Participants showed good insight only to people scored high or

Participants showed good insight; only 5 (8.2%) to 8 (13.1%) people scored high (4 or 5) in the SUMD dimensions. Overall, illness perceptions for cognitive and comprehension dimensions were favorable, but unfavorable for the emotional dimension. Clinical status of sample was characterized by mild symptoms as measured by the PANSS, CDS, and BAI scales. Descriptive data are presented in Table 1.
An analysis of differences in insight, illness perception and clinical status scores comparing groups by diagnosis, educational level, or having a partner, showed no significant results in general. Only in the PANSS negative dimension patients with schizophrenia (t(59)=3.10, 0.01), lower educational level (t(59)=2.25, 0.05), and without a partner scored higher (t(59)=2.12, 0.05). Time from onset, current age and age at onset showed no significant correlation with insight, illness perception and clinical status scores. Depression was associated with older current (r=0.48, p≤0.001) and onset age (r=0.47, p≤0.001).
Data for the association of insight and illness perception are presented in Table 2. Cognitive and emotional perceptions of illness were not related to any of the three dimensions of insight. Comprehension was negatively and significantly correlated to both, unawareness of mental disorder and of its social consequences; that is, patients who feel they scd1 understand well their disorder show better insight of illness and its social effects. Comprehension was not related to insight into medication effects. A detailed analysis of illness perception items revealed only three significant results: patients perceiving treatment as useful showed better insight of the disorder (but not of its social consequences) and of the effects of medication, and those who see the experienced symptoms as severe are more aware of the social consequences.
Regarding clinical status (Table 3), higher scores for positive symptoms and general psychopathology were significantly related to poorer insight (higher unawareness scores). Higher scores on negative symptoms were related to unawareness of social consequences. Overall, cognitive and emotional perceptions of illness were significantly related to most clinical status parameters, whereas comprehension showed no significant results.

Discussion
Participants showed fairly good levels of insight and favorable cognitive and comprehension illness perceptions, but emotions towards illness were unfavorable. From a perspective of lack of insight as a symptom (Cooke et al., 2005; Osatuke et al., 2008), sample patients’ good overall insight could be attributed to the fact that none of the participants was in a frank psychotic episode, and those who presented severe residual symptoms had to be excluded as they could not follow the interview. Furthermore, it should not be overlooked that positive and general psychopathology, although mild, were significantly associated with all three dimensions of insight, replicating the link between insight and psychopathology (McEvoy et al., 2006; Mintz et al., 2003, 2004; Mutsatsa et al., 2006), which is not always supported by research (Hasson-Ohayon et al., 2006; Lincoln et al., 2007; McEvoy et al., 1989). Results might also concur with the view of lack of insight as a coping process against distress (Buckley et al., 2007; Cooke et al., 2005; Osatuke et al., 2008). Insight improves patient’s prognosis but at the same time it increases psychological distress. The acceptance of having an illness, particularly influenced by the stigmatizing beliefs, might explain this paradox (Lysaker et al., 2007). The association of insight and demoralization seems stronger as self-stigma increases (Cavelti et al., 2012b; Lysaker et al., 2013a) and patients with good insight accompanied by stigmatizing beliefs have the highest risk of experiencing low quality of life, negative self-esteem, and depressed mood (Staring et al., 2009). As all participants had partial or total symptom remission, that is, illness was under control, patients might have been more willing to acknowledge a mental disorder and the benefits of treatment. Yet, insight was high and depression was scd1 low, but they were not significantly related. Lack of insight could have etiological bases other than denial or coping, yet they still serve to psychologically protect the individual from depression (Osatuke et al., 2008); this hypothesis requires adequate evaluation, unfortunately, data was not sufficient for testing.