Increasing evidence supports the important role of illness state and individual characteristics in insight among patients with schizophrenia (SCZ).

To determine factors predicting the lack of insight among patients with SCZ.

It was a cross-sectional, descriptive and analytical study, involving 40 patients with DSM-IV diagnosis of SCZ followed in the outpatient psychiatry department at the Hedi Chaker University Hospital of Sfax inTunisia . The SAIQ (Self Appraisal of Illness Questionnaire) was used to measure 3 domains of insight (need for Treatment, Worry, and Presence/Outcome of Illness) and the PANSS (Positive and Negative Syndrome Scale) was used to measure the intensity of psychotic symptoms.

The average age of our patients was 41 years (21-64 years). The mean duration of disease was 14 years and the number of hospitalization was 2.5.

The scores of insight were independent from sociodemographic factors. The lack of insight in SAIQ was significantly correlated with a greater number of hospitalizations (p = 0.03). The worry subscale was associated with a longer duration of disease (p = 0.04) while the presence/outcome of illness subscale was associated with the intensity of negative symptoms (p = 0.03). There was no correlation between insight and positive syndrome.

Our results show that the lack of insight is closely related to negative symptoms and the duration of the illness in patients with SCZ. Therefore, interventions to better the insight should focus on early diagnosis and psychosocial therapy to improve negative symptoms.