma, insight into treatment, and medication compliance on QoL were supported using SEM. Our findings indicated that cognitive insight had a significant, positive, and direct effect on both self-stigma and insight into treatment; in contrast, it had a negative and direct effect on medication compliance. Notably, no evidence indicated a direct effect of cognitive insight on QoL. Thus, individuals with high cognitive insight reported low QoL because of stigma, low medication compliance, and their increased insight into treatment. In contrast, cognitive insight might indirectly ameliorate QoL mediated by the effect of insight into treatment on medication compliance. The findings provide additional support of the links between cognitive and clinical insight, self-stigma, medication compliance, and QoL in those with schizophrenia and suggest the need for screening and intervention services appropriate for this high-risk population.

Relationships of perceived public stigma of mental illness and psychosis-like experiences in a non-clinical population sample.

PURPOSE: Studies on the association between psychopathology, perceived public stigma, and labeling in mental illness have focused primarily on severe but rare mental disorders, especially schizophrenia, or other clinically defined psychotic disorders. Although evidence is mounting that psychosis-like experiences show high prevalence in the general population and lead to an increased risk of psychotic disorders, little is known about how psychosis-like experiences independently affect perceived public stigma in the non-clinical population. The aim of the present study was to examine the relationship between psychosis-like experiences and perceived public stigma in a non-clinical sample. METHODS: For this cross-sectional study, we recruited 524 individuals (239 male, 285 female) who had no lifetime history of psychiatric disorder. Participants completed questionnaires that asked for sociodemographic and clinical information, a measure of perceived public stigma (Perceived Psychiatric Stigma Scale [PPSS]), and two measures of psychosis-like experiences (Peters et al. Delusions Inventory [PDI]; Cardiff Anomalous Perceptions Scale [CAPS]). RESULTS: Of the sociodemographic characteristics analyzed in this study-gender, age, education level, marital status, and religion-only age simultaneously influenced PPSS, PDI, and CAPS scores. As hypothesized, perceived public stigma was positively correlated with measures of psychosis-like experiences, even after controlling for age. Furthermore, the perceived stigma was more strongly associated with delusion proneness than with anomalous perceptual experiences. CONCLUSION: The association between psychopathology and perceived public stigma appears to extend beyond clinically defined psychosis to more common psychosis-like experiences in a sample drawn from the general Han Chinese population.

Internalized stigma and stigma resistance among patients with mental illness in Han Chinese population.

Research suggests that accurate measurement is essential in evaluating internalized stigma and abilities to combat with stigma for treatment compliances and outcomes in individuals with mental illness. The purpose of this study was to assess the reliability and validity of the Chinese version of the Internalized Stigma of Mental Illness Scale (ISMIS-C), which is one of the few tools available to measure internalized stigma and stigma resistance (SR) simultaneously. A total of 160 outpatients with (n = 103) and without (n = 57) psychotic disorders were administrated with the ISMIS-C, and measures of self-esteem, self-efficacy, depression, and hopelessness. Overall, the 29-item ISMIS-C was presented to be internal reliable (Cronbach's alpha = 0.90), and reliable over time (intraclass correlation coefficients = 0.36-0.73). The construct validity of the ISMIS-C derived from the factor analysis was nearly identical to the original version. ISMIS-C dimension scores were well correlated with each other and measures of self-esteem, self-efficacy, depression, and hopelessness. Our data also demonstrated that psychotic patients experienced higher internalized stigma scores than those without psychotic diagnoses, but endorsed indifferently on SR scores. This scale can be used as an informative device when investigating "internalized stigma" and "SR" among individuals with or without psychotic disorders.

Assessing anomalous perceptual experiences in nonpsychiatric individuals and outpatients with psychosis in Taiwan: an investigation using the cardiff anomalous perceptions scale (CAPS).

