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Systematic Review Reveals Heterogeneity in the Use of the Scale to Assess Unawareness of Mental Disorder (SUMD)

  • Schizophrenia and Other Psychotic Disorders (SJ Siegel, Section Editor)
  • Published:
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Abstract

The Scale to Assess Unawareness of Mental Disorder (SUMD) is one of the most widely used instruments to measure insight into mental disorders. The aim of this study was to review all studies using the SUMD in the last 20 years. We performed an electronic search of MEDLINE using PubMed to identify all relevant studies published from 1993 to 2012. The following data were extracted from each article: characteristics of the SUMD (version, rating scale, scoring, and item/dimension used), methodological aspects (country, language, subject inclusion criteria, and sample size), and statistical methods to analyse insight. Of the 133 articles screened, 100 studies were included in the review. Fifty-two studies were published over the past five years. The SUMD was rarely used in its entirety, and the use of selected items or subscales was heterogeneous across studies. The studies also varied in terms of response modalities and in the use of 3- or 5-point Likert scales. The calculation of insight scores was highly variable and included the following: treating items as categorical or continuous variables, separate analysis of individual items, items expressed in terms of the sum total or the mean scores, and a range of score values used to define insight. This paper provides a systematic review of studies using the SUMD and reveals important differences in the versions used, the methods of calculation, and the interpretation of scores across studies. The use of a modified SUMD may compromise the psychometric properties of the scale, lead to erroneous conclusions, and prevents comparison of results across studies. Our review underlines the need for the standardised use of the SUMD.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Amador XF, Gorman JM. Psychopathologic domains and insight in schizophrenia. Psychiatr Clin N Am. 1998;21:27–42.

    Article  CAS  Google Scholar 

  2. Karow A, Pajonk FG. Insight and quality of life in schizophrenia: recent findings and treatment implications. Curr Opin Psychiatry. 2006;19:637–41.

    Article  PubMed  Google Scholar 

  3. Drake RJ, Pickles A, Bentall RP, Kinderman P, Haddock G, Tarrier N, et al. The evolution of insight, paranoia and depression during early schizophrenia. Psychol Med. 2004;34:285–92.

    Article  PubMed  CAS  Google Scholar 

  4. Pedrelli P, McQuaid JR, Granholm E, Patterson TL, McClure F, Beck AT, et al. Measuring cognitive insight in middle-aged and older patients with psychotic disorders. Schizophr Res. 2004;71:297–305.

    Article  PubMed  Google Scholar 

  5. Subotnik KL, Nuechterlein KH, Irzhevsky V, Kitchen CM, Woo SM, Mintz J. Is unawareness of psychotic disorder a neurocognitive or psychological defensiveness problem? Schizophr Res. 2005;75:147–57.

    Article  PubMed  Google Scholar 

  6. Schwartz-Stav O, Apter A, Zalsman G. Depression, suicidal behavior and insight in adolescents with schizophrenia. Eur Child Adolesc Psychiatry. 2006;15:352–9.

    Article  PubMed  Google Scholar 

  7. Sevy S, Nathanson K, Visweswaraiah H, Amador X. The relationship between insight and symptoms in schizophrenia. Compr Psychiatry. 2004;45:16–9.

    Article  PubMed  Google Scholar 

  8. Amador XF, Flaum M, Andreasen NC, Strauss DH, Yale SA, Clark SC, et al. Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry. 1994;51:826–36.

    Article  PubMed  CAS  Google Scholar 

  9. Smith TE, Hull JW, Israel LM, Willson DF. Insight, symptoms, and neurocognition in schizophrenia and schizoaffective disorder. Schizophr Bull. 2000;26:193–200.

    Article  PubMed  CAS  Google Scholar 

  10. Moore O, Cassidy E, Carr A, O’Callaghan E. Unawareness of illness and its relationship with depression and self-deception in schizophrenia. Eur Psychiatry. 1999;14:264–9.

    Article  PubMed  CAS  Google Scholar 

  11. Smith CM, Barzman D, Pristach CA. Effect of patient and family insight on compliance of schizophrenic patients. J Clin Pharmacol. 1997;37:147–54.

    Article  PubMed  CAS  Google Scholar 

  12. Sim K, Chan YH, Chua TH, Mahendran R, Chong SA, McGorry P. Physical comorbidity, insight, quality of life and global functioning in first episode schizophrenia: a 24-month, longitudinal outcome study. Schizophr Res. 2006;88:82–9.

    Article  PubMed  Google Scholar 

  13. Piccinni A, Catena M, Del Debbio A, Marazziti D, Monje C, Schiavi E, et al. Health-related quality of life and functioning in remitted bipolar I outpatients. Compr Psychiatry. 2007;48:323–8.

