Many patients with schizophrenia are unaware of the symptoms and consequences of their illness. Poor insight has been associated with medication non-adherence, frequent relapses, and poor prognosis.

To assess the effect of daily Short Message Service (SMS) reminders on patients’ insight.

A multicenter, prospective, randomized, controlled study was conducted. Outpatients with at least 18 years old, diagnosis of schizophrenia (DSM-IV), and adherence problems (at least one affirmative answer Morisky Green questionnaire) were included. Participants were randomized to receive a daily SMS reminder on their cell phone to take their medication in the following 3 months or current standard of care. Insight was assessed using the Scale to Assess Unawareness of Mental Disorder (SUMD) at baseline, month 3 and 6.

254 patients were analyzed. Mean age: 39.7 years (SD = 11.03), 66.5% men. Baseline socio-demographic and clinical characteristics were similar between groups. Baseline mean general insight score (SUMD items 1 to 3) was 6.16 (SD = 3.36) in the intervention group and 6.93 (SD = 3.01) in the control group, p = 0.05. At month 3, patients in the intervention group presented a higher insight vs. control: 5.51 (SD = 3.14) and 6.28 (SD = 2.91) respectively. The absolute difference mean SUMD score between groups: −0.77 (95% CI −1.53, −0.01; p = 0.04). Patients in the intervention group persisted with a better awareness of illness three months after stopping SMS (month 6): mean difference score −1.01 (95% CI −1.80, −0.21; p = 0.01).

A SMS-based intervention with daily reminders to take medication showed an insight change in a sample of non-adherent outpatients.