Insight in Schizophrenia: A Review
First Online: 08 June 2010 DOI:
Cite this article as: Baier, M. Curr Psychiatry Rep (2010) 12: 356. doi:10.1007/s11920-010-0125-7 Abstract
About 30% to 50% of people with schizophrenia experience lack of insight, meaning they may not acknowledge their illness or the need for treatment. Researchers have developed valid tools for measuring insight. Accordingly, a great deal of descriptive and correlational research has been done on insight, treatment adherence, symptom severity, and other associated variables. Several possible etiologic models and treatment modalities for lack of insight have been proposed. Possible brain dysfunctions causing lack of insight are being investigated. Cognitive-behavioral therapy and motivational interviewing have been successful in teaching patients to cope with the symptoms and make changes in health-related behaviors. Ultimately, people with schizophrenia need to know how to ask for help with coping with their symptoms.
Keywords Insight Schizophrenia Awareness References Papers of particular interest, published recently, have been highlighted as • Of importance
Lincoln TM, Lullmann E, Rief W: Correlates and long-term consequences of poor insight in patients with schizophrenia: a systematic review. Schizophr Bull 2007, 33:1324–1342.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4 (text revision). Washington, DC, American Psychiatric Association; 2000.
Lysaker P, Bell M: Insight and cognitive impairment: performance on repeated administrations of the Wisconsin Card Sorting test. J Nerv Ment Dis 1994, 182:656–660.
McEvoy JP, Aland J, Wilson WH, et al.: Measuring chronic schizophrenic patients’ attitudes toward their illness and treatment. Hosp Community Psychiatry 1981, 32:856–858.
Amador XF, Kronengold H: Understanding and assessing insight. In Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders, edn 2. Edited by Amador XF, David AS. London: Oxford University Press; 2004:197–229.
• Bayard S, Capdevielle D, Boulenger J-P: Dissociating self-reported cognitive complaint from clinical insight in schizophrenia. Eur Psychiatry 2009, 24:251–258.
This study clarifies the difference between clinical insight and cognitive deficits
Hasson-Ohayon I, Kravetz S, Meir T: Insight into severe mental illness, hope, and quality of life of persons with schizophrenia and schizoaffective disorders. Psychiatry Res 2009, 167:231–238.
Beck AT, Baruch E, Balter JM: A new instrument for measuring insight: the Beck Cognitive Insight Scale. Schizophr Res 2004, 68:319–329.
Mintz AR, Dobson KS, Romney DM: Insight in schizophrenia: a meta-analysis. Schizophr Res 2003, 61:75–88.
Torrey EF: The relationship of insight to violent behavior and stigma. In Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders, edn 2. Edited by Amador XF, David AS. London: Oxford University Press; 2004:243–256.
Rickelman BL: Anosognosia in individuals with schizophrenia: toward recovery of insight. Issues Ment Health Nurs 2004, 25:227–242.
Flashman LA: Disorders of awareness in neuropsychiatric syndromes: an update. Curr Psychiatry Rep 2002, 4:346–353.
Medalia A, Thysen J: A comparison of insight into clinical symptoms versus insight into neuro-cognitive symptoms in schizophrenia. Schizophr Res 2010, 118:134–139.
Medalia A, Thysen J: Insight into neurocognitive dysfunction in schizophrenia. Schizophr Bull 2008, 34:1221–1230.
Aleman A, Agrawal N, Morgan KD: Insight in psychosis and neuropsychological function. Meta-analysis. Br J Psychiatry 2006, 189:204–212.
• Langdon R, Ward P: Taking the perspective of the other contributes to awareness of illness in schizophrenia. Schizophr Bull 2009, 35:1003–1011.
This study differentiates the two traditional views of insight—psychological defense and anosognosia—from metacognition deficits
Bora E, Sehitoglu G, Aslier M: Theory of mind and unawareness of illness in schizophrenia. Is poor insight a mentalizing deficit? Eur Arch Psychiatry Clin Neurosci 2007, 257:104–111.
Amador XF, Johanson A-L: I Am Not Sick, I Don’t Need Help: Helping the Seriously Mentally Ill Accept Treatment. A Practical Guide for Families and Therapists. Peconic, NY: Vida Press; 2002.
• Osatuke K, Ciesla J, Kasckow JW, et al.: Insight in schizophrenia: a review of etiological models and supporting research. Compr Psychiatry 2008, 49:70–77.
This review describes seven possible causative models and reports on the research base for each
Rusch N, Corrigan PW: Motivational interviewing to improve insight and treatment adherence in schizophrenia. Psychiatr Rehabil J 2002, 26:23–32.
Linden M, Godemann F: The differentiation between ‘lack of insight’ and ‘dysfunctional health beliefs’ in schizophrenia. Psychopathology 2007, 40:236–241.
Emmons KM, Rollnick S: Motivational interviewing in health care settings: opportunities and limitations. Am J Prev Med 2001, 20:68–74.
Kirmayer LJ, Corin E, Jarvis GE: Inside knowledge: cultural constructions of insight in psychosis. In Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders, edn 2. Edited by Amador XF, David AS. London: Oxford University Press; 2004:197–229.
Bellack AS: Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophr Bull 2006, 32:432–442.
Dzurec LC: How do they see themselves? Self-perception and functioning for people with chronic schizophrenia. J Psychosoc Nurs Ment Health Serv 1990, 28:10–14.
Wittorf A, Jakobi U, Bechdolf A, et al.: The influence of baseline symptoms and insight on the therapeutic alliance early in the treatment of schizophrenia. Eur Psychiatry 2009, 24:259–267.
Buckley PF, Wirshing DA, Bhushan P: Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs 2007, 21:129–141.
Lysaker PH, Buck KD, Salvatore G: Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches. Expert Rev Neurother 2009, 9:1035–1043.
Naeem F, Kingdon D, Turkington D: Predictors of response to cognitive behaviour therapy in the treatment of schizophrenia: a comparison of brief and standard interventions. Cognit Ther Res 2008, 32:651–656.
Brabban A, Tai S, Turkington D: Predictors of outcome in brief cognitive therapy for schizophrenia. Schizophr Bull 2009, 35:859–864.
Tai S, Turkington D: The evolution of cognitive behavior therapy for schizophrenia: current practice and recent developments. Schizophr Bull 2009, 35:865–873.
Turkington D, Kingdom D, Weiden PJ: Cognitive behavior therapy for schizophrenia. Am J Psychiatry 2006, 163:365–373.
Corrigan PW, McCracken SG, Holmes EP: Motivational interviews as goal assessment for persons with psychiatric disability. Community Ment Health J 2001, 37:113–122.
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