The Cardiff anomalous perceptions scale (CAPS) has been recently designed for the assessment of anomalous perceptual experiences in the general population, and includes dimensions that measure distress, intrusiveness, and frequency. The purpose of this study was to assess the psychometric properties of a Taiwanese version of the CAPS. The English version of the CAPS was translated into Taiwanese (CAPS-T) and the latter was applied to this study. We administered the questionnaire to a consecutive sample of 192 participants with (n = 106; clinical group including schizophrenia and affective psychosis) or without psychotic disorders (n = 86; non-clinical group). In addition to the CAPS-T, the Taiwanese version of the brief psychiatric symptom rating scale (BSRS) measured the severity of the psychopathology. We also tested the psychometric properties of the CAPS-T including construct validity, internal consistency, test-retest reliability, and convergent and discriminative validity. Overall, the CAPS-T showed good construct validity, internal consistency, and stability over time and correlated significantly with the psychoticism subscale of the BSRS. As predicted, the mean differences in CAPS-T scores between participants with or without a psychotic disorder were significant. Convergent and discriminative validity were satisfactory. A score of 5 was found to the best threshold in discriminating between clinical and non-clinical samples. Our findings indicate that the Taiwanese version of the CAPS is a reliable and valid instrument to measure the multidimensionality of perceptual anomalies in general and appears to complement the clinical measures of psychosis proneness in Taiwan.

The psychometric properties of the Peters et al. delusions inventory (PDI) in Taiwan: reliability, validity, and utility.

PURPOSE: The Peters et al. Delusions Inventory (PDI) is a commonly used instrument to measure delusion proneness in the general population and includes dimensions that measure distress, preoccupation, and conviction of unusual beliefs. This self-report scale has already been translated into several languages. However, there has not been a validated Taiwanese version previously reported. The aims of the present study were to translate and test the cross-cultural reliability and validity of the PDI in Taiwanese as well as to establish its sensitivity, specificity, and discriminative validity. METHODS: We administered the questionnaire to a consecutive sample of 253 participants with (n = 154; clinical group including schizophrenia and affective psychosis) or without psychotic disorders (n = 99; non-clinical group). In addition to the Taiwanese version of the PDI (PDI-T), the Taiwanese version of the Brief Psychiatric Symptom Rating Scale (BSRS) was used to measure the severity of psychopathology. We tested the psychometric properties of the PDI-T, including its construct validity, internal consistency, test-retest reliability, concurrent, and discriminative validity. RESULTS: Overall, the PDI-T showed good construct validity, internal consistency, and stability over time, and it was significantly correlated with the BSRS subscales of psychotic symptoms. The convergent and discriminative validity was satisfactory. The area under the receiver operating characteristic curve of the PDI-T was 0.752. This research found that the most appropriate PDI-T yes/no cut-off scores for determining the absence and presence of delusion proneness were 5 and 13. CONCLUSIONS: The PDI is a reliable and valid instrument for measuring the dimensionality of delusion proneness and appears to complement subclinical psychosis assessment scales for both epidemiological and clinical research in Taiwan.

Beck Hopelessness Scale: exploring its dimensionality in patients with schizophrenia.

Hopelessness is a pre-eminent risk factor for suicide and non-fatal self-harm. Although the Beck Hopelessness Scale is often used for schizophrenia, its factor structure has been given relatively little consideration in this context. This study aimed to examine the reliability and validity of the Taiwanese version of the Beck Hopelessness Scale (BHS-T) in a chronic schizophrenia out-patient sample. One hundred and two (102) outpatients were evaluated using the translated Taiwanese version of the BHS (BHS-T), as well as several Beck-related symptom rating scales and the Positive and Negative Syndrome Scale (PANSS) for psycho-pathology. The patients were also evaluated for suicidal intent using the critical items of the Scale for Suicide Ideation (SSI) and suicide attempts. The psychometric properties of the BHS-T were also evaluated, including construct validity, internal consistency, test-retest reliability, convergence, and discriminative validity. The BHS-T showed good overall reliability and stability over time. This translated scale comprised a two-factor solution corresponding negative expectation and loss of motivation dimensions. Differences in mean hopelessness scores between participants with and without suicidal intent were significant. The results also indicated that, among individuals with schizophrenia, "negative expectation in the future" is more closely linked to suicide intent than "loss of motivation for the future". The BHS-T is a reliable and valid instrument for measuring the multi-dimensionality of hopelessness and may complement clinical suicidal risk assessments in individuals with schizophrenia.

