Background Impaired insight is common in schizophrenia and may influence the interpretation of patient-reported outcome measures, which are increasingly used in patient-centred care and research. However, little is known about how insight relates to self-reported symptom impact. This study examined this relationship in people with schizophrenia in community settings. Methods Latent class analysis was applied to responses from 162 participants on the Patient-Reported Impact of Symptoms in Schizophrenia (PRISS) scale. Sociodemographic, clinical and functional disability variables were analysed as predictors of class membership. Insight was assessed using the Positive and Negative Syndrome Scale (PANSS) G12 item in a subset of participants. Invariance analyses evaluated the consistency of the latent class structure across samples and gender. Results A four-class model was identified: Low symptom impact (50.62%); Disorganisation (26.54%); Suspiciousness (10.5%); and Severe (12.35%). The Severe clas showed a higher prevalence of clinician-rated negative symptoms. No association was observed between PANSS-G12-rated clinical insight and self-reported negative symptoms. The latent class structure was invariant across samples and gender, although women more frequently reported disturbance of volition, depression and feelings of guilt. Disability, psychological treatment and hospitalisation history were associated with class membership. Conclusions Findings suggest that impaired PANSS-G12-rated clinical insight is associated with greater self-reported impact of disorganisation and suspiciousness, but not with the self-reported impact of negative symptoms. Four distinct profiles of symptom impact were identified, with self-reported depression being more prevalent in the most severe profile. These findings may support patient-centred assessment in schizophrenia.
Background Social cognition is a core impairment in psychotic disorders and is strongly associated with functional outcomes. Although social cognitive training is effective, challenges remain regarding skill generalization and accessibility. This study aimed to develop culturally adapted French- and English-Canadian versions of RC2S and to assess the feasibility and acceptability of remote delivery. Methods Fourteen individuals with a psychotic disorder were assessed at baseline, offered 24 twice-weekly RC2S sessions with a therapist over 12 weeks, and reassessed post-intervention. Motivation and therapeutic alliance were assessed through intra-session questionnaires. RC2S uses a personalized approach targeting social cognition and combines pen-and-paper exercises with digital relational simulations using avatars to promote skill transfer. Feasibility and acceptability were examined descriptively and paired-samples t-tests assessed exploratory pre–post changes. Results All participants who initiated RC2S met the predefined completion criterion (≥50% of sessions), and all completed at least 75% of planned sessions (mean = 20.9). Acceptability was high for cultural adaptation, ease of use, and remote interaction (all>4.1/5), although ratings were lower for the RC2S interface (mean = 3.75/5). Motivation and therapeutic alliance remained high throughout the intervention (MUSIC>5.1;WAI > 4.3). Therapist support, perceived benefits, and remote accessibility were key facilitators. The largest exploratory pre–post changes occurred in therapist-administered goal attainment and functional impact measures. Findings from independently administered measures were more mixed, although a large change was observed for theory of mind. Conclusions Findings support the feasibility and acceptability of remotely delivered, culturally adapted RC2S. Exploratory outcomes were mixed, requiring confirmation in a randomized trial with independent, blinded outcome assessment.
Adopting a continuum perspective, this study examined figurative language comprehension in individuals with high or low levels of schizotypy within a non-clinical population. We investigated whether difficulties in figurative language processing are specifically driven by the presence of a competing literal interpretation. We hypothesized that higher schizotypy would be associated with fewer figurative responses and more literal and concrete responses for ambiguous idioms only, with no comparable effect for unambiguous idioms. A total of 377 French-speaking adults from the general population completed an idiom comprehension task and the Schizotypal Personality Questionnaire (SPQ). Based on total SPQ scores, 139 participants were included in the group analyses (73 high schizotypy, 66 low schizotypy). The task combined two methodological approaches previously examined separately by including both ambiguous and unambiguous idioms while distinguishing figurative, literal, and concrete response options. Participants with high schizotypy produced significantly fewer figurative responses and significantly more concrete responses than those with low schizotypy, whereas no difference was observed for literal responses. Importantly, these group differences were found regardless of idiom ambiguity, indicating that they were not specifically driven by the presence of a competing literal interpretation. These findings suggest that reduced figurative interpretations in schizotypy cannot be explained solely by competition from a plausible literal interpretation. More importantly, they highlight that distinguishing literal from concrete response options may help clarify previous inconsistencies in figurative language research in schizotypy and schizophrenia.
Objective Executive dysfunction is a hallmark cognitive deficit in schizophrenia, yet phenotypic heterogeneity within the disorder complicates clinical translation. This study aimed to identify discrete executive profiles within a large Korean schizophrenia cohort using the Wisconsin Card Sorting Test (WCST) and to evaluate their clinical and functional correlates. Method We analyzed WCST performance in 276 individuals with schizophrenia and 361 healthy controls. A principal component analysis (PCA)-derived executive composite was validated against chart-reviewed clinical variables in a patient subset (n = 145). K-means cluster analysis was utilized to characterize cognitive heterogeneity, stratifying patients into distinct neurocognitive profiles. Results Patients with schizophrenia exhibited severe, broad executive impairment compared to controls, particularly in total errors (Hedges' g = 2.268), categories achieved (g = 2.122), and conceptual-level responses (g = 1.751). Within the patient group, cluster analysis robustly identified three distinct executive profiles: mild/near-normal (n = 83), intermediate (n = 88), and severe (n = 105). While age was independently associated with the general executive dysfunction composite (β = 0.254, p = 0.004), conceptual disorganization showed a prominent, theoretically consistent trend-level association (β = 0.166,p = 0.065). Exploratory neurodevelopmental burden and mediation pathways did not show robust statistical signals. Conclusions Executive dysfunction in schizophrenia is characterized by reproducible, clinically interpretable sub-profiles rather than a uniform deficit. Stratifying patients into mild, intermediate, and severe executive clusters provides a practical framework for neurocognitive heterogeneity, which may facilitate target selection for individualized cognitive remediation and functional rehabilitation strategies.
We investigated differences in cognitive and social functioning between patients with schizophrenia who met criteria for recovery or remission and healthy controls. This cross-sectional study included 55 patients with schizophrenia who met recovery or remission criteria and 20 healthy controls. Cognitive function was assessed using the Japanese version of the Brief Assessment of Cognition in Schizophrenia (BACS-J), and social function was assessed using the Japanese version of the Social Functioning Scale. Executive function scores did not differ significantly among the three groups; however, the other primary and composite scores of the BACS-J differed significantly among the three groups. In the post hoc analysis, verbal fluency (VF) and attention and processing speed (AP) were higher in the recovery group compared with the remission group (VF: p = 0.043; AP: p = 0.045). All domains of social functioning differed significantly among the three groups. In the post hoc analysis, significant differences between the recovery and remission groups were observed in interpersonal communication (p = 0.002), prosocial activity (p = 0.005), employment/occupation (p < 0.001), and total score (p = 0.005). These results indicate that VF and AP may be important cognitive domains related to clinical recovery in patients with schizophrenia. Furthermore, social functioning domains that require interaction with others may be more important for recovery than daily living skills.
