Skip to main content

Advertisement

SpringerLink
Log in

Insight, Global Functioning and Psychopathology Amongst In-patient Clients with Schizophrenia

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

To explore whether cognitive impairment and global functioning can predict the degree of insight into illness as well as whether insight is mediated by specific symptom dimensions of psychopathology in schizophrenia. A dimensional/cross sectional approach was used. A mixed group of clients (n = 36) were assessed as part of a routine clinical evaluation. The Wechsler Adult Intelligence Scale (WAIS) was used as a measure of intellectual performance, the Brief Symptom Inventory (BSI) was used as a measure of general psychopathology while the Global Assessment of Functioning (GAF) scale assessed clients’ psychosocial functioning; insight was assessed with the Insight and Treatment Attitudes Questionnaire (ITAQ). The correlation matrix of all outcome variables was examined; confounding effects of illness duration were tested by partial correlation analyses. GAF correlated with insight (ρ = 0.41, P = 0.01) and the interpersonal sensitivity dimension of BSI (ρ = −0.38, P = 0.03. Insight correlated positively with the anxiety (ρ = 0.38, P = 0.03) and psychoticism (ρ = 0.36, P = 0.04) dimensions of BSI. Our results suggest that insight is part of the phenomenology in schizophrenia, not being determined by neurocognitive disturbances. Improved insight was associated with more frequent psychotic symptoms endorsement, higher levels of anxiety and less severe psychopathological symptoms and difficulties in psychosocial functioning; clients with more pronounced difficulties in their personal and social interactions exhibited worse psychosocial functioning and more severe psychopathological symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Davies EJ: Developmental aspects of schizophrenia and related disorders: Possible implications for treatment strategies. Advances in Psychiatric Treatment 13:384–391, 2007. doi:10.1192/apt.bp.106.002600

    Article  Google Scholar 

  2. Liddle PF: The symptoms of chronic schizophrenia: A re-examination of the positive-negative dichotomy. British Journal of Psychiatry 151:145–151, 1987

    Article  PubMed  CAS  Google Scholar 

  3. Amador XF, David AS: Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders, 2nd edn., Oxford, Oxford University Press, 2004

    Google Scholar 

  4. Kemp R, David A: Insight and compliance In Treatment Compliance and the Therapeutic Alliance in Serious Mental Illness, Switzerland, Harwood Academic Publishers, pp. 61–84, 1997

    Google Scholar 

  5. McGlashan T: Does attitude toward psychosis relate to outcome? American Journal of Psychiatry 138:797–801, 1981

    PubMed  CAS  Google Scholar 

  6. McEvoy JP, Apperson LJ, Applebaum PS: Insight into schizophrenia. Its relationship to acute psychopathology. Journal of Nervous and Mental Disease 177:43–47, 1989. doi:10.1097/00005053-198901000-00007

    Article  PubMed  CAS  Google Scholar 

  7. Amador XF, Flaum M, Andreasen NC, et al.: Awareness of illness in schizophrenia and schizoaffective and mood disorders. American Journal of Psychiatry 51(10):826–836, 1994

    CAS  Google Scholar 

  8. David A, Van Os J, Jones P, et al.: Insight and psychotic illness cross-sectional and longitudinal associations. British Journal of Psychiatry 167:621–628, 1995

    Article  PubMed  CAS  Google Scholar 

  9. Amador XF, Strauss DH, Yale SA, et al.: Assessment of insight in psychosis. American Journal of Psychiatry 150:873–879, 1993

    PubMed  CAS  Google Scholar 

  10. McEvoy JP, Applebaum PS, Apperson J, et al.: Why must some schizophrenic patients be involuntarily committed? The role of insight. Comprehensive Psychiatry 30:13–17, 1989. doi:10.1016/0010-440X(89)90113-2

    Article  PubMed  CAS  Google Scholar 

  11. Davidhizar RE: Beliefs, feelings and insight of patients with schizophrenia about taking medication. Journal of Advanced Nursing 12:177–182, 1987. doi:10.1111/j.1365-2648.1987.tb01318.x

    Article  PubMed  CAS  Google Scholar 

  12. David A, Buchanan A, Reed A, et al.: The assessment of insight. British Journal of Psychiatry 161:599–602, 1992. doi:10.1192/bjp.161.5.599