Assessing cognitive insight in nonpsychiatric individuals and outpatients with schizophrenia in Taiwan: an investigation using the Beck Cognitive Insight Scale.

BACKGROUND: The Beck Cognitive Insight Scale (BCIS) was designed for the assessment of the cognitive processes involved in self-reflection and the ability to modify erroneous beliefs and misinterpretations. Studies investigating the factor structure of the BCIS have indicated a two-factor model in the psychotic population. The factor structure of the BCIS, however, has not received much consideration in the nonpsychiatric population. The present study examined the factor structure and validity of the BCIS and compared its scores between nonpsychiatric individuals and outpatients with psychosis. METHOD: The Taiwanese version of the BCIS was administered to 507 nonpsychiatric individuals and 118 outpatients with schizophrenia. The psychometric properties of the BCIS were examined through the following analyses: exploratory and confirmatory factor analyses, reliability, correlation analyses, and discriminative validity. RESULTS: The BCIS showed adequate internal consistency and stability over time. Exploratory and confirmatory factor analyses on the 15-item measure indicated a two-factor solution that supported the two dimensions of the Taiwanese BCIS, which was also observed with the original BCIS. Following the construct validation, we obtained a composite index (self-reflectiveness minus self-certainty) of the Taiwanese BCIS that reflected cognitive insight. Consistent with previous studies, our results indicated that psychosis is associated with low self-reflectiveness and high self-certainty, which possibly reflect lower cognitive insight. Our results also showed that better cognitive insight is related to worse depression in patients with schizophrenia spectrum disorders, but not in nonpsychiatric individuals. The receiver operating characteristic (ROC) analyses revealed that the area under the curve (AUC) was 0.731. A composite index of 3 was a good limit, with a sensitivity of 87% and a specificity of 51%. CONCLUSION: The BCIS proved to be useful for measuring cognitive insight in Taiwanese nonpsychiatric and psychotic populations.

WITHDRAWN: The psychometric properties of the Taiwanese version of the Cardiff Anomalous Perceptions Scale.

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The influence of sex on cognitive insight and neurocognitive functioning in schizophrenia.

Both impaired insight and cognitive deficits in schizophrenia are core features of this disorder. Previous studies have demonstrated the complex relationships between neurocognition and cognitive insight, as well as the contribution of neurocognition in explaining cognitive insight. However, there is lack of research regarding the influences of sex on the relation of neurocognition and cognitive insight. The present study sought to elucidate sex differences in cognitive insight and neurocognition in schizophrenia. Seventy three outpatients (male=39) with DSM-IV diagnosis of schizophrenia or schizoaffective disorder were enrolled in the cross-sectional study. The participants were assessed with cognitive insight using the Beck Cognitive Insight Scale, executive functions using the Wisconsin Card Sorting Test, sustained attention using the Conner's Continuous Performance Test (Second Edition), and intelligence using the Wechsler Adult Intelligence Scale-Third version, respectively. Sex differences in demographic and clinical variables were small; nevertheless, female patients had significantly later age of illness onset and higher levels of formal education than males (p<0.05). Poor cognitive insight was attributed to impairment in performance of executive function and sustained attention. Results from hierarchical regression analyses indicated sex as a moderator only in the association between cognitive insight and executive function. Our findings support an association between poor cognitive insight and neurocognitive impairment in outpatients with schizophrenia and suggest that the relationship may be sex-specific. This study highlights potential targets for effective intervention and rehabilitation in improving patients' insight toward mental illness.