    Article  PubMed  Google Scholar 

  14. Jovanovski D, Zakzanis KK, Young DA, Campbell Z. Assessing the relationship between insight and everyday executive deficits in schizophrenia: a pilot study. Psychiatry Res. 2007;151:47–54.

    Article  PubMed  Google Scholar 

  15. Raffard S, Bayard S, Gely-Nargeot M-C, Capdevielle D, Maggi M, Barbotte E, et al. Insight and executive functioning in schizophrenia: a multidimensional approach. Psychiatry Res. 2009;167:239–50.

    Article  PubMed  Google Scholar 

  16. Marková IS, Berrios GE. Insight in clinical psychiatry. A new model. J Nerv Ment Dis. 1995;183:743–51.

    Article  PubMed  Google Scholar 

  17. Schwartz RC. Insight and illness in chronic schizophrenia. Compr Psychiatry. 1998;39:249–54.

    Article  PubMed  CAS  Google Scholar 

  18. Mintz AR, Dobson KS, Romney DM. Insight in schizophrenia: a meta-analysis. Schizophr Res. 2003;61:75–88.

    Article  PubMed  Google Scholar 

  19. Raffard S, Bayard S, Capdevielle D, Garcia F, Boulenger J-P, Gely-Nargeot M-C. Lack of insight in schizophrenia: a review. Part I: theoretical concept, clinical aspects and Amador’s model. Encephale. 2008;34:597–605.

    Article  PubMed  CAS  Google Scholar 

  20. Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM. Assessment of insight in psychosis. Am J Psychiatry. 1993;150:873–9.

    PubMed  CAS  Google Scholar 

  21. Schwartz RC, Skaggs JL, Petersen S. Critique of recent empirical research on insight and symptomatology in schizophrenia. Psychol Rep. 2000;86:471–4.

    Article  PubMed  CAS  Google Scholar 

  22. Raffard S, Trouillet R, Capdevielle D, Gely-Nargeot M-C, Bayard S, Larøi F, et al. French adaptation and validation of the scale to assess unawareness of mental disorder. Can J Psychiatry. 2010;55:523–31.

    PubMed  Google Scholar 

  23. Paillot C, Ingrand P, Millet B, Amador X-F, Senon J-L, Olié J-P, et al. French translation and validation of the Scale to assess Unawareness of Mental Disorder (SUMD) in patients with schizophrenics. Encephale. 2010;36:472–7.

    Article  PubMed  CAS  Google Scholar 

  24. Ruiz A, Pousa E, Duñó R, Crosas J, Cuppa S, García C. Spanish adaptation of the Scale to Asses Unawareness of Mental Disorder (SUMD). Actas Esp Psiquiatr. 2008;36:111–1198.

    PubMed  CAS  Google Scholar 

  25. Fiss N, Chaves AC. Translation, adaptation and reliability study of the Scale to Assess Unawareness of Mental Disorder–SUMD. Rev Bras Psiquiatr. 2005;27:143–5.

    Article  PubMed  Google Scholar 

  26. Young DA, Davila R, Scher H. Unawareness of illness and neuropsychological performance in chronic schizophrenia. Schizophr Res. 1993;10:117–24.

    Article  PubMed  CAS  Google Scholar 

  27. Kemp RA, Lambert TJ. Insight in schizophrenia and its relationship to psychopathology. Schizophr Res. 1995;18:21–8.

    Article  PubMed  CAS  Google Scholar 

  28. Amador XF, Friedman JH, Kasapis C, Yale SA, Flaum M, Gorman JM. Suicidal behavior in schizophrenia and its relationship to awareness of illness. Am J Psychiatry. 1996;153:1185–8.

    PubMed  CAS  Google Scholar 

  29. Cassano GB, Pini S, Saettoni M, Rucci P, Dell’Osso L. Occurrence and clinical correlates of psychiatric comorbidity in patients with psychotic disorders. J Clin Psychiatry. 1998;59:60–8.

    Article  PubMed  CAS  Google Scholar 

  30. Schwartz RC, Cohen BN, Grubaugh A. Does insight affect long-term impatient treatment outcome in chronic schizophrenia? Compr Psychiatry. 1997;38:283–8.

    Article  PubMed  CAS  Google Scholar 

  31. Mohamed S, Fleming S, Penn DL, Spaulding W. Insight in schizophrenia: its relationship to measures of executive functions. J Nerv Ment Dis. 1999;187:525–31.