    Article  PubMed  CAS  Google Scholar 

  13. Birchwood M, Smith J, Drury V, et al.: A self report insight scale for psychosis: Reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica 89:62–67, 1994. doi:10.1111/j.1600-0447.1994.tb01487.x

    Article  PubMed  CAS  Google Scholar 

  14. Drake RJ, Lewis, SW: Insight and neurocognition in schizophrenia. Schizophrenia Research 62:165–173, 2003. doi:10.1016/S0920-9964(02)00382-1

    Article  PubMed  Google Scholar 

  15. Sanz M, Constable G, Lopez I, et al.: A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychological Medicine 28:437–446, 1998. doi:10.1017/S0033291797006296

    Article  PubMed  CAS  Google Scholar 

  16. Cuesta MJ, Peralta V, Zarzuela A: Reappraising insight in psychosis, multi-scale longitudinal study. British Journal of Psychiatry 177:233–240, 2000. doi:10.1192/bjp.177.3.233

    Article  PubMed  CAS  Google Scholar 

  17. Aleman A, Agrawal N, Morgan KD, David AS: Insight in psychosis and neuropsychological function, a meta-analysis. British Journal of Psychiatry 9:204–212, 2006. doi:10.1192/bjp.189.3.204

    Article  Google Scholar 

  18. Lincoln TM, Lullmann E, Rief, W: Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophrenia Bulletin 33(6):1324–1342, 2007. doi:10.1093/schbul/sbm002

    Article  PubMed  Google Scholar 

  19. Fennig S, Everett E, Bromet E et al.: Insight in first-admission psychotic patients. Schizophrenia Research 22:257–263, 1996. doi:10.1016/S0920-9964(96)00077-1

    Article  PubMed  CAS  Google Scholar 

  20. McEvoy J, Hartman M, Gottlieb D, et al.: Common sense, insight and neuropsychological test performance in schizophrenia patients. Schizophrenia Bulletin 22:635–641, 1996

    PubMed  CAS  Google Scholar 

  21. Markova IS, Berrios GE: The assessment of insight in clinical psychiatry: A new scale. Acta Psychiatrica Scandinavica 86:159–164, 1992. doi:10.1111/j.1600-0447.1992.tb03245.x

    Article  PubMed  CAS  Google Scholar 

  22. Crumlish N, Samalani P, Sefasi A et al.: Insight, psychopathology and global functioning in schizophrenia in urban Malawi. British Journal of Psychiatry 191:262– 263, 2007

    Article  Google Scholar 

  23. Mintz AR, Dobson KS, Romney DM: Insight in schizophrenia: A meta-analysis. Schizophrenia Research 61:75–88, 2003. doi:10.1016/S0920-9964(02)00316-X

    Article  PubMed  Google Scholar 

  24. Pyne JM, Bean D, Sullivan, G: Characteristics of patients with schizophrenia who do not believe they are mentally ill. Journal of Nervous and Mental Disease 189(3):46–153, 2001. doi:10.1097/00005053-200103000-00002

    Article  PubMed  CAS  Google Scholar 

  25. Pin S, Cassano GB, Dell-Osso L, et al.: Insight into illness in schizophrenia, schizoaffective disorder, and mood disorders with psychotic features. American journal of psychiatry 158:122–124, 2003

    Article  Google Scholar 

  26. Lysaker PH, Roe D, Yanos PT: Toward understanding the insight paradox: Internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophrenia Bulletin 33:203–208, 2003

    Google Scholar 

  27. Smith TE, Hull JW, Goodman, M, et al.: The relative influences of symptoms, insight and neurocognition on social adjustment in schizophrenia and schizoaffective disorder. Journal of Nervous and Mental Disease 187:102–108, 1999

    Article  PubMed  CAS  Google Scholar 

  28. Donohoe G, Owens N, O’Donnell C, et al.: Predictors of compliance with neuroleptic medication among inpatients with schizophrenia: A discriminate function analysis. European Psychiatry 16:293–298, 2001 doi:10.1016/S0924-9338(01)00581-8

