OBJECTIVE To evaluate the level of insight into illness in patients with schizophrenia and its associations with demographic factors, clinical symptoms, executive functions, and selected metabolic parameters. SUBJECTS AND METHODS This cross-sectional study included 60 outpatients diagnosed with schizophrenia according to DSMIV criteria. Participants were divided into two groups based on the median score of the Self-Appraisal of Illness Questionnaire (SAIQ): preserved insight (n=30) and impaired insight (n=30). Positive symptoms were assessed with the Positive Symptoms Rating Scale (PSRS), negative symptoms with the Brief Negative Symptom Assessment (BNSA), executive functions with the Wisconsin Card Sorting Test (WCST) and Wechsler-Bellevue Intelligence Scale-II (WB-II) subscales. Metabolic parameters included body mass index (BMI), systolic and diastolic blood pressure, and waist circumference. Statistical analysis was performed using t-tests, ANOVA, Pearson correlation, and multiple linear regression (p<0.05). RESULTS Patients with impaired insight exhibited significantly higher positive (PSRS: 28.5±4.2 vs 18.3±3.1; p<0.001) and negative symptoms (BNSA: 35.2±5.6 vs 22.1±4.0; p<0.001), poorer executive performance (WCST total score: 45.6±8.9 vs 68.4±7.2; p<0.001), higher BMI (28.7±3.4 vs 24.5±2.8; p<0.01), and elevated blood pressure values. SAIQ total score negatively correlated with positive (r=-0.62; p<0.001) and negative symptoms (r=-0.58; p<0.001), illness duration (r=-0.45; p<0.01), and positively with years of education (r=0.48; p<0.01) and WCST score (r=0.52; p<0.001). Regression analysis showed that negative symptoms (β=-0.41; p<0.001) and executive dysfunction (β=-0.35; p<0.01) were the strongest independent predictors of poor insight (R²=0.62). CONCLUSION Impaired insight in schizophrenia is strongly associated with greater psychopathological burden, neurocognitive deficits (especially executive dysfunction), and metabolic disturbances. These findings support the implementation of integrated therapeutic strategies targeting insight, cognition, and cardiometabolic health to improve long-term outcomes.

The new classification systems in psychiatry have dressed both patients and psychiatrists in completely new attire. One (DSM -5) is widely used and critics are hardly at peace with the psychiatry of normal living conditions and phenomena and a missed opportunity to 'save the normal'. The second attire is still standing on the mold in tailoring salon in Geneva (ICD-11) and is being ornamented by the online testing through a global network of clinical practice, now around 15,000 clinicians and mental health professionals, before it is distributed to psychiatrists worldwide. The objective is to (be) treated better and to keep quiet. We remain silent for fear, shame and insecurity in the face of devastating tendencies in the modern world. Unprocessed traumas and mourning from the past in current global setting support various mental disorders. Trauma leaves strong emotions, so if it has not been processed and the loss has not been mourned, these charged emotions get the characteristics of emotional volcanoes or timed bombs that are easily activated. Unprocessed group trauma among political or ideological leaders can become a means of strong manipulation of the masses. And the 'masses' are immersed, globally, in the mentalization of cognitive achievement at the expense of the emotional principle. By forcing competitiveness, perfectionism and narcissism, people try to 'be successful' at all costs. Perfectionism is a phenomenon that, under the influence of scientific and technological progress, computerization and globalization, increasingly affects the psychosocial development, functioning of the individual and society as a whole. Perfectionism is increasingly associated with anxiety and affective disorders, obsessive-compulsive disorders, eating disorders, and suicidality. Virtual reality, virtual sexuality, pornography, pervasive alienation and loneliness create a position of shame and cultural discomfort, which is so far the price of conformism. But in the Manichean prism, we might also call the new age an era of shamelessness and perversion in the broader sociocultural context leaving open the key question: "Can modern civilization avoid self-destruction?"

BACKGROUND To establish the prevalence of metabolic syndrome and its parameters in group of patients with schizophrenia in polypharmacy - receiving first generation antipsychotics versus clozapine alone treated group. SUBJECTS AND METHODS 48 outpatients with schizophrenia divided into two groups: the first group of 21 patients in polypharmacy with first generation antipsychotics, and the second group of 27 patients treated with clozapine alone were assessed for the presence of metabolic syndrome. We used logistic regression models to assess the relationship between metabolic syndrome and antipsychotic therapy, gender and age. RESULTS Metabolic syndrome was found in 52.1% of all subjects. Compared to first generation antipsychotics polypharmacy, the monopharmacy with clozapine was associated with elevated rates of metabolic syndrome (28.6% vs. 70.4%, p=0.004). With regard to particular parameters of metabolic syndrome, the elevated plasma triglycerides were significantly more present in subjects within Clozapine group (p=0.03). Logistic regression analysis showed that female gender (p=0.004), and clozapine treatment (p=0.005) were significantly associated with metabolic syndrome. CONCLUSION Compared to polypharmacy with first generation antipsychotics, the higher prevalence of metabolic syndrome is found in patients treated with Clozapine alone. The most prevalent metabolic disorder is dyslipidemia.