الفهرس 
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Abstract
Disturbance in self-concept clarity is suggested to be considered as one
of a core feature of schizophrenia. A growing body of research reflects that
the incoherence or disorganization in sense of self may mask individuals with
schizophrenia from perceiving reality accurately. Patients often perceived
themselves as if they lost contact to themselves and usually spent a lot of time
wondering about the kind of person they are. Therefore this study provides a
starting point to understand the relationship between positive and negative
symptoms and self-concept clarity among patients with schizophrenia. In that
sense, this study sheds a crucial step in acquaintance with the picture of selfconcept
clarity across the course of psychotic illness.
This study aimed to assess the self- concept clarity, as well as positive
and negative symptoms among patients with schizophrenia. And, to identify
the relationship between self- concept clarity and both positive and negative
symptoms among patients with schizophrenia.
This study utilized a descriptive correlational research design. It was
conducted at the inpatient wards of El-Maamoura Hospital for Psychiatric
Medicine in Alexandria.
The study subjects were a convenient sample of 200 inpatients with
schizophrenia fulfilling the criteria: able to communicate in coherent manner
and aging ranged between 20 – 50 years and their duration of illness not
exceeding 10 years.
Three tools were used for data collection:
Tool I: Socio-demographic and clinical data structured interview
schedule:
This tool was developed by the researcher; it includes two parts to elicit
data about socio-demographic characteristics and clinical characteristics for
the patients with schizophrenia.
Tool II: The Brief Psychiatric Rating Scale (BPRS-version 4.0)
This scale was developed by Ventura et al. (1993) to examine the
existence and severity of different psychiatric symptoms. It contains 24-items.
These 24 items are categorized to four: positive symptoms, negative
symptoms, depression- anxiety, and agitation-mania. Items related to positive and negative symptoms were used only for this study in addition to items of self-neglect.
Tool III: Self-concept Clarity Scale:
Self -concept clarity scale was developed by Campbell et al. (1996) to
measure the perceived internal consistency and temporal stability of selfbeliefs
. The scale consisted of twelve items.
Method:
- Tool III (self-concept clarity Scale) was translated into the Arabic
language.
- Tool III was presented to a jury composed of five experts in the field of
Psychiatric Nursing and Mental Health, to examine the face validity of
the tools and was accepted as valid.
- A pilot study was carried out on 15 inpatients with schizophrenia, and it
proved that the study tools were clear and applicable.
- Reliabilities of tools II and III were tested using the Cronbach’s alpha
method on 10 adult inpatients with schizophrenia. Tool II (Brief) and
tool III (Sccs) proved to be reliable (Cronbach’s alpha = 0.905, and
0.758 respectively).
- Male wards only were selected for this research (because the number of
female patients decreased in the hospital in this period).
- The wards were selected randomly (except ward A and ward B because
in this period those wards were used for newly admitted patients until
they prove that those patients are free from COVID-19.
- On each randomly selected ward, all patients who met the
predetermined inclusion criteria were recruited. Each patient was met
on individual basis
- The researcher observed the patient for items which included in tool II,
intermittently for half an hour/day for seven consecutive days
- Collection of data was done during the period from 25th January to 25th
May 2021.
- The data were computerized and verified using the SPSS (Statistical
Package for Social Science) to perform tabulation and statistical
analysis.
The following are the main results yielded by the study:
I. Socio demographic and clinical characteristics of the studied
patients:-
- The studied patients’ age ranged between 20 and 50 years, with a mean
age of 34.90 ± 8.54 years.
- 54.5% of the studied subjects were unemployed. 26.5% of the studied
subjects had secondary education.
- 81.0% of studied subjects were single and 73.0% of studied subjects
were living with their parents/ siblings.
- 50.5% of the studied subjects had been ill for 10 years. 32.5% of the
studied subjects had duration of illness ranging from 5 to less than 10
years.
- 47.5% of the studied subjects had an onset of illness at an age ranging
from 20 to less than 30 years, with a mean of 27.50 ± 8.36 years.
II. Severity of psychotic symptoms among patients with schizophrenia:
- 19.0% of the studied subjects suffering from severe level of
grandiosity, and 5.5% had severe level of self-neglect.
- 34.0% of the studied subjects were suffering from moderate level of
hallucinations, and 46.5% of them have a moderate level of blunted
affect.
- The mean score of psychotic symptoms among studied subjects in both
positive symptoms and negative symptoms were 3.15, 3.01 respectively
III. Self-concept clarity among the studied subjects:
- 50.5% of the studied subjects reported lower level self-concept clarity.
While, 38.5%of the studied subjects had moderate level of self-concept
clarity. Only 11.0% had high self-concept clarity.
IV. The correlation ship between self-concept clarity and positive and
negative symptoms among the studied patients revealed that.
- Self-concept clarity was highly statistical significant correlated with
positive symptoms and negative symptoms (rs =0.242, P<0.001, and rs
=0.225, P=0.001, respectively). This means that the lower self-concept
clarity, the higher severe psychopathology in relation to both positive
and negative symptoms.
V. Examining the independent association of positive and negative
symptoms with self-concept clarity after controlling the independent
covariates yielded.
- Model 1indicates that overall positive and negative symptoms was
positively associated with self-concept clarity (B= 0.671, t= 4.148,
P<0.001).
- Models 2 and 3 reflect that the relationship between overall positive and
negative symptoms and self-concept clarity remained positively
significant even after controlling the covariates (socio- demographic
and clinical variables in Models 2 and 3).
Accordingly, the following are the main recommendations of the present
study:-
1. Conducting psycho-educational and cognitive remediation programs
that incorporate Self-concept clarity enhancement to enable patients
with schizophrenia to develop clear, consistent and stable sense of self.
2. The assessment of Self-concept clarity should be encompassed in the
theoretical and practical aspects of psychiatric nursing curricula to
enhance students’ awareness with the importance of its assessment.
3. Endorsing and reinforcing the assessment of Self-concept clarity in the
hospital’ clinical chart or record in order to gain a comprehensive
understanding of patients’ behaviors.
4. Further researches are needed to focus on self-concept clarity as
potential barriers to recovery from schizophrenia.