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PubMedDate not supplied

Impaired insight in Alzheimer's disease.

We studied insight into illness in 41 patients with probable Alzheimer's disease. An impaired insight score was developed by measuring discrepancies between patient report and caregiver report on standard instruments of activities of daily living. Insight was more impaired in subjects with greater dementia severity and subjects with paranoid delusions. In a multivariate analysis, the best neuropsychological predictors of impaired insight were the Continuous Performance Test and the Visual Reproduction Test. We speculate that the impaired insight of Alzheimer's disease has two components: confabulation reflecting prefrontal dysfunction and anosognosia reflecting right-hemisphere dysfunction.

Activities of Daily Living↗
PubMedDate not supplied

Insight and cognitive impairment: effects on quality-of-life reports from mild cognitive impairment and Alzheimer's disease patients.

This study follows previous work to determine the effect of patient insight and cognitive impairment on the reliability and validity of self-reported quality of life (QOL) from patients diagnosed with Alzheimer's disease (AD) and mild cognitive impairment (MCI). AD and MCI patients (N = 68) and their caregivers participated. Patients with impaired insight provided QOL ratings that were less reliable than those provided by patients with better insight. Patient-caregiver agreement for. QOL reports was used as an index of validity. Neither better insight nor lesser cognitive impairment suggested better agreement. Thus, even when patient insight is intact, patient reports are unlikely to agree with caregiver reports. Patient and caregiver reports about patient QOL may represent 2 unique, yet potentially valid, perspectives.

Aged↗
PubMed1992

The meaning of insight in clinical psychiatry.

Insight can be defined not only in terms of people's understanding of their illness, but also in terms of understanding how the illness affects individuals' interactions with the world. The term 'insight' encompasses a complex concept which should not be considered as an isolated symptom which is present or absent. Instead, it may be more appropriate to think of insight as a continuum of thinking and feeling, affected by numerous internal and external variables. Different psychiatric disorders involve different mechanisms in the process of impairment of insight; this may influence the ways in which insight should be assessed in clinical practice.

Adult↗
PubMed1996

Relationship between insight, educational background and cognition in schizophrenia.

BACKGROUND: There is a paucity of research into the relationship between insight and variables including cognitive function, educational background and symptomatology in schizophrenia. METHOD: Sixty-four patients with DSM-III-R diagnosis schizophrenia were assessed with the Schedule for Assessment of Insight, Mini Mental State cognitive test, a new measure of knowledge about treatment (the Understanding of Medication Questionnaire), and educational background and compliance assessments. RESULTS: Insight scores correlated significantly with a range of variables. In a multiple regression analysis only knowledge about treatment and number of years in education explained a significant proportion of insight. CONCLUSION: Educational background and the intellectual ability required to learn complex concepts, such as models of mental illness, appear to be more important than previously considered. Research is limited by the lack of a generally accepted definition of insight.

Adult↗
PubMed1996

Psychological predictors of insight and compliance in psychotic patients.

BACKGROUND: A possible neuropsychological basis for poor insight in psychosis has been proposed. Consistent supporting evidence for this is lacking. METHOD: Seventy-four consecutive acutely psychotic in-patients who were recruited for a randomised controlled trial of compliance therapy were given a battery of neuropsychological tests, along with a comprehensive clinical assessment, before and after the intervention. RESULTS: Performance on neuropsychological tests improved during the patients' admission and treatment in hospital, as did symptoms and levels of insight. Cognitive function showed no relationship to insight and compliance initially, and very little after the intervention. Factors related to insight and compliance prior to discharge included: diagnosis, attitudes to medication, side-effects, being a detained patient, and whether or not compliance therapy was given. CONCLUSIONS: Clinical variables and attitudes to treatment appear to be more relevant to compliance and the development of insight in acute psychosis than neuropsychological impairment.

Adolescent↗
PubMed2006

Sensitometric comparisons of Insight and Ektaspeed Plus films: effects of chemical developer depletion.