    Article  PubMed  CAS  Google Scholar 

  29. Michalakeas A, Skoutas C, Charalambous A. et al.: Insight in schizophrenia and mood disorders and its relation to psychopathology. Acta Psychiatrica Scandinavica 90(1):46–49, 1994. doi:10.1111/j.1600-0447.1994.tb01554.x

    Article  PubMed  CAS  Google Scholar 

  30. Aga VM, Agarwal AK, Gupta SC: The relationship of insight to psychopathology in schizophrenia: A cross-cultural study. Indian Journal of Psychiatry 37(3):129–35, 1995

    Google Scholar 

  31. Buckley PF, Hasan S, Friedman L, et al.: Insight and schizophrenia. Comprehensive Psychiatry 42(1):39–41, 2001. doi:10.1053/comp.2001.16569

    Article  PubMed  CAS  Google Scholar 

  32. Collins AA, Remington GJ, Coolter K et al.: Insight, neurocognitive function and symptom clusters in chronic schizophrenia. Schizophrenia Research 27:37–44, 1997. doi:10.1016/S0920-9964(97)00075-3

    Article  PubMed  CAS  Google Scholar 

  33. Takai A, Uermatsu M, Ueki H: Insight and its related factors in chronic schizophrenic patients: A preliminary study. European Journal of Psychiatry 6:159–170, 1992

    Google Scholar 

  34. Smith TE, Hull JW, Israel LM: Insight, symptoms and neurocognition in schizophrenia and schizoaffective disorder. Schizophrenia Bulletin 26:193–200, 1993

    Google Scholar 

  35. Kemp RA, Lambert TRJ: Insight in schizophrenia and its relationship to psychopathology. Schizophrenia Research 18:21–28, 1995. doi:10.1016/0920-9964(95)00018-6

    Article  PubMed  CAS  Google Scholar 

  36. Schwartz RC: Insight and illness in chronic schizophrenia. Comprehensive Psychiatry 39:249–254, 1994. doi:10.1016/S0010-440X(98)90031-1

    Article  Google Scholar 

  37. Bartko I, Zador HG: Clinical symptomatology and drug compliance in schizophrenic patients. Acta Psychiatrica Scandinavica 77(11):74–76, 1988. doi:10.1111/j.1600-0447.1988.tb05080.x

    Article  PubMed  CAS  Google Scholar 

  38. Heinrichs DW, Cohen BP, Carpenter WT Jr.: Early insight and the management of schizophrenic decompensation. Journal of Nervous Mental Disease 173:133–138, 1985. doi:10.1097/00005053-198503000-00001

    Article  CAS  Google Scholar 

  39. Dickerson FB, Boronow JJ, Ringel N, et al.: Lack of insight among outpatients with schizophrenia. Psychiatric services 48(2):195–199, 1997

    PubMed  CAS  Google Scholar 

  40. Saravanan B, Jacob KS, Johnson J, et al.: Assessing insight in schizophrenia: East meets west. The British Journal of Psychiatry 190:243–247, 2007. doi:10.1192/bjp.bp.106.029363

    Article  PubMed  Google Scholar 

  41. Peralta V, Cuesta MJ: Lack of insight: Its status within schizophrenic psychopathology. Biological Psychiatry 15(36):559–561, 1994. doi:10.1016/0006-3223(94)90620-3

    Article  Google Scholar 

  42. Becker RE: Depression in schizophrenia. Hospital and Community Psychiatry 39:1269–1275, 1988

    PubMed  CAS  Google Scholar 

  43. Mohamed S, Fleming S, Penn DL, et al.: Insight in schizophrenia: Its relationship to measures of executive functions. Journal of Nervous and Mental Disease 187:525–531, 1999. doi:10.1097/00005053-199909000-00001

    Article  PubMed  CAS  Google Scholar 

  44. Young DA, Davila R, Scher H: Unawareness of illness and neuropsychological performance in chronic schizophrenia. Schizophrenia Research 10:117–124, 1993. doi:10.1016/0920-9964(93)90046-L

    Article  PubMed  CAS  Google Scholar 

  45. Carroll A, Fattah S, Clyde S, et al.: Correlates of insight and insight change in schizophrenia. Schizophrenia Research 35:247–253, 1999. doi:10.1016/S0920-9964(98)00142-X

