Supplementary Material for: Impact of delusions and hallucinations on clinical insight dimensions in schizophrenia spectrum disorders

Introduction:
Insight in psychosis has been conceptualized as a continuous, dynamic and multidimensional phenomenon. This study aims to determine the impact of delusions and hallucinations in different dimensions of clinical insight in schizophrenia spectrum disorders.

Methods:
Cross-sectional multicenter study including 516 patients (336 men) diagnosed with schizophrenia spectrum disorders. Based on dichotomized scores of Positive and Negative Syndrome Scale (PANSS) items P1 (delusions) and P3 (hallucinations), patients were assigned to four groups according to current clear presence of delusions (scores 4 or above 4 in PANSS item P1) and/or hallucinations (scores 4 or above 4 in PANNS item P3). Insight was assessed using the three main dimensions of the Scale of Unawareness of Mental Disorder (SUMD).

Results:
Around 40% of patients showed unawareness of illness; 30% unawareness of the need for treatment; and 45% unawareness of the social consequences of the disorder. Patients with current clear presence of delusions had higher overall lack of awareness, regardless of current clear presence of hallucinations. Similarly, the clear presence of delusions showed a greater predictive value on insight than the presence of hallucinations, although the implication of both in the prediction was modest.

Conclusions:
Our results confirm that lack of insight is highly prevalent in schizophrenia spectrum disorders, particularly when patients experience delusions. This study adds insight related data to the growing symptom-based research, where specific types of psychotic experiences such as hallucinations and delusions could form different psychopathological patterns, linking the phenomenology of delusions to a lack of clinical insight.

Introduction:
精神病性障碍中的临床自知力已被概念化为一种连续、动态且多维度的现象。本研究旨在明确妄想与幻觉对精神分裂症谱系障碍患者临床自知力不同维度的影响。

Methods:
本研究为横断面多中心研究，共纳入516名精神分裂症谱系障碍患者（其中男性336名）。基于阳性与阴性症状量表（Positive and Negative Syndrome Scale, PANSS）的P1项（妄想）与P3项（幻觉）的二分法得分，根据当前是否明确存在妄想（PANSS P1项得分≥4分）和/或幻觉（PANSS P3项得分≥4分），将患者分为四组。采用精神障碍自知力缺陷量表（Scale of Unawareness of Mental Disorder, SUMD）的三个核心维度对患者的自知力进行评估。

Results:
约40%的患者存在疾病自知力缺失，30%存在治疗需求自知力缺失，45%存在疾病社会后果认知缺陷。无论当前是否明确存在幻觉，存在明确妄想的患者整体自知力缺失程度均更高。同样，相较于幻觉的存在，明确存在的妄想对自知力的预测价值更高，尽管二者对预测模型的贡献均较为有限。

Conclusions:
本研究结果证实，精神分裂症谱系障碍患者的自知力缺失患病率极高，尤其在存在妄想症状的患者中更为显著。本研究为日益增多的基于症状的研究补充了与自知力相关的数据；在该研究框架下，幻觉、妄想等特定类型的精神病性体验可形成不同的精神病理模式，且妄想的现象学特征与临床自知力缺失存在关联。