The aim of this study was to compare the sensitometric properties of Insight and Ektaspeed Plus radiographic films manually and automatically processed using fresh and depleted chemical solutions. Ten sets of each type of film were obtained (1 set = 5 films), 5 sets being manually processed and 5 sets being automatically processed. A total of 100 films (50 Ektaspeed Plus and 50 Insight film) were exposed and developed. The first two sets of each film type were developed in fresh chemicals (one set per each type of processing), on the first day of the experiment. The other sets were processed in the same progressively depleted solutions once a week until the end of experiment, which was completed within 4 weeks. Characteristic curves were constructed to compare the sensitometric properties of the films: contrast, latitude and speed. Processing solution depletion had different effects on manually and automatically developed films, which was confirmed by the changes in the form of the characteristic curves in the third week of the automatic processing and fourth week of the manual processing. Ektaspeed Plus showed 11% reduction in contrast values for manual processing and 53% for automatic processing, while Insight contrast values showed a reduction of 25% and 59%, respectively. Insight film, however, showed lesser loss of speed and lesser increase of latitude than Ektaspeed Plus. In conclusion, chemical depletion in automatic film processing was faster than in manual developing. In depleted chemicals, both types of films had an increase in latitude values and a decrease in speed and contrast. Insight was more resistant than Ektaspeed Plus to decrease in speed and latitude when processed using older chemicals, whereas contrast in Ektaspeed Plus was comparatively more stable.

Solutions↗
PubMed2005

Radionuclide-based insights into the pathophysiology of ischemic heart disease: beyond diagnosis.

This review article discusses the historical origin of cardiac radionuclide-based methods, the physiologic background that justifies their existence, as well as the basic pathophysiologic concepts of coronary artery disease and their connection with the technologic design and application of these methods. Most importantly, this review discusses the important insights that these methods have provided to the understanding of the mechanisms of ischemia, risk stratification, and both treatment choice and treatment efficacy in ischemic heart disease. Nuclear cardiology originated as an attempt to provide complementary physiologic information to the anatomic information provided by coronary angiography. To comprehend the design and applications of nuclear cardiology methods, one must have a basic understanding of coronary artery disease as an inflammatory process that may manifest as acute or chronic states. Basic concepts on myocyte metabolic pathways, coronary blood flow, ischemic cascade, ventricular remodeling, and ejection fraction become critical for this purpose. Insights into risk stratification may permit patient-tailored therapy approaches. Insights into prognosis have made nuclear cardiology a robust tool for outcome predictions, with an exceptionally high negative predictive value. Evaluation of prognosis in special patient populations such as diabetics has originated important pathophysiologic concepts. Most insights into phenomena such as myocardial hibernation, myocardial stunning, and viability have been generated by nuclear cardiology techniques. Finally, new applications of radionuclide-based methods such as molecular identification of "vulnerable" atherosclerotic plaques, "ischemic memory" using fatty acid imaging, and myocardial innervation imaging provide new avenues for insightful research.

Animals↗
PubMed2001

An eye movement study of insight problem solving.

The representational change theory of insight claims that insight problems cause impasses because they mislead problem solvers into constructing inappropriate initial representations. Insight is attained when the initial representation is changed. In the present study (N = 24), we tested three specific implications of these hypotheses against eye movements recorded while participants solved matchstick arithmetic problems. The results were consistent with the predictions, providing converging evidence with prior findings using solution rates and solution times. Alternative theories of insight can explain individual findings, but only the representational change theory accounts for both the performance data and the eye movement data. The present study also suggests that eye movement recordings provide an important new window into processes of insight problem solving.

Adult↗
PubMed2003

Aha! Insight experience correlates with solution activation in the right hemisphere.

