Mental health (MH) system in Serbia still relies heavily on the medical model with very restricted availability of community-based support. The aim of this study was to provide insight into the everyday experiences and unmet needs of psychiatric users suffering from schizophrenia spectrum disorders in Serbia who are also users of community MH services.

We recruited the participants (N = 11; 9 males; aged 26–65, M = 48.5), long-term psychiatric users (11–57 years, M = 29.4) diagnosed with a schizophrenia spectrum disorder, from a community MH centre. We conducted in-depth semi-structured interviews with them, which we analysed relying on the principles of thematic analysis.

Three broad themes relevant to participants’ well-being and quality of life were identified: leading a meaningful and fulfilled life; the importance of continuity of socialisation and support; and maintaining control and a sense of agency. Community MH services have markedly figured in facilitating all three dimensions.

Findings suggest that providing continuous services that address the users’ need to engage in activities that give them meaning and purpose, provide socialisation and peer support, and promote their autonomy and agency can play a vital role in advancing the process of recovery and well-being of long-term psychiatric users.

Interactions between the endocannabinoid system (ECS) and neurotransmitter systems might mediate the risk of developing a schizophrenia spectrum disorder (SSD). Consequently, we investigated in patients with SSD and healthy controls (HC) the relations between (1) plasma concentrations of two prototypical endocannabinoids (N-arachidonoylethanolamine [anandamide] and 2-arachidonoylglycerol [2-AG]) and (2) striatal dopamine synthesis capacity (DSC), and glutamate and y-aminobutyric acid (GABA) levels in the anterior cingulate cortex (ACC). As anandamide and 2-AG might reduce the activity of these neurotransmitters, we hypothesized negative correlations between their plasma levels and the abovementioned neurotransmitters in both groups.

Blood samples were obtained from 18 patients and 16 HC to measure anandamide and 2-AG plasma concentrations. For all subjects, we acquired proton magnetic resonance spectroscopy scans to assess Glx (i.e. glutamate plus glutamine) and GABA + (i.e. GABA plus macromolecules) concentrations in the ACC. Ten patients and 14 HC also underwent [18F]F-DOPA positron emission tomography for assessment of striatal DSC. Multiple linear regression analyses were used to investigate the relations between the outcome measures.

A negative association between 2-AG plasma concentration and ACC Glx concentration was found in patients (p = 0.008). We found no evidence of other significant relationships between 2-AG or anandamide plasma concentrations and dopaminergic, glutamatergic, or GABAergic measures in either group.

Our preliminary results suggest an association between peripheral 2-AG and ACC Glx levels in patients.

Whether exist a potential association between schizophrenia spectrum disorders following past exposure to ionizing radiation and SARS CoV-2 infection is unknown.

To assess a possible role of double radiation-viral exposure in pre- and postnatal periods in schizophrenia spectrum disorders genesis.

Integration and analysis of information available with the results of own clinical and epidemiological studies.

The renaissance of interest to the viral hypothesis of schizophrenia is observing during the current COVID-19 pandemic. There is an increasing number of cases and case series reports on psychotic schizophreniform disorders following SARS CoV-2 infection diagnosed as COVID-19-asssociated brief psychotic disorder, first episode psychosis, acute and transient psychotic disorder. The prevalence rate of schizophrenia in A-bomb survivors in Nagasaki was very high – 6 % (Nakane and Ohta, 1986), and increased in those prenatally exposed to A-bombing (Imamura et al., 1995) and medical X-irradiation (Gross et al., 2018). We found a significant increase in the schizophrenia incidence in the Chornobyl exclusion zone personnel, as well as schizophreniform syndromes in Chornobyl clean-up workers (liquidators) irradiated by moderate to high doses (more than 0.30 Sv). The neural diathesis-stressor hypothesis of schizophrenia spectrum disorders was proposed (Loganovsky and Loganovskaja, 2000; Loganovsky et al., 2005). Recently we observed the clinical case of organic schizophrenia-like disorder in the liquidator who was ill with COVID-19.

The linkage between schizophrenia spectrum disorders following past exposure to ionizing radiation and SARS CoV-2 infection can exist that should be studied on the irradiated cohorts with following COVID-19.

No significant relationships.

Mental healthcare provision is undergoing substantial reconfiguration in many regions of the world. Such changes require a broad evidence-based approach incorporating epidemiological data and information of local needs.

To estimate the prevalence of schizophrenia spectrum disorders (SSDs) in the Lazio region and its geographical distribution using the regional health information systems (HIS).

