Adherence, insight and disability in paranoid schizophrenia.

Insight has long been linked to both prognosis and functioning in patients with schizophrenia; likewise, it is key to treatment adherence. This study seeks to assess the association between insight, adherence to pharmacological treatment, and disability in schizophrenia, and to study the potential mediating role of adherence between insight and disability. Insight (SUMD), adherence (CRS), and disability (WHO-DAS) were measured in 80 clinically stable patients with DSM-IV TR paranoid schizophrenia. Psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS). In a first step, predictors of disability were identified using linear regression to identify variables related to disability and further a mediation analysis was carried out. Negative symptoms, insight, and adherence account for 54.2% of the variance in disability. Negative symptoms act directly on disability, while the effect of insight on disability is partially mediated by adherence. Insight is key in disability in schizophrenia and should be leveraged in treatment programs.

[Etiology of isolated general malaise]. / Etiología del malestar general aislado.

Isolated general malaise (IGM) is defined as an imprecise sensation of feeling bad, without any other signs or symptoms that suggest even a diagnostic orientation. 137 patients who demanded medical help for IGM were selected and divided into three groups, according to their evolution: IGM of banal or benign cause; IGM of easy or attainable diagnosis; and IGM of difficult or prolonged diagnosis. The 37 patients of the latter group were integrated under the title of Unexplained General Malaise Syndrome (UGMS). The criteria of these syndromes are defined. The patients with UGMS were studied in order to make a diagnosis of its unknown disease, which was achieved in all cases except two. The non-specific symptoms that the patients with UGMS manifest and their relation to final diagnosis are described. When the final diagnosis was made, the number of diagnostic tests used, the time of hospitalisation and the derived economic cost was estimated in each case compared to the corresponding mean data, obtained. Depression as the most frequent aetiology detected in the patients with UGMS, should be the first consideration made in any evaluation.