    Article  PubMed  CAS  Google Scholar 

  32. Arango C, Adami H, Sherr JD, Thaker GK, Carpenter Jr WT. Relationship of awareness of dyskinesia in schizophrenia to insight into mental illness. Am J Psychiatry. 1999;156:1097–9.

    PubMed  CAS  Google Scholar 

  33. Pallanti S, Quercioli L, Pazzagli A, Rossi A, Dell’Osso L, Pini S, et al. Awareness of illness and subjective experience of cognitive complaints in patients with bipolar I and bipolar II disorder. Am J Psychiatry. 1999;156:1094–6.

    PubMed  CAS  Google Scholar 

  34. Cuesta MJ, Peralta V, Zarzuela A. Reappraising insight in psychosis. Multi-scale longitudinal study. Br J Psychiatry. 2000;177:233–40.

    Article  PubMed  CAS  Google Scholar 

  35. Ghaemi SN, Boiman E, Goodwin FK. Insight and outcome in bipolar, unipolar, and anxiety disorders. Compr Psychiatry. 2000;41:167–71.

    Article  PubMed  CAS  Google Scholar 

  36. Larøi F, Fannemel M, Rønneberg U, Flekkøy K, Opjordsmoen S, Dullerud R, et al. Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests. Psychiatry Res. 2000;100:49–58.

    Article  PubMed  Google Scholar 

  37. Rossi A, Arduini L, Prosperini P, Kalyvoka A, Stratta P, Daneluzzo E. Awareness of illness and outcome in schizophrenia. Eur Arch Psychiatry Clin Neurosci. 2000;250:73–5.

    Article  PubMed  CAS  Google Scholar 

  38. Chen EY, Kwok CL, Chen RY, Kwong PP. Insight changes in acute psychotic episodes: a prospective study of Hong Kong Chinese patients. J Nerv Ment Dis. 2001;189:24–30.

    Article  PubMed  CAS  Google Scholar 

  39. Pini S, Cassano GB, Dell’Osso L, Amador XF. Insight into illness in schizophrenia, schizoaffective disorder, and mood disorders with psychotic features. Am J Psychiatry. 2001;158:122–5.

    Article  PubMed  CAS  Google Scholar 

  40. Thompson KN, McGorry PD, Harrigan SM. Reduced awareness of illness in first-episode psychosis. Compr Psychiatry. 2001;42:498–503.

    Article  PubMed  CAS  Google Scholar 

  41. Dell’Osso L, Pini S, Cassano GB, Mastrocinque C, Seckinger RA, Saettoni M, et al. Insight into illness in patients with mania, mixed mania, bipolar depression and major depression with psychotic features. Bipolar Disord. 2002;4:315–22.

    Article  PubMed  Google Scholar 

  42. Sajatovic M, Rosch DS, Sivec HJ, Sultana D, Smith DA, Alamir S, et al. Insight into illness and attitudes toward medications among inpatients with schizophrenia. Psychiatr Serv. 2002;53:1319–21.

    Article  PubMed  Google Scholar 

  43. Young DA, Campbell Z, Zakzanis KK, Weinstein E. A comparison between an interview and a self-report method of insight assessment in chronic schizophrenia. Schizophr Res. 2003;63:103–9.

    Article  PubMed  Google Scholar 

  44. Pini S, Dell’Osso L, Amador XF, Mastrocinque C, Saettoni M, Cassano GB. Awareness of illness in patients with bipolar I disorder with or without comorbid anxiety disorders. Aust N Z J Psychiatry. 2003;37:355–61.

    Article  PubMed  Google Scholar 

  45. Arduini L, Kalyvoka A, Stratta P, Rinaldi O, Daneluzzo E, Rossi A. Insight and neuropsychological function in patients with schizophrenia and bipolar disorder with psychotic features. Can J Psychiatry. 2003;48:338–41.

    PubMed  Google Scholar 

  46. Lysaker PH, Bryson GJ, Lancaster RS, Evans JD, Bell MD. Insight in schizophrenia: associations with executive function and coping style. Schizophr Res. 2003;59:41–7.

    Article  PubMed  Google Scholar 

  47. Sim K, Mahendran R, Siris SG, Heckers S, Chong SA. Subjective quality of life in first episode schizophrenia spectrum disorders with comorbid depression. Psychiatry Res. 2004;129:141–7.

    Article  PubMed  Google Scholar 

  48. Freudenreich O, Deckersbach T, Goff DC. Insight into current symptoms of schizophrenia. Association with frontal cortical function and affect. Acta Psychiatr Scand. 2004;110:14–20.

