Translation into Arabic and validation of the Schedule for the Assessment of Insight–Expanded Version (SAI-E) for use in Tunisia Jaafar Nakhli ⁎ , Salem Mlika, Saoussen Bouhlel, Badii Amamou, Ines Chaieb, Selma Ben Nasr, Béchir Ben Hadj Ali Farhat Hached University Hospital, Sousse, Tunisia Abstract Background: The Schedule for the Assessment of Insight–Expanded Version (SAI-E) consists of 11 items that encompass: awareness of having a mental illness, ability to rename psychotic phenomena as abnormal, and compliance with treatment. Aims: To translate into Arabic and validate the Tunisian version of this instrument. Method: The Arabic translation of the SAI-E was obtained by the “forward/backward translation” method. Adaptations were made after a pilot study involving 20 outpatients with schizophrenia and after taking account the opinions of 15 experts in psychiatry. For validation, 150 outpatients suffering from schizophrenia were recruited by a random drawing in the psychiatric department in Sousse (Tunisia). For factor analysis, principal components analysis and Varimax rotation were adopted. Convergent validity was assessed by correlating the translated scale with the G12 item (lack of judgment and awareness of the disease) of the positive and Negative Syndrome Scale (PANSS). Internal consistency was assessed by Cronbach alpha coefficient and inter-rater reliability was assessed by the use of intra-class correlation coefficient (ICC). Results: Regarding construct validity, factor analysis revealed three factors that were responsible for 70.2% of the variance. As for concurrent validity, we found a negative correlation between the score of the SAI-E and that of the G12 item of the PANSS (r = - 0.82 and p b 10 -3 ). The study of internal consistency between the 11 items was found to be good (α = 0.82). The test–retest reliability was satisfactory (r = 0.8, p b 10 -3 ), and so was inter-rater reliability (ICC = 0.84). Conclusion: In the Tunisian cultural context, the SAI-E presented three factors with good consistency and an inter-rater reliability compatible with the insight dimensions that are intended to be evaluated. © 2014 Elsevier Inc. All rights reserved. 1. Introduction Unawareness of illness or lack of insight is an important characteristic of psychotic disorders, especially schizophrenia. It is related to severity of illness, poor outcome, poor medication compliance and more hospitalizations [1,2]. Different authors have developed standardized instruments assessing insight in its different dimensions [3–7]. Among these instruments the most well known and widely used are The Insight and Treatment Attitudes Questionnaire (ITAQ) [8], the Schedule for the Assessment of Insight (SAI) [9] and its expanded version (SAI-E) [10], the Scale to Assess Unawareness of Mental Disorder (SUMD) [11], and the Birch-wood self-report Insight Scale (IS) [12]. Comparative studies have demonstrated that the scores of these scales are strongly correlated, which indicates that they have a good concurrent validity [8,13]. The SAI-E remains the most practical as it is brief and easy to administrate for schizophrenic patients who generally have cognitive impair- ments [9,10,14]. It was developed for the assessment of insight in psychotic patients and it is based on a concept of insight that includes three distinct dimensions. These dimensions are: 1) awareness of mental illness; 2) ability to relabel unusual mental events (e.g. hallucinations) as pathological; and 3) treatment compliance, both expressed and observed [14]. They are closely corresponding to the dimensions of insight proposed by David et al. [14], Available online at www.sciencedirect.com ScienceDirect Comprehensive Psychiatry 55 (2014) 1050 – 1054 www.elsevier.com/locate/comppsych ⁎ Corresponding author. E-mail address: nakhlijaaf@yahoo.fr (J. Nakhli). 0010-440X/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.comppsych.2014.02.016