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Causal model of insight and psychopathology based on the PANSS factors: 1-year cross-sectional and longitudinal revalidation

Hwang, Samuel Suk-Hyuna b; Chang, Jae Seungd; Lee, Kyu Younge; Kim, Se Hyunb; Ahn, Yong Minb c; Kim, Yong Sika b c

International Clinical Psychopharmacology: July 2009 - Volume 24 - Issue 4 - p 189-198
doi: 10.1097/YIC.0b013e32832d6bca
Original Articles

This study presents results of a 1-year follow-up investigation of the causal model of insight in schizophrenia using a subsample of acute patients starting or switching to amisulpride included in an earlier study. Our causal model of insight based on the Positive and Negative Syndrome Scale factors, with the positive, negative, and autistic preoccupation factors designated as the primary predictors, and the activation factor as a mediating variable of insight, was examined for fitness at the stabilized stage (8 week) and at the chronic stage (1 year) using the structural equation modeling method. Results showed that the intercorrelations among the factors and regression coefficients toward insight changed in their magnitudes, but the validity of our hypothesized model of insight was still confirmed for both the stages with nearly perfect goodness-of-fitness indices. The fitness of the model was also confirmed for the longitudinal changes in the scores of insight and psychopathology. An alternative model, which included the anxiety/depressive factor as a second mediating variable between insight and the positive and negative factors, was also found to be valid for both the stages. A post-hoc causal model with anxiety/depressive factor showed tentative evidence favoring anxiety/depressive variable predicting insight than the other way around.

aInterdisciplinary Program in Brain Science, Department of Natural Science, Sillim-Dong, Kwanak-Gu

bInstitute of Human Behavioral Medicine

cDepartment of Psychiatry and Behavioral Science, Seoul National University, College of Medicine, Yeongeon-Dong, Jongno-Gu

dDepartment of Psychiatry, Seoul National University Bundang Hospital, Bundang-Gu, Seongnam-Si, Gyeonggi-Do

eDepartment of Neuropsychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Korea

Correspondence to Dr Yong Sik Kim, Department of Psychiatry and Behavioral Science, Seoul National University, College of Medicine, 28 Yeongeon-Dong, Jongno-Gu, Seoul 110-744, Korea

Tel: +82 2 2072 2204; fax: +82 2 744 7241; e-mail:

Received 12 November 2008 Accepted 27 April 2009

© 2009 Lippincott Williams & Wilkins, Inc.