    Article  PubMed  CAS  Google Scholar 

  49. Koren D, Seidman LJ, Poyurovsky M, Goldsmith M, Viksman P, Zichel S, et al. The neuropsychological basis of insight in first-episode schizophrenia: a pilot metacognitive study. Schizophr Res. 2004;70:195–202.

    Article  PubMed  Google Scholar 

  50. Liraud F, Droulout T, Parrot M, Verdoux H. Agreement between self-rated and clinically assessed symptoms in subjects with psychosis. J Nerv Ment Dis. 2004;192:352–6.

    Article  PubMed  Google Scholar 

  51. Miller CJ, Klugman J, Berv DA, Rosenquist KJ, Ghaemi SN. Sensitivity and specificity of the Mood Disorder Questionnaire for detecting bipolar disorder. J Affect Disord. 2004;81:167–71.

    Article  PubMed  Google Scholar 

  52. Pini S, de Queiroz V, Dell’Osso L, Abelli M, Mastrocinque C, Saettoni M, et al. Cross-sectional similarities and differences between schizophrenia, schizoaffective disorder and mania or mixed mania with mood-incongruent psychotic features. Eur Psychiatry. 2004;19:8–14.

    Article  PubMed  Google Scholar 

  53. Simon AE, Berger GE, Giacomini V, Ferrero F, Mohr S. Insight in relation to psychosocial adjustment in schizophrenia. J Nerv Ment Dis. 2004;192:442–5.

    Article  PubMed  Google Scholar 

  54. Beck AT, Baruch E, Balter JM, Steer RA, Warman DM. A new instrument for measuring insight: the beck cognitive insight scale. Schizophr Res. 2004;68:319–29.

    Article  PubMed  Google Scholar 

  55. Sim K, Swapna V, Mythily S, Mahendran R, Kua EH, McGorry P, et al. Psychiatric comorbidity in first episode psychosis: the Early Psychosis Intervention Program (EPIP) experience. Acta Psychiatr Scand. 2004;109:23–9.

    Article  PubMed  CAS  Google Scholar 

  56. Goodman C, Knoll G, Isakov V, Silver H. Insight into illness in schizophrenia. Compr Psychiatry. 2005;46:284–90.

    Article  PubMed  Google Scholar 

  57. Chen EYH, Tam DKP, Wong JWS, Law CW, Chiu CPY. Self-administered instrument to measure the patient’s experience of recovery after first-episode psychosis: development and validation of the psychosis recovery inventory. Aust N Z J Psychiatry. 2005;39:493–9.

    Article  PubMed  Google Scholar 

  58. Iancu I, Poreh A, Lehman B, Shamir E, Kotler M. The positive and negative symptoms questionnaire: a self-report scale in schizophrenia. Compr Psychiatry. 2005;46:61–6.

    Article  PubMed  Google Scholar 

  59. Caton CLM, Hasin DS, Shrout PE, Drake RE, Dominguez B, Samet S, et al. Predictors of psychosis remission in psychotic disorders that co-occur with substance use. Schizophr Bull. 2006;32:618–25.

    Article  PubMed  Google Scholar 

  60. Shad MU, Muddasani S, Keshavan MS. Prefrontal subregions and dimensions of insight in first-episode schizophrenia–a pilot study. Psychiatry Res. 2006;146:35–42.

    Article  PubMed  Google Scholar 

  61. Varga M, Magnusson A, Flekkøy K, Rønneberg U, Opjordsmoen S. Insight, symptoms and neurocognition in bipolar I patients. J Affect Disord. 2006;91:1–9.

    Article  PubMed  CAS  Google Scholar 

  62. Cuesta MJ, Peralta V, Zarzuela A, Zandio M. Insight dimensions and cognitive function in psychosis: a longitudinal study. BMC Psychiatry. 2006;6:26.

    Article  PubMed  Google Scholar 

  63. Simon AE, Berger GE, Giacomini V, Ferrero F, Mohr S. Insight, symptoms and executive functions in schizophrenia. Cogn Neuropsychiatry. 2006;11:437–51.

    Article  PubMed  Google Scholar 

  64. Lysaker PH, Whitney KA, Davis LW. Awareness of illness in schizophrenia: associations with multiple assessments of executive function. J Neuropsychiatry Clin Neurosci. 2006;18:516–20.

    Article  PubMed  Google Scholar 

  65. Sim K, Chua TH, Chan YH, Mahendran R, Chong SA. Psychiatric comorbidity in first episode schizophrenia: a 2 year, longitudinal outcome study. J Psychiatr Res. 2006;40:656–63.

    Article  PubMed  Google Scholar 

  66. Bora E, Sehitoglu G, Aslier M, Atabay I, Veznedaroglu B. Theory of mind and unawareness of illness in schizophrenia: is poor insight a mentalizing deficit? Eur Arch Psychiatry Clin Neurosci. 2007;257:104–11.

    Article  PubMed  Google Scholar 

  67. Jovanovski D, Zakzanis KK, Atia M, Campbell Z, Young DA. A comparison between a researcher-rated and a self-report method of insight assessment in chronic schizophrenia revisited: a replication study using the SUMD and SAIQ. J Nerv Ment Dis. 2007;195:165–9.

    Article  PubMed  Google Scholar 

  68. Varga M, Magnusson A, Flekkøy K, David AS, Opjordsmoen S. Clinical and neuropsychological correlates of insight in schizophrenia and bipolar I disorder: does diagnosis matter? Compr Psychiatry. 2007;48:583–91.

    Article  PubMed  Google Scholar 

  69. Bell M, Fiszdon J, Richardson R, Lysaker P, Bryson G. Are self-reports valid for schizophrenia patients with poor insight? Relationship of unawareness of illness to psychological self-report instruments. Psychiatry Res. 2007;151:37–46.

    Article  PubMed  Google Scholar 

  70. Faragian S, Kurs R, Poyurovsky M. Insight into obsessive-compulsive symptoms and awareness of illness in adolescent schizophrenia patients with and without OCD. Child Psychiatry Hum Dev. 2008;39:39–48.

    Article  PubMed  Google Scholar 

  71. Poyurovsky M, Faragian S, Kleinman-Balush V, Pashinian A, Kurs R, Fuchs C. Awareness of illness and insight into obsessive-compulsive symptoms in schizophrenia patients with obsessive-compulsive disorder. J Nerv Ment Dis. 2007;195:765–8.

    Article  PubMed  Google Scholar 

  72. Sim K, Chan YH, Chong SA, Siris SG. A 24-month prospective outcome study of first-episode schizophrenia and schizoaffective disorder within an early psychosis intervention program. J Clin Psychiatry. 2007;68:1368–76.

    Article  PubMed  Google Scholar 

  73. Fraguas D, Mena A, Franco C, Martín-Blas MM, Nugent K, Rodríguez-Solano JJ. Attributional style, symptomatology and awareness of illness in schizophrenia. Psychiatry Res. 2008;158:316–23.

    Article  PubMed  Google Scholar 

  74. Monteiro LC, Silva VA, Louzã MR. Insight, cognitive dysfunction and symptomatology in schizophrenia. Eur Arch Psychiatry Clin Neurosci. 2008;258:402–5.

    Article  PubMed  Google Scholar 

  75. Tranulis C, Lepage M, Malla A. Insight in first episode psychosis: who is measuring what? Early Interv Psychiatry. 2008;2:34–41.

    Article  PubMed  Google Scholar 

  76. Lepage M, Buchy L, Bodnar M, Bertrand M-C, Joober R, Malla A. Cognitive insight and verbal memory in first episode of psychosis. Eur Psychiatry. 2008;23:368–74.

    Article  PubMed  Google Scholar 

  77. Roe D, Hasson-Ohayon I, Kravetz S, Yanos PT, Lysaker PH. Call it a monster for lack of anything else: narrative insight in psychosis. J Nerv Ment Dis. 2008;196:859–65.

    Article  PubMed  Google Scholar 

  78. Dias VV, Brissos S, Carita AI. Clinical and neurocognitive correlates of insight in patients with bipolar I disorder in remission. Acta Psychiatr Scand. 2008;117:28–34.

    PubMed  CAS  Google Scholar 

  79. Dias VV, Brissos S, Frey BN, Kapczinski F. Insight, quality of life and cognitive functioning in euthymic patients with bipolar disorder. J Affect Disord. 2008;110:75–83.

    Article  PubMed  Google Scholar 

  80. Karow A, Pajonk F-G, Reimer J, Hirdes F, Osterwald C, Naber D, et al. The dilemma of insight into illness in schizophrenia: self- and expert-rated insight and quality of life. Eur Arch Psychiatry Clin Neurosci. 2008;258:152–9.

    Article  PubMed  CAS  Google Scholar 

  81. Bayard S, Capdevielle D, Boulenger J-P, Raffard S. Dissociating self-reported cognitive complaint from clinical insight in schizophrenia. Eur Psychiatry. 2009;24:251–8.

    Article  PubMed  Google Scholar 

  82. Choudhury S, Khess CRJ, Bhattacharyya R, Sanyal D. Insight in schizophrenia and its association with executive functions. Indian J Psychol Med. 2009;31:71–6.

