Short insight scale validated for schizophrenia in clinical practice

By Eleanor McDermid, Senior medwireNews Reporter

Researchers have validated a short version of the Scale to Assess Unawareness in Mental Disorder (SUMD), with the aim of encouraging assessment of insight in patients with schizophrenia in clinical practice.

Lack of insight is associated with poor treatment response and outcomes in patients with schizophrenia, say study author Laurent Boyer (Aix-Marseille University, France) and colleagues. The SUMD is widely used in clinical trials but is impractical in clinical practice because of its length: it contains 74 items.

For the current study, Boyer et al validated a previously published short version of the SUMD, using data from 531 French schizophrenia patients. They say that this version, which contains just nine items, “may appear to be more practical than the long version and could lead to the inclusion of insight assessments as a part of routine clinical practice to offer individualised care.”

The team used two models to assess the reliability and validity of the abbreviated SUMD: one in which the answer “not applicable” was replaced with the value 0, and one in which it was treated as a missing value. For both models, the scale had satisfactory scalability and internal consistency.

The scale, which had a three-factor structure (awareness of disease and need for treatment, awareness of positive symptoms, awareness of negative symptoms), also showed good external validity. The two symptom-related factors correlated significantly with patients’ scores on the Positive and Negative Syndrome Scale (PANSS), and all SUMD factors correlated with the PANSS item “lack of judgment and conscience of the disease.”

Despite its potential utility in clinical practice compared with the original SUMD, the researchers note that the short version has a reduced focus, “which does not assess the attribution phenomenon.”

They therefore stress that it should not replace the full version of the scale. “Indeed, the long version is of particular interest because of its multidimensional approach to defining insight and its detailed assessment of patients’ awareness of and attributions for a wide range of signs and symptoms,” the team writes in BMC Psychiatry.

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