Cases of SSDs (15-64-year-old) were identified using an algorithm based on data from the hospital discharge registry [ICD IX CM: 295, 297, 298 (excl. 298.0)] and the ticket exemption database [code 044], between 2006 and 2019. Crude, and age- and gender-specific prevalence estimates on December 31, 2019, were calculated. To compare prevalence between different areas within the region, we calculated age- and gender-adjusted prevalence rates

A total of 18,371 cases were identified. Crude prevalence rate was 4.29/1,000 (95% CI 4.29-4.30) and 5.93/1,000 (95% CI 5.92-5.949 for women and men, respectively. An increase in the prevalence rate by age was observed in both genders. The age- and gender-adjusted prevalence rate was 5.03/1,000 (95 % CI 4.96-5.10), with significant differences within the region, ranging from 4.25/1,000 in the province of Viterbo to 5.42/1,000 in the city of Rome and 6.02/1000 in the province of Frosinone.

Our results showed that the overall prevalence of SSDs among adults in the Lazio region is similar to estimates published in prior reviews, but an uneven regional geographical distribution was observed. While possible underestimation must be considered, HIS represents a valuable source of information useful for epidemiological surveillance and healthcare planning.

No significant relationships.

Despite of the heightened risks and burdens of physical comorbidities across the entire schizophrenia spectrum disorders (SSD), relatively little is known about physical multimorbidity (CPM) in this population. The study’s main objective was to explore the differences in the CPM prevalence between SSD patients and the general population (GEP).

The primary outcome was to explore the difference in CPM prevalence in the younger SSD and GEP groups (<35 years).The secondary outcome was the number of psychiatric readmissions.

This nested cross-sectional study enrolled 343 SSD patients and 620 GEP participants.

Younger SSD patients had more than three-fold higher odds for CPM than GEP. We also demonstrated an association between the presence of CPM and the number of psychiatric admissions in the SSD population independently of possible confounders. We did not observe significant interaction of CPM and age in the prediction of clozapine use. Younger women with SSD had statistically significant, almost four-fold higher odds of CPM than women from GEP.

This study suggests that women with SSD are at increased physical comorbidity risk compared to men, particularly early in the course of psychiatric illness. Our results highlight the importance of addressing physical health from the first contact with a mental health service to preserve general health, and provide the best possible treatment outcome. Treatment of SSD must be customized to meet the needs of patients with different physical multimorbidity patterns.

No significant relationships.

Mindfulness-based interventions have received growing attention over the last years for the treatment of various mental disorders, including schizophrenia spectrum disorders (SSD), demonstrating their transdiagnostic validity. However, no study has examined the relationship of probable mechanisms underlying the therapeutic effects of mindfulness in SSD.

The current study examines the relationship between mindfulness, depression, anxiety, and quality of life in individuals with SSD through quantitative measures.

A total of 83 participants with SSD were recruited at the in- and outpatient facility of the Charité – Universitätsmedizin Berlin in Germany. Participants completed the Southampton Mindfulness Questionnaire, Comprehensive Inventory for Mindful Experiences, and Freiburger Mindfulness Inventory, the Depression, Anxiety, Stress Scale, and the World Health Organization Quality of Life Questionnaire. PROCESS analysis examined the relationship between mindfulness and quality of life and the mediating role of depression and anxiety.

Indicated a significant positive association between mindfulness and physical health, psychological and environmental quality of life. Depression and anxiety were found to mediate this relationship, with higher depression and anxiety scores being related to lower mindfulness and quality of life. In this relationship, however, depression was found to be the stronger predictor.

The findings of this study provide insight into the mechanisms of mindfulness. Initial evidence for the transdiagnostic and process-based clinical relevance of MBIs for SSD has been found and future studies can further explore the role of mindfulness for central therapeutic processes of change by employing longitudinal designs.

No significant relationships.

Concerns have been raised about ecological momentary assessment (EMA) acceptability among patients with schizophrenia spectrum disorders (SSD), which is of major relevance during the e-Mental health-focused COVID-19 pandemic.

To investigate i) the levels of adherence to a passive smartphone-based EMA tool, the Evidence-Based Behavior (eB2), among SSD patients; and ii) putative predictors of this.

Sample: SSD (F20-29-ICD10) outpatients, age 18-64, without financial incentives, recruited over 17/06/2019-11/03/2020 at the Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain). Those who accepted the eB2 installation -users- and those who did not -non-users- were compared in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight and metacognitive variables by a multivariable binary logistic regression model.