    Article  PubMed  Google Scholar 

  83. Kobayashi H, Morita K, Takeshi K, Koshikawa H, Yamazawa R, Kashima H, et al. Effects of aripiprazole on insight and subjective experience in individuals with an at-risk mental state. J Clin Psychopharmacol. 2009;29:421–5.

    Article  PubMed  CAS  Google Scholar 

  84. Parellada M, Fraguas D, Bombín I, Otero S, Castro-Fornieles J, Baeza I, et al. Insight correlates in child- and adolescent-onset first episodes of psychosis: results from the CAFEPS study. Psychol Med. 2009;39:1433–45.

    Article  PubMed  CAS  Google Scholar 

  85. Pousa E, Duñó R, Blas Navarro J, Ruiz AI, Obiols JE, David AS. Exploratory study of the association between insight and Theory of Mind (ToM) in stable schizophrenia patients. Cogn Neuropsychiatry. 2008;13:210–32.

    Article  PubMed  Google Scholar 

  86. Shabani A, Koohi-Habibi L, Nojomi M, Chimeh N, Ghaemi SN, Soleimani N. The Persian bipolar spectrum diagnostic scale and mood disorder questionnaire in screening the patients with bipolar disorder. Arch Iran Med. 2009;12:41–7.

    PubMed  Google Scholar 

  87. Varga M, Babovic A, Flekkoy K, Ronneberg U, Landro NI, David AS, et al. Reduced insight in bipolar I disorder: neurofunctional and neurostructural correlates: a preliminary study. J Affect Disord. 2009;116:56–63.

    Article  PubMed  CAS  Google Scholar 

  88. Capdevielle D, Raffard S, Bayard S, Garcia F, Baciu O, Bouzigues I, et al. Competence to consent and insight in schizophrenia: is there an association? A pilot study. Schizophr Res. 2009;108:272–9.

    Article  PubMed  Google Scholar 

  89. Diaz-Marsá M, Sánchez S, Rico-Villademoros F. Effectiveness and tolerability of oral ziprasidone in psychiatric inpatients with an acute exacerbation of schizophrenia or schizoaffective disorder: a multicenter, prospective, and naturalistic study. J Clin Psychiatry. 2009;70:509–17.

    Article  PubMed  Google Scholar 

  90. Kim S-W, Shin I-S, Kim J-M, Lee S-H, Lee Y-H, Yang S-J, et al. Effects of switching to long-acting injectable risperidone from oral atypical antipsychotics on cognitive function in patients with schizophrenia. Hum Psychopharmacol. 2009;24:565–73.

    Article  PubMed  CAS  Google Scholar 

  91. • Dassa D, Boyer L, Benoit M, Bourcet S, Raymondet P, Bottai T. Factors associated with medication non-adherence in patients suffering from schizophrenia: a cross-sectional study in a universal coverage health-care system. Aust N Z J Psychiatry. 2010;44:921–8. This study reported that insight was one of the most important features associated with non-adherence in schizophrenia.

    Article  PubMed  Google Scholar 

  92. Nakamae T, Kitabayashi Y, Okamura A, Shibata K, Iwahashi S, Naka F, et al. Insight and quality of life in long-term hospitalized Japanese patients with chronic schizophrenia. Psychiatry Clin Neurosci. 2010;64:372–6.

    Article  PubMed  Google Scholar 

  93. Buchy L, Czechowska Y, Chochol C, Malla A, Joober R, Pruessner J, et al. Toward a model of cognitive insight in first-episode psychosis: verbal memory and hippocampal structure. Schizophr Bull. 2010;36:1040–9.

    Article  PubMed  CAS  Google Scholar 

  94. Aspiazu S, Mosquera F, Ibañez B, Vega P, Barbeito S, López P, et al. Manic and depressive symptoms and insight in first episode psychosis. Psychiatry Res. 2010;178:480–6.

    Article  PubMed  Google Scholar 

  95. Kim S-W, Kim S-J, Mun J-W, Bae K-Y, Kim J-M, Kim S-Y, et al. Psychosocial factors contributing to suicidal ideation in hospitalized schizophrenia patients in Korea. Psychiatry Investig. 2010;7:79–85.

    Article  PubMed  Google Scholar 

  96. Beck E-M, Cavelti M, Kvrgic S, Kleim B, Vauth R. Are we addressing the « right stuff » to enhance adherence in schizophrenia? Understanding the role of insight and attitudes towards medication. Schizophr Res. 2011;132:42–9.

