We investigated which factors could influence insight in psychosis.

117 in-out patients recruited in the Psychiatric Service of Santa Maria Hospital, Lisbon (Portugal) diagnosed with schizophrenia, schizoaffective and schizophreniform disease, psychosis also drug induced, were evaluated with SAI to asses insight, MARS for medication compliance, WHOQOOL-BREF for Quality of Life, BPRS and PANSS for psychopathological symptoms, I.A test (Reduced Raven's Matrix) for Intellectual Ability. Bivariate correlations were operated using Spearman correlation coefficient (p<0,01). Regression analyses with stepwise ascending regression were computed to assess predictors for insight.

We found significant negative correlations between SAI total score and Delusions, Conceptual Disorganization, Hallucinatory Behavior, Suspiciousness, Poor Rapport, Stereotyped Thinking, Somatic Concerns, Unusual Thought Content, Lack of Judgment of Insight of PANSS, Self Neglect of BPRS and Professional State. Positive significant correlation was between SAI and MARS total score. The regression analysis showed negative relations between PANSS Poor Rapport, Suspiciousness, Guilt Feelings, Active Social Avoidance and Insight; positive relation between Depression (PANSS) and Insight.

Poor Insight was determined by Poor Rapport and Social Avoidance maybe because patients are less predisposed to compare their situations with the surroundings, showing defensive denial and less criticism towards symptoms. Suspiciousness contributes to poor insight due to distrustful attitude that makes difficult to accept the diagnosis and the idea of being seek. Guilt feelings determine poor insight as they are prodromes of delusions. Depression increases insight as a consequence of the painful feelings that make patients think about their situations.