Sample (N=77): n=41 males; age: 47.69±9.76 years, n=24 users (31.2%). n=14 users (70%) had the eB2 installed at follow-up (median=14.50 weeks).

X2=25.296,df=6,p<0.001. Nagelkerke-R2=44.7%. Correctly classified: 76.9%, users:54.5%, non-users:88.4%.

Acceptability of a smartphone-based EMA application among SSD patients was low. Age (young) and good premorbid adjustment predicted acceptability. e-Mental Health methods need to be tailored for patients with SSD. Otherwise, these highly vulnerable individuals may be neglected by e-health-based services in the post-COVID-19 years ahead.

HIV-positive patients with schizophrenia spectrum disorders experience burden of double stigma. Comorbid pathology may alter structure of stigma and shall be considered in development of individual destigmatization programs.

Study of psychiatric stigma features in HIV-positive and HIV-negative patients with schizophrenic disorders.

ISMI (Ritsher et al., 2003), PDD (Link et al., 1991) – to study stigma in 70 patients divided into three groups with respect to their diagnosis (I — F20.x, II — F21.x, III— F2x+HIV); BPRS (Overall & Gorham, 1962) – to assess psychiatric status, RSAS (Eckblad et al., 1982) – to assess anhedonia. Dispersion analysis (Kruskal and Mann–Whitney tests), Spearman and Pearson correlation were used.

Patients with comorbid HIV-infection showed increased level of perceived stigma, although they resisted the stigma internalization better than others did (Table 1).

Patients with schizotypal disorders and patients at early stages of HIV infection experienced the most alienation and frailty to internalization of stigma (Tables 1, 2).

Correlation relationship between social anhedonia and perceived stigma (r=0.5, p<0.05) observed in patients with HIV infection.

Comorbid HIV infection in psychiatric patients contributes to the psychiatric stigma structure. Differentiated approaches in rehabilitation of HIV-positive mental patients should be used.

The relationship between history of childhood trauma (CT) and current schizophrenic symptoms is complex and controversial. Most of the studies report more positive psychotic symptoms (PPS) in psychotic patients who had suffered CT. Findings for negative psychotic symptoms (NPS) are mixed: most authors do not find differences or even find less.

The purpose of this study is to evaluate and describe the types of CT suffered by patients diagnosed with schizophrenia spectrum disorders (SSD), and to analyse the relationship between history of CT and the present-time intensity of PPS and NPS.

We conducted a cross-sectional study of 45 adult patients with a SSD. Instruments: Childhood Trauma Questionnaire, short form (CTQ-SF) for measuring CT and Positive and Negative Syndrome Scale (PANSS) to assess the PPS and NPS of psychosis.

77.8% of the patients reported having suffered any kind of CT. By types of trauma: 48.9% reported emotional abuse, 28.9% physical abuse, 40.0% sexual abuse, 55.6% emotional neglect and 46.7% physical neglect. A lineal correlation between CTQ-SF and PANSS+/- scores was performed. Neither total PANSS+ nor any particular PANSS+ items correlate with CTQ scores. A significant inverse lineal association of moderate intensity exists between total PANSS− score and CT intensity (ρ = −0.300, p = 0.045)

In line with previous research, our study has found inverse correlation between NPS and CT. In contrast, no association was found between PPS and CT. Our sample was mostly composed by chronic patients, which might explain the differences with the previous literature.

No significant relationships.

The therapeutic effectiveness of mindfulness-based interventions (MBIs) has been shown for various mental disorders. However, for schizophrenia spectrum disorders (SSD), only a few trials have been conducted, mostly in outpatient settings.

This study aimed to investigate feasibility, acceptability, and preliminary effectiveness of a four-week mindfulness-based group therapy (MBGT) for in-patients with SSD.

A pre-registered randomized controlled trial (RCT) was conducted at the in-patient ward for SSD. All measures were employed at baseline, post-intervention (4-weeks), and follow-up (12-weeks). The primary outcome was ‘mindfulness’. Secondary outcomes were rater-blinded positive- and negative symptoms, depression, social functioning, as well as self-rated mindfulness, depression, anxiety, psychological flexibility, quality of life, and medication regime.

