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Aims: This study aimed to investigate the mediating pathway of 3 factors (psychotic symptoms, attitude toward medication, and cognitive processing speed) on the effect of insight on personal-social functioning in patients with schizophrenia. Methods: Chinese inpatients with schizophrenia (n = 168; mean age 18 ± 50 years) diagnosed according to the DSM-IV were randomly assigned to treatment with antipsychotic medication alone or combined treatment. Positive and Negative Syndrome Scale (PANSS), Drug Attitude Inventory (DAI), Assessment of Insight (SAI), and Social-Personal Performance Scale (PSPS) scores were evaluated at baseline and at 3, 6, and 12 months. Cognitive function was assessed at baseline. Multiple mediation analyses were conducted with baseline data, end point data, and changes-in-scale scores between baseline and the end point, respectively. Results: At baseline and at 12 months, only psychotic symptoms mediated the effect of insight on personal-social functioning. For changes-in-scale scores over the 12-month follow-up, in patients receiving treatment with medication alone, the effect of improved insight on improved personal-social function was mediated by psychotic symptoms only; in patients receiving a combined treatment, the effect of improved insight on improved personal-social functioning was mediated by both psychotic symptoms and attitudes toward medication, independently. Conclusions: The link between insight and personal-social functions is mainly mediated by psychotic symptoms. Psychosocial intervention improves the predicting effect of insight on personal-social function by improving both the attitude toward medication and psychotic symptoms independently.

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Introduction There is an increasing interest in the patterns of mental health care of people with serious mental illnesses in China, where outpatient and community‐based care are not fully developed and long‐term hospitalization is still not uncommon. Comparison of sociodemographic and clinical characteristics of long‐term and short‐term inpatients diagnosed with schizophrenia can be informative about pattern of treatment and their relationship to services needs. Methods Seventy‐three long‐term schizophrenia inpatients (current length of stay of more than 5 years) were compared to 116 short‐term schizophrenia inpatients (current length of stay of 30 days or less) assessed with the Individual Background Questionnaire, the Positive and Negative Syndrome Scale (PANSS) and the Social Support Rating Scale (SSRS). Results There was no significant difference between the groups on the total PANSS symptom score but the short‐term inpatients scored significantly higher than their long‐term counterparts on the Positive Syndrome sub‐scale and the SSRS and lower on the Negative Syndrome sub‐scale. Discussion Differences in symptomatology and social functioning may be related to better medication adherence and more extended social isolation among long‐term inpatients while the increased positive symptoms are likely to reflect more acute disease process in short‐term inpatients, and possibly poorer medication adherence. These differences may be especially pronounced in developing countries like China in which community‐based services need to be more fully developed to facilitate medication adherence and prevent relapse, and to support community adjustment of socially isolated patients who otherwise require hospitalization.