Insight, satisfaction with pharmacological treatment and treatment outcome in patients with schizophrenia: results of the long-term prospective study CLIPS

Background: Schizophrenia patients that lack capacity or motivation to follow treatment instructions show reduced possibility for stable improvement of clinical status and an increased risk for recurrent symptomatic episodes. The aim of this study is to assess the relationship between components known to be important for treatment adherence: patients’ satisfaction with pharmacological treatment, illness severity, cognitive capacity and insight in symptoms and disease. Methods Data are derived from 507 patients enrolled in a long-term prospective study in Sweden. All parameters were assessed at baseline for a cross-sectional relational analysis. Insight as well as remission state were also determined each year in a 3-year follow-up longitudinal study. Results Patients satisfied with treatment show less severe symptoms, are more often in remission and show a higher degree of insight in symptoms and disease. Neither satisfaction with treatment nor insight correlates to cognition in this study. During follow-up, insight scores increased in parallel to the number of patients in remission in the group where patients alternate between remission and not-remission. Insight in symptoms increased first and thereafter insight regarding underlying cause, is else schizophrenia as a disease. Conclusions Patients that clinically do better are more satisfied with treatment and show more insight in their symptoms and disease. Positive treatment results appear to directly improve patients’ satisfaction and insight, suggesting those to be a state phenomenon secondary to treatment outcome. This supports the need for stable symptomatic remission as treatment goal.