In one experiment, we tested for an association between semantic activation in the right hemisphere (RH) and left hemisphere (LH) and the Aha! experience when people recognize solutions to insight-like problems. The compound remote associate problems used in this experiment sometimes evoke an Aha! experience and sometimes do not. On each trial, participants (N = 44) attempted to solve these problems and, after 7 sec, named a target word, made a solution decision, and rated their insight experience of recognizing the solution. As in prior studies, the participants demonstrated more solution priming for solutions presented to the left visual field-RH (lvf-RH) than for solutions presented to the right visual field-LH (rvf-LH). As was predicted, following unsolved problems the participants showed greater priming for solutions that they rated as evoking an insight experience on the subsequent solution decision than for solutions that did not evoke an insight experience. This association was stronger for solutions presented to the lvf-RH than for those presented to the rvf-LH. These results tie the subjective experience of insight to an objective measure--semantic priming--and suggest that people have an Aha! experience in part because they already had semantic activation that could lead them to recognize the solution quickly. We believe semantic activation in both hemispheres cooperatively contributes to problem solving, but weak solution activation that contributes to the Aha! experience is more likely to occur in the RH than in the LH.

Brain↗
PubMed2003

[Constraint-based approach to individual differences in insight problem-solving].

In this study, we explored individual differences in insight problem-solving. According to the dynamic constraint relaxation theory (Hiraki & Suzuki, 1998), there are three sources of individual differences in insight problem-solving: the initial strengths of constraints, the evaluation of problem-solving attempts, and the learning rate that updates the strength value of each constraint. In order to validate the theory's predictions, we compared the subjects who could solve a geometric insight problem within 10 minutes with those who could not. A microscopic analysis of the solution processes and rating task revealed that the initial strengths of the constraints and the adequacy of evaluation are different between the two, but their learning rates are not. These results suggest that insightful problem-solvers try non-standard attempts more often even in the initial phase of their problem-solving and evaluate their attempts more precisely. The results were discussed in contrast with other approaches to insight.

Humans↗
PubMed1981

The forbidden quest and the analytic ideal: the superego and insight.

As is evident in the history of civilization, in myths and dreams, and in Freud's self-analysis, insight has been both prohibited and heroically sought. Psychoanalytic insight into unconscious processes and contents involves a gradual transformation of inner interdictions and ideals through the tolerance of previously forbidden curiosity and knowledge. The analytic process depends upon relaxation of censorship and analysis of the motives and modes of self-criticism and self-punishment. While the superego may also uphold truth, the ideal of insight into psychic reality is relatively rare. The formation and consolidation of an analytic ideal of insight is an outgrowth of and contribution to analysis and analytic education. Analytic education should result in freedom from inner constraints on insight, in independent thought and judgement, and in a continuing "after-education."

Dreams↗
PubMed1993

The relationship between insight and control in obsessive-compulsive disorder: implications for the insanity defense.

In this paper the authors examine the relationship between insight and control in patients with obsessive-compulsive disorder (OCD) in an effort to better understand the concept of volitional control of behavior especially as it relates to changes in the insanity defense that were recommended by the American Psychiatric Association (APA), specifically that the volitional prong be dropped. Yale-Brown Obsessive Compulsive Scale ratings in 56 subjects with OCD were reviewed with specific attention to items measuring the patients' subjective sense of decreased volitional control over their compulsions and their insight into their behavior. No statistically significant correlation was found between the control over compulsions item and the insight item. The authors conclude that the experience of volitional control in patients with OCD is not significantly related to the level of insight they have into the irrationality of their behavior. The authors then review cognitive therapy literature and show that though cognition and volition may appear to be dissociated in some disorders, even in the absence of insight, a relatively gross measure of legally relevant cognitive disturbance, subtle cognitive changes can be identified in patients with seemingly purely volitional disorders such as OCD.

Adult↗
PubMed2006

Theory of mind and unawareness of illness in schizophrenia: is poor insight a mentalizing deficit?