N=40 participants were randomized into either four-week treatment-as-usual (TAU; n=19) or MBGT+TAU (n = 21). Protocol adherence was 95.2%, and the retention rate to treatments was 95%. ANCOVA analysis revealed significant improvements in the MBGT+TAU compared to TAU for the primary outcome and negative symptoms. Exploratory analyses showed medium-to-large intervention effects on secondary outcomes mindfulness, positive, negative, and depressive symptoms, psychological flexibility, quality of life, and social functioning for MBGT+TAU and small-to-moderate changes on positive symptoms and social functioning for TAU. No serious adverse effects were reported.

This study supports the feasibility and acceptability of MBGT for in-patients with SSD, including high protocol adherence and retention rates. A proof of concept of the MBIs and corresponding improvements on various clinical and process parameters warrant a fully powered RCT to determine effectiveness, cost-efficiency, and longitudinal outcomes of MBGT for SSD.

No significant relationships.

Yoga may pose a promising complementary therapy in the multimodal treatment of schizophrenia spectrum disorders (SSD). However, to date, no studies have qualitatively examined the patients’ experience of practising Yoga.

This qualitative study aimed to assess the mechanisms and processes of Yoga-based group therapy (YBGT) for in-patients with SSD by exploring their subjective experiences.

Twenty-five semi-structured interviews were conducted with in-patients with SSD after they participated in a YBGT session. Interviews were transcribed, coded by two independent researchers, and analysed using an inductive thematic approach. The research team collaboratively discussed emerging categories to reduce redundancy and form meaningful themes and subthemes.

The analysis revealed seven main themes. YBGT was perceived as feasible and focusing on individual adaptation, captured by the theme ‘inclusivity’. Nevertheless, participants encountered ‘challenges’; thus, physical limitations need to be considered. While practising together, participants experienced ‘interconnectedness’ and developed a ‘mindful stance’ as they accepted their limitations and adapted exercises with self-compassion. Following the flow of asanas required physical persistence, which ultimately led many participants to experience ‘confidence’ and ‘relaxation’. YBGT affected ‘symptom representation’ as heightened awareness led participants to notice impeding as well as improved symptoms.

YBGT seemed to have various promising effects on in-patients with SSD. Future research should examine to what extent these effects can be sustained and how the mindful approach during YBGT can be transferred to areas outside the Yoga class. Furthermore, a randomised-controlled trial could investigate the effectiveness of a manualised YBGT.

No significant relationships.

Schizophrenia spectrum disorders (SSD) are characterized by heterogeneity. Cognitive decline, due to recent research results, appears to be a core symptom of schizophrenia. Dimensional approach of SSDs allows the separate assessment of each psychotic symptom, as well as cognitive functioning. Thus, correlations among them and their alterations, between baseline and follow up examination, can be estimated.

The objective of this study is to correlate observed alterations in cognitive performance in patients diagnosed with schizophrenia spectrum disorders, compared with baseline measurement, with alterations in severity of psychotic symptoms.

85 Patients diagnosed with schizophrenia spectrum disorders, attended in the Outpatient Department of Early Intervention in Psychosis of University of Thessaly, Greece and its affiliated psychiatric clinics, were evaluated the last 24 months, using the CRDPSS (Clinician-Rated Dimensions of Psychosis Symptoms Severity) measure and the validated greek version of the MoCA test. 37 of them had a follow up evaluation. The relationship between the two new categorical variables [dMoCA (positive- negative) and dmCRDPSS7 (positive-negative)] was assessed with x² test.

Alterations in cognitive function, as assessed with MoCA scale and dMoCA variable, were inversely correlated with the alteration in mean severity of other dimensions of psychosis symptoms (dmCRDPSS7), x²(1, N = 37) = 9.4891, p = .0021.

Our data suggest that alterations in cognitive performance may predict an inverse effect in the severity of psychotic symptoms. Periodic follow up of cognitive functioning in patients diagnosed with schizophrenia spectrum disorders is suggested, since it can be interpreted in clinically useful information considering relapse.

No significant relationships.

Patients with schizophrenia spectrum disorders (SSD) have worse physical health and reduced life expectancy compared to the general population. In 2009, the European Psychiatric Association, the European Society of Cardiology and the European Association for the Study of Diabetes published a position paper aimed to improve cardiovascular and diabetes care in patients with severe mental illnesses. However, the initiative did not produce the expected results. Experts in SSD or in cardiovascular and metabolic diseases convened to identify main issues relevant to management of cardiometabolic risk factors in schizophrenia patients and to seek consensus through the Delphi method.

The steering committee identified four topics: 1) cardiometabolic risk factors in schizophrenia patients; 2) cardiometabolic risk factors related to antipsychotic treatment; 3) differences in antipsychotic cardiometabolic profiles; 4) management of cardiometabolic risk. Twelve key statements were included in a Delphi questionnaire delivered to a panel of expert European psychiatrists.

Consensus was reached for all statements with positive agreement higher than 85% in the first round. European psychiatrists agreed on: 1) high cardiometabolic risk in patients with SSD, 2) importance of correct risk management of cardiometabolic diseases, from lifestyle modification to treatment of risk factors, including the choice of antipsychotic drugs with a favourable cardiometabolic profile. The expert panel identified the psychiatrist as the central coordinating figure of management, possibly assisted by other specialists and general practitioners.

This study demonstrates high level of agreement among European psychiatrists regarding the importance of cardiovascular risk assessment and management in subjects with SSD.

Patients with schizophrenia spectrum disorders (SSD) tend to lack insight, which is linked to poor outcomes. The effect size of previous treatments on insight changes in SSD has been small. Metacognitive interventions may improve insight in SSD, although this remains unproved.

We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of metacognitive interventions designed for SSD, namely Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT), on changes in cognitive and clinical insight at post-treatment and at follow-up.

Twelve RCTs, including 10 MCT RCTs (n = 717 participants) and two MERIT trials (n = 90), were selected, totalling N = 807 participants. Regarding cognitive insight six RCTs (n = 443) highlighted a medium effect of MCT on self-reflectiveness at post-treatment, d = 0.46, p < 0.01, and at follow-up, d = 0.30, p < 0.01. There was a small effect of MCT on self-certainty at post-treatment, d = −0.23, p = 0.03, but not at follow-up. MCT was superior to controls on an overall Composite Index of cognitive insight at post-treatment, d = 1.11, p < 0.01, and at follow-up, d = 0.86, p = 0.03, although we found evidence of heterogeneity. Of five MCT trials on clinical insight (n = 244 participants), which could not be meta-analysed, four of them favoured MCT compared v. control. The two MERIT trials reported conflicting results.

Metacognitive interventions, particularly Metacognitive Training, appear to improve insight in patients with SSD, especially cognitive insight shortly after treatment. Further long-term RCTs are needed to establish whether these metacognitive interventions-related insight changes are sustained over a longer time period and result in better outcomes.

The Bern Psychopathology Scale (BPS) is based on a system-specific approach to classifying the psychopathological symptom pattern of schizophrenia. It consists of subscales for three domains (language, affect and motor behaviour) that are hypothesized to be related to specific brain circuits. The aim of the study was to examine the factor structure of the BPS in patients with schizophrenia spectrum disorders.

One hundred and forty-nine inpatients with schizophrenia spectrum disorders were recruited at the Department of Psychiatry II, Ulm University, Germany (n = 100) and at the University Hospital of Psychiatry, Bern, Switzerland (n = 49). Psychopathology was assessed with the BPS. The VARCLUS procedure of SAS® (a type of oblique component analysis) was used for statistical analysis.

Six clusters were identified (inhibited language, inhibited motor behaviour, inhibited affect, disinhibited affect, disinhibited language/motor behaviour, inhibited language/motor behaviour) which explained 40.13% of the total variance of the data. A binary division of attributes into an inhibited and disinhibited cluster was appropriate, although an overlap was found between the language and motor behaviour domains. There was a clear distinction between qualitative and quantitative symptoms.

The results argue for the validity of the BPS in identifying subsyndromes of schizophrenia spectrum disorders according to a dimensional approach. Future research should address the longitudinal assessment of dimensional psychopathological symptoms and elucidate the underlying neurobiological processes.

There is increasing interest in the clinical and aetiological overlap between autism spectrum disorders and schizophrenia spectrum disorders, reported to co-occur at both diagnostic and trait levels. Individually, sub-clinical autistic and psychotic traits are associated with poor clinical outcomes, including increased depressive symptomatology, self-harming behaviour and suicidality. However, the implications when both traits co-occur remain poorly understood. The study aimed to (1) examine the relationship between autistic and psychotic traits and (2) determine if their co-occurrence increases depressive symptomatology, self-harm and suicidality.

Cross-sectional data from a self-selecting (online and poster advertising) sample of the adult UK population (n = 653) were collected using an online survey. Validated self-report measures were used to assess sub-clinical autistic and psychotic traits, depressive symptomatology, self-harming behaviour and suicidality. Correlation and regression analyses were performed.

A positive correlation between sub-clinical autistic and positive psychotic traits was confirmed (rs = 0.509, p < 0.001). Overall, autistic traits and psychotic traits were, independently, significant predictors of depression, self-harm and suicidality. Intriguingly, however, depression was associated with a negative interaction between the autistic domain attention to detail and psychotic traits.

This study supports previous findings that sub-clinical autistic and psychotic traits are largely independently associated with depression, self-harm and suicidality, and is novel in finding that their combined presence has no additional effect on depression, self-harm or suicidality. These findings highlight the importance of considering both autistic and psychotic traits and their symptom domains in research and when developing population-based depression prevention and intervention strategies.

We aimed to test a mindfulness-based psychoeducation group (MBPEG), v. a conventional psychoeducation group (CPEG) v. treatment as usual (TAU), in patients with schizophrenia-spectrum disorders over a 24-month follow-up.

This single-blind, multi-site, pragmatic randomized controlled trial was conducted in six community treatment facilities across three countries (Hong Kong, mainland China and Taiwan). Patients were randomly allocated to one of the treatment conditions, and underwent 6 months of treatment. The primary outcomes were changes in duration of re-hospitalizations and mental state (Positive and Negative Syndrome Scale; PANSS) between baseline and 1 week, and 6, 12 and 18 months post-treatment.

A total of 300 patients in each country were assessed for eligibility between October 2013 and 30 April 2014, 38 patients per country (n = 342) were assigned to each treatment group and included in the intention-to-treat analysis. There was a significant difference in the length of re-hospitalizations between the three groups over 24 months (F 2,330 = 5.23, p = 0.005), with MBPEG participants having a shorter mean duration of re-hospitalizations than those in the other groups. The MBPEG and CPEG participants had significant differential changes in proportional odds ratios of complete remission (all individual PANSS items <3) over the 24-month follow-up (37 and 26%, respectively), as opposed to only 7.2% of the TAU group (χ2 = 8.9 and 8.0, p = 0.001 and 0.003, relative risk = 3.5 and 3.1, 95% confidence interval 2.0–7.2 and 1.6–6.3).

Compared with TAU and CPEG, MBPEG improves remission and hospitalization rates of people with schizophrenia spectrum disorders over 24 months.

This study presents an initial evaluation of the psychometric properties of the Dynamic Occupation Assessment of Executive Function (DOAEF), a new tool designed to assess adolescents’ executive function (EF) in daily situations and offering two levels of mediation through the administration process.

In the preliminary study, we tested 22 healthy adolescents. In the advanced stage, the instrument was administered to 105 healthy adolescents and to another 92 adolescents diagnosed with schizophrenia spectrum disorders. Information regarding EF was assessed by the DOAEF and Wisconsin Card Sorting Computer Version Test (WCST-CV-64).

Inter-rater, test–retest and internal consistency indices were found to be satisfactory. Correlation between the DOAEF and the WCST-CV-64 scores supports the DOAEF's convergent validity. Significant differences were found between the healthy participants and the adolescents diagnosed with schizophrenia spectrum disorders, thus supporting the DOAEF's criterion validity.

The DOAEF may be useful in assessing the level of mediation, which patients need for the comprehension of daily situations in which EFs are required.

Insight, positive and negative symptoms, hope, depression and self-stigma are relevant variables in schizophrenia spectrum disorders. So far, research on their mutual influences has been patchy. This study simultaneously tests the associations between these variables.

A total of 284 people with schizophrenia spectrum disorders were assessed using the Schedule for the Assessment of Insight, Positive and Negative Syndrome Scale, Integrative Hope Scale, Centre for Epidemiological Studies Depression Scale and Internalized Stigma of Mental Illness scale. Path analysis was applied to test the hypothesized relationships between the variables.

Model support was excellent. Strong and mutual causal influences were confirmed between hope, depression and self-stigma. The model supported the assumption that insight diminishes hope and increases depression and self-stigma. While negative symptoms directly affected these three variables, reducing hope and increasing depression and self-stigma, positive symptoms did not. However, positive symptoms diminished self-stigma on a pathway via insight.

This study provides a comprehensive synopsis of the relationships between six variables relevant for schizophrenia spectrum disorders. Research implications include the need to investigate determinants of consequences of insight, and the sequence of influences exerted by positive and negative symptoms. Clinical implications include the importance of interventions against self-stigma and of taking a contextualized approach to insight.