    Article  PubMed  Google Scholar 

  97. Braw Y, Sitman R, Sela T, Erez G, Bloch Y, Levkovitz Y. Comparison of insight among schizophrenia and bipolar disorder patients in remission of affective and positive symptoms: analysis and critique. Eur Psychiatry. 2012;27(8):612–8.

    Google Scholar 

  98. Bressi C, Porcellana M, Marinaccio PM, Nocito EP, Ciabatti M, Magri L, Altamura AC. The association between insight and symptoms in bipolar inpatients: an Italian prospective study. Eur Psychiatry. 2012;27(8):619–24.

    Google Scholar 

  99. González-Suárez B, Gomar JJ, Pousa E, Ortiz-Gil J, García A, Salvador R, et al. Awareness of cognitive impairment in schizophrenia and its relationship to insight into illness. Schizophr Res. 2011;133:187–92.

    Article  PubMed  Google Scholar 

  100. Parellada M, Boada L, Fraguas D, Reig S, Castro-Fornieles J, Moreno D, et al. Trait and state attributes of insight in first episodes of early-onset schizophrenia and other psychoses: a 2-year longitudinal study. Schizophr Bull. 2011;37:38–51.

    Article  PubMed  Google Scholar 

  101. Favrod J, Maire A, Bardy S, Pernier S, Bonsack C. Improving insight into delusions: a pilot study of metacognitive training for patients with schizophrenia. J Adv Nurs. 2011;67:401–7.

    Article  PubMed  Google Scholar 

  102. Antonius D, Prudent V, Rebani Y, D’Angelo D, Ardekani BA, Malaspina D, et al. White matter integrity and lack of insight in schizophrenia and schizoaffective disorder. Schizophr Res. 2011;128:76–82.

    Article  PubMed  Google Scholar 

  103. Brent BK, Giuliano AJ, Zimmet SV, Keshavan MS, Seidman LJ. Insight into illness in patients and caregivers during early psychosis: a pilot study. Schizophr Res. 2011;127:100–6.

    Article  PubMed  Google Scholar 

  104. Ayesa-Arriola R, Rodríguez-Sánchez JM, Morelli C, Pelayo-Terán JM, Pérez-Iglesias R, Mata I, et al. Insight dimensions in first-episode psychosis patients: clinical, cognitive, pre-morbid and socio-demographic correlates. Early Interv Psychiatry. 2011;5:140–9.

    Article  PubMed  Google Scholar 

  105. • Lysaker PH, Dimaggio G, Buck KD, Callaway SS, Salvatore G, Carcione A, et al. Poor insight in schizophrenia: links between different forms of metacognition with awareness of symptoms, treatment need, and consequences of illness. Compr Psychiatry. 2011;52:253–60. This work explores the links between insight and metacognition in schizophrenia.

    Article  PubMed  Google Scholar 

  106. Ekinci O, Ugurlu GK, Albayrak Y, Arslan M, Caykoylu A. The relationship between cognitive insight, clinical insight, and depression in patients with schizophrenia. Compr Psychiatry. 2012;53:195–200.

    Article  PubMed  Google Scholar 

  107. Rubio G, Marín-Lozano J, Ferre F, Martínez-Gras I, Rodriguez-Jimenez R, Sanz J, et al. Psychopathologic differences between cannabis-induced psychoses and recent-onset primary psychoses with abuse of cannabis. Compr Psychiatry. 2012;53(8):1063–70.

    Article  PubMed  Google Scholar 

  108. Trevisi M, Talamo A, Bandinelli PL, Ducci G, Kotzalidis GD, Santucci C, et al. Insight and awareness as related to psychopathology and cognition. Psychopathology. 2012;45:235–43.

    Article  PubMed  Google Scholar 

  109. Misdrahi D, Petit M, Blanc O, Bayle F, Llorca P-M. The influence of therapeutic alliance and insight on medication adherence in schizophrenia. Nord J Psychiatry. 2012;66:49–54.

    Article  PubMed  Google Scholar 

  110. Schaub D, Brüne M, Bierhoff H-W, Juckel G. Comparison of self- and clinician’s ratings of personal and social performance in patients with schizophrenia: the role of insight. Psychopathology. 2012;45:109–16.

    Article  PubMed  Google Scholar 

  111. •• Faget-Agius C, Boyer L, Padovani R, Richieri R, Mundler O, Lançon C, et al. Schizophrenia with preserved insight is associated with increased perfusion of the precuneus. J Psychiatry Neurosci JPN. 2012;37:110125. This work is one of the first studies to propose a neurobiological understanding of insight.