This study investigates the impact of theory of mind (ToM) deficits on poor insight in schizophrenia. The scale for unawareness of mental disorder (SUMD) was administered to 58 stable outpatients with schizophrenia. First and second order false belief tasks, the Eyes test and a battery of nonToM cognitive measures were administered. The Second order false belief task was the best predictor of each global insight and symptom attribution scores of the SUMD. ToM tasks explained the substantial amount of the variance (ranging from 22.5% to 29.9%) for the insight scores and classified the significant amount of the patients who were aware of the illness correctly. WCST perseveration scores did not contribute to insight scores beyond that contributed by second order false belief tasks. The Second order ToM tasks seems to have critical importance for the awareness of the disorder. Beyond more direct self-evaluation, the awareness of the disorder and its consequences may also require the ability to evaluate the self from the perspective of others. "Understanding the others' belief about another person" may be conceptually very similar to "understanding the others' belief about self" (instead of another person).

Adult↗
PubMed2005

Externalizing and personalizing biases in persecutory delusions: the relationship with poor insight and theory-of-mind.

The presence of externalizing bias (EB) for negative events together with personalizing bias (PB) (a bias to blame others rather than circumstances) may jointly constitute a vulnerability to develop persecutory delusions (PDs). Whereas EB purportedly serves to defend a vulnerable self-concept by avoiding negative self-attributions and might therefore exacerbate poor insight, PB may reflect cognitive deficits, including theory-of-mind impairment. We investigated these proposals in 34 schizophrenic patients with a history of PDs and 21 healthy controls. Patients with moderate- to severe-PDs and patients without a current PD showed excessive EB which was, surprisingly, absent in patients with mild persecutory delusions (mild-PDs). That EB might wax and wane with fluctuating delusional intensity was interpreted in accord with a new dynamic model of attribution self-representation cycles. As predicted, EB exacerbated poor insight. However, counter to predictions, theory-of-mind impairment did not increase PB, which was marked in all participants, whether clinical or non-clinical; instead, theory-of-mind impairment was also correlated with poor insight. Our findings indicate multiple pathways to poor insight, one of which is a theory-of-mind difficulty, impairing the capacity to simulate other perspectives for the purpose of critically evaluating one's own beliefs and circumstances.

Adult↗
PubMed2005

Prefrontal subregions and dimensions of insight in first-episode schizophrenia--a pilot study.

Deficits in insight are multidimensional, and include symptom unawareness and misattribution. We and others have observed that these deficits may be related to a prefrontal dysfunction. However, few studies have examined the relationship between specific prefrontal sub-regions and the awareness and attributional dimensions of insight in schizophrenia. This study examined the correlation between insight dimensions of awareness and attribution of symptoms and dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC) volume in 14 subjects with first-episode, antipsychotic-naïve (FEAN) schizophrenia. In addition, 21 healthy subjects provided control data for volumetric assessments. Insight was assessed with Scale to Assess Unawareness of Mental Disorders. Morphometric assessments were adjusted for intra-cranial volume and were conducted by trained raters blind to clinical information using BRAINS-2. Average scores on current awareness of symptoms (1=aware; 5=unaware) were negatively correlated with right DLPFC volume and average scores on current attribution of symptoms (1=attribute; 5=misattribute) with right medial OFC volume. Unawareness and misattribution of symptoms in FEAN schizophrenia may have distinct neuroanatomical bases. DLPFC deficits may have resulted in illness unawareness by interfering with self-monitoring, while OFC abnormalities may have mediated symptom misattribution by conferring aberrant salience to perceived symptomatology.

Adult↗
PubMed2005

Clinical picture of obsessive-compulsive disorder with poor insight: a regression model.

DSM-IV included a type of obsessive-compulsive disorder (OCD) with poor insight in the official classification. The present study was performed using a continuous measure of the level of insight to analyze the association between this variable and characteristics of the disorder. Seventy-four consecutive OCD outpatients (DSM-IV criteria) were assessed using: a semistructured interview for sociodemographic and clinical features, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the National Institute of Mental Health Obsessive-Compulsive Scale (NIMH-OCS), the Hamilton Depression and Anxiety Rating Scales (HDRS, HARS), and the Overvalued Ideas Scale (OVIS) as a continuous measure of the level of insight. Stepwise multiple regression analysis revealed that demographic and clinical factors were related to the OVIS score. The following four factors were found to be significantly related to the OVIS score: the Y-BