Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres Comparison of clinician-rated and self-report insight in Korean patients with schizophrenia using VAGUS insight scale Seong Hoon Jeong a , In-Won Chung b,c , Hee Yeon Jung d,e , Samuel S. Hwang f , Se Hyun Kim b,c , Tak Youn b,c , Jun Ku Chung g , Yong Sik Kim b,c, ⁎ a Department of Psychiatry, Eulji University Hospital, Daejeon, Republic of Korea b Department of Neuropsychiatry, Dongguk University International Hospital, Gyeonggi, Republic of Korea c Institute of Clinical Psychopharmacology, Dongguk University School of Medicine, Gyeonggi, Republic of Korea d Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea e Department of Psychiatry and Behavioral Science and Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea f Department of Psychology, Chonnam National University, Gwangju, Republic of Korea g Multimodal Imaging Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada ARTICLE INFO Keywords: Insight Schizophrenia VAGUS Self-report Clinician-rated ABSTRACT This study was aimed to explore self-report auditory verbal hallucinations to provide unique and valuable in- formation in addition to clinician-rated assessment in patients with schizophrenia. The VAGUS (http://www. vagusonline.com) is a recently developed insight scale that includes both clinician-rated (CR) and self-report (SR) versions. Insight measures obtained by the two versions of the VAGUS from the clinicians and the patients, respectively, in forty-one patients diagnosed with schizophrenia by DSM-IV-TR criteria were compared. Correlation coefficients for inter-scale convergence and 3-D biplots for multivariate relationship were derived from the subscales of the VAGUS. For external validation, correlation analyses with abridged version of Scale to Assess Unawareness in Mental Disorder (SUMD-A) and PANSS G12 item were conducted. Total scores of VAGUS- CR and –SR were 5.2 ± 2.6 and 4.9 ± 2.2, respectively. There was a strong correlation between them along with moderate pairwise correlations among the subscales. The 3-D biplots demonstrated that most subscales were clustered as a single factor apart from self-report Symptom Attribution separated as an independent factor. The VAGUS-CR, not -SR correlated significantly with the SUMD-A and PANSS G12. The utility of the VAGUS in reaching more overall understanding of the elusive phenomenon of insight in patients with schizophrenia is discussed. 1. Introduction Insight is an elusive phenomenon in patients with schizophrenia. Lack of insight is believed to be the single most important factor in determining treatment compliance, risk of relapse, psychosocial func- tioning, and, ultimately, prognosis in patients with schizophrenia (Amador and Kronengold, 2004; Emsley et al., 2008). Tremendous ef- forts have been invested to define and understand this phenomenon (Amador et al., 1993; Aleman et al., 2006a, 2006b; David et al., 1992; Karow and Pajonk, 2006; Marková et al., 2003). Yet, comprehensive understanding still requires further clarification of the concept and elaboration of study methods (Lysaker et al., 2013). Thus, researches on insight have seen a trend toward increasing complexity, both on the conceptual and methodological levels (Hwang et al., 2009). Recently, the complementary role of self-report scale in insight as- sessment has been reappraised (Jovanovski et al., 2007; Karow et al., 2008; Uher et al., 2012). Self-report may not only be as valid as in- terview-based assessment, but may provide valuable information which is not accessible from the latter (Uher et al., 2012). Although a trained observer might produce a more valid assessment, it might under-ap- preciate patient's unique beliefs and values. More fundamentally, without any objective laboratory tests, the clinician inevitably has to depend on patient's verbal description of his/her attitude and judge- ment. Self-rating provides more direct access to patient's internal ex- periences and, therefore, provides more intimate reflection of in- dividual's opinion and belief (Cleary et al., 2014; Karow et al., 2008). In this regard, self-report may be advantageous in uncovering multi- dimensional nature, thus in finding neurobiological substrate of insight http://dx.doi.org/10.1016/j.psychres.2017.10.003 Received 15 December 2016; Received in revised form 29 September 2017; Accepted 1 October 2017 ⁎ Correspondence to: Department of Psychiatry, Dongguk University International Hospital, Institute of Clinical Psychopharmacology, Dongguk University Medical Center, 27 Dongguk-ro, Ilsandong-gu, Goyang-si 410–773, Republic of Korea. E-mail address: kys@snu.ac.kr (Y.S. Kim). Psychiatry Research 258 (2017) 93–100 Available online 02 October 2017 0165-1781/ © 2017 Published by Elsevier Ireland Ltd. MARK