Open Access Open Badges Research article

Insight, psychopathology, explanatory models and outcome of schizophrenia in India: a prospective 5-year cohort study

Shanthi Johnson1, Manoranjitham Sathyaseelan1, Helen Charles1, Visalakshi Jeyaseelan2 and Kuruthukulangara Sebastian Jacob2*

Author Affiliations

1 College of Nursing, Christian Medical College, Vellore, 632004, India

2 Christian Medical College, Vellore, 632002, India

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BMC Psychiatry 2012, 12:159  doi:10.1186/1471-244X-12-159

Published: 27 September 2012



The sole focus of models of insight on bio-medical perspectives to the complete exclusion of local, non-medical and cultural constructs mandates review. This study attempted to investigate the impact of insight, psychopathology, explanatory models of illness on outcome of first episode schizophrenia.


Patients diagnosed to have DSM IV schizophrenia (nā€‰=ā€‰131) were assessed prospectively for insight, psychopathology, explanatory models of illness at baseline, 6, 12 and 60 months using standard instruments. Multiple linear and logistic regression and generalized estimating equations (GEE) were employed to assess predictors of outcome.


We could follow up 95 (72.5%) patients. Sixty-five of these patients (68.4%) achieved remission. There was a negative relationship between psychosis rating and insight scores. Urban residence, fluctuating course of the initial illness, and improvement in global functioning at 6 months and lower psychosis rating at 12 months were significantly related to remission at 5 years. Insight scores, number of non-medical explanatory models and individual explanatory models held during the later course of the illness were significantly associated with outcome. Analysis of longitudinal data using GEE showed that women, rural residence, insight scores and number of non-medical explanatory models of illness held were significantly associated with BPRS scores during the study period.


Insight, the disease model and the number of non-medical model positively correlated with improvement in psychosis arguing for a complex interaction between the culture, context and illness variables. These finding argue that insight and explanatory models are secondary to psychopathology, course and outcome of the illness. The awareness of mental illness is a narrative act in which people make personal sense of the many challenges they face. The course and outcome of the illness, cultural context, acceptable cultural explanations and the prevalent social stigma interact to produce a complex and multifaceted understanding of the issues. This complexity calls for a nuanced framing of insight.

Schizophrenia; Outcome; Insight; Explanatory models; Culture