    Article  PubMed  CAS  Google Scholar 

  46. McCabe R, Quayle E, Beirne A, et al.: Insight, global neuropsychological functioning and symptomatology in chronic schizophrenia. Journal of Nervous and Mental Disorders 190:519–522, 2002. doi:10.1097/00005053-200208000-00004

    Article  Google Scholar 

  47. Flashman LA, McAllister TW, Andreasen NC, et al.: Smaller brain size associated with unawareness of illness in patients with schizophrenia. American Journal of Psychiatry 157:1167–1169, 2000 doi:10.1176/appi.ajp.157.7.1167

    Article  PubMed  CAS  Google Scholar 

  48. Larøia F, Fannemel M, Rønneberg C, et al.: Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests. Psychiatry Research: Neuroimaging Section 100:49–58, 2000

    Article  Google Scholar 

  49. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th edn., Washington, DC, American Psychiatric Association, 1994

  50. Wechsler D: WAIS-III-UK, Wechsler Adult Intelligence Scale, 3rd edn. Psychological Corporation, 1998

  51. McEvoy JP, Freter S, Merritt M, et al.: Insight about psychosis among outpatients with schizophrenia. Hospital and community psychiatry 44(9):883–889, 1993

    PubMed  CAS  Google Scholar 

  52. Derogatis LR: Brief Symptom Inventory: Administration, Scoring, and Procedures Manual. Minneapolis, MN, National Computer Systems, 1993

    Google Scholar 

  53. Cuesta MJ, Peralta V: Lack of insight in schizophrenia. Schizophrenia Bulletin 20:359–366, 1994

    PubMed  CAS  Google Scholar 

  54. Goldberg RW, Green-Paden LD, Lehman AF, et al.: Correlates of insight in serious mental illness. Journal of Nervous and Mental Disorders 189:137–145, 2001. doi:10.1097/00005053-200103000-00001

    Article  CAS  Google Scholar 

  55. Young DA, Zakzanis KK, Bailey C, et al.: Further parameters of insight and neuropsychological deficit in schizophrenia and other chronic mental disease. Journal of Nervous and Mental Disease 186:44–50, 1998. doi:10.1097/00005053-199801000-00007

    Article  PubMed  CAS  Google Scholar 

  56. Startup M: Awareness of own and others’ schizophrenic illness. Schizophrenia Research 26:203–211, 1997. doi:10.1016/S0920-9964(97)00050-9

    Article  PubMed  CAS  Google Scholar 

  57. Freudenreich O, Deckersbach T, Goff DC: Insight into current symptoms of schizophrenia: Association with frontal cortical function and affect. Acta Psychiatrica Scandinavica 110:14–20, 2004. doi:10.1111/j.1600-0447.2004.00319.x

    Article  PubMed  CAS  Google Scholar 

  58. Tirupati S, Padmavati R, Thara R, et al.: Insight and psychopathology in never-treated schizophrenia. Comprehensive Psychiatry 48(3):264–268, 2007. doi:10.1016/j.comppsych.2006.10.006

    Article  PubMed  Google Scholar 

  59. Cuesta MJ, Peralta V, Caro F, et al.: Is poor insight in psychotic disorders associated with poor performance on wisconsin card sorting test. American Journal of Psychiatry 152:1380–1382, 1995

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of East Anglia, Norwich, UK

    Evgenia Stefanopoulou

  2. Cambian Healthcare, 4th Floor, Waterfront Building, Chancellors Road, Hammersmith Embankment, London, UK

    Antonio Romero Lafuente

  3. Cambian Healthcare, Storthfield House, Storth Lane, Normanton, Derby, UK

    J. Andres Saez Fonseca & Adam Huxley

Authors
  1. Evgenia Stefanopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Romero Lafuente
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Andres Saez Fonseca
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adam Huxley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam Huxley.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stefanopoulou, E., Lafuente, A.R., Saez Fonseca, J.A. et al. Insight, Global Functioning and Psychopathology Amongst In-patient Clients with Schizophrenia. Psychiatr Q 80, 155–165 (2009). https://doi.org/10.1007/s11126-009-9103-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-009-9103-9

Keywords

Search

Navigation