    Google Scholar 

  112. McFarland J, Cannon DM, Schmidt H, Ahmed M, Hehir S, Emsell L, et al. Association of grey matter volume deviation with insight impairment in first-episode affective and non-affective psychosis. Eur Arch Psychiatry Clin Neurosci. 2013;263(2):133–41

    Google Scholar 

  113. Chan SKW, Chan KKS, Lam MML, Chiu CPY, Hui CLM, Wong GHY, et al. Clinical and cognitive correlates of insight in first-episode schizophrenia. Schizophr Res. 2012;135:40–5.

    Article  PubMed  Google Scholar 

  114. Majadas S, Olivares J, Galan J, Diez T. Prevalence of depression and its relationship with other clinical characteristics in a sample of patients with stable schizophrenia. Compr Psychiatry. 2012;53:145–51.

    Article  PubMed  Google Scholar 

  115. Ware J, Snow K, Kosinski M, Gandek B. SF-36 health survey manual and interpretation guide. Boston: New England Medical Center; 1993.

    Google Scholar 

  116. Kalantar JS, Talley NJ. The effects of lottery incentive and length of questionnaire on health survey response rates: a randomized study. J Clin Epidemiol. 1999;52:1117–22.

    Article  PubMed  CAS  Google Scholar 

  117. Eaker S, Bergström R, Bergström A, Adami HO, Nyren O. Response rate to mailed epidemiologic questionnaires: a population-based randomized trial of variations in design and mailing routines. Am J Epidemiol. 1998;147:74–82.

    Article  PubMed  CAS  Google Scholar 

  118. Gummesson C, Atroshi I, Ekdahl C. Performance of health-status scales when used selectively or within multi-scale questionnaire. BMC Med Res Methodol. 2003;3:3.

    Article  PubMed  Google Scholar 

  119. Fang J, Fleck MP, Green A, McVilly K, Hao Y, Tan W, et al. The response scale for the intellectual disability module of the WHOQOL: 5-point or 3-point? J Intellect Disabil Res. 2011;55:537–49.

    Article  PubMed  CAS  Google Scholar 

  120. Chachamovich E, Fleck MP, Power M. Literacy affected ability to adequately discriminate among categories in multipoint Likert Scales. J Clin Epidemiol. 2009;62:37–46.

    Article  PubMed  Google Scholar 

  121. Fitzpatrick R. Surveys of patient satisfaction: II–Designing a questionnaire and conducting a survey. BMJ. 1991;302:1129–32.

    Article  PubMed  CAS  Google Scholar 

  122. Drake RJ, Dunn G, Tarrier N, Bentall RP, Haddock G, Lewis SW. Insight as a predictor of the outcome of first-episode nonaffective psychosis in a prospective cohort study in England. J Clin Psychiatry. 2007;68:81–6.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the French 2009 Institut de Recherche en Santé Publique (CUD-QV, Concepts, Usages et Déterminants en Qualité de Vie).

R. Dumas, C. Lançon, and L. Boyer conceptualized and designed this review. R. Dumas collected and analyzed the data. R. Dumas, K. Baumstarck, P. Michel, C. Lançon, P. Auquier, and L. Boyer interpreted the data. R. Dumas, K. Baumstarck, and L. Boyer drafted and wrote the manuscript.

Conflict of Interest

Rémy Dumas declares that he has no conflict of interest.

Karine Baumstarck declares that she has no conflict of interest.

Pierre Michel declares that he has no conflict of interest.

Christophe Lançon declares that he has no conflict of interest.

Pascal Auquier declares that he has no conflict of interest.

Laurent Boyer declares that she has no conflict of interest.

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Authors and Affiliations

  1. EA 3279 – Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France

    Rémy Dumas, Karine Baumstarck, Pierre Michel, Christophe Lançon, Pascal Auquier & Laurent Boyer

  2. Department of Psychiatry, Sainte-Marguerite University Hospital, 13009, Marseille, France

    Rémy Dumas & Christophe Lançon

  3. EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13284, Marseille, France

    Rémy Dumas

  4. Department of Psychiatry, Sainte-Marguerite University Hospital, 270 bd Sainte-Marguerite, 13274, Marseille, France

    Rémy Dumas

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  1. Rémy Dumas
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  6. Laurent Boyer
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Correspondence to Rémy Dumas.

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This article is part of the Topical Collection on Schizophrenia and Other Psychotic Disorders

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Dumas, R., Baumstarck, K., Michel, P. et al. Systematic Review Reveals Heterogeneity in the Use of the Scale to Assess Unawareness of Mental Disorder (SUMD). Curr Psychiatry Rep 15, 361 (2013). https://doi.org/10.1007/s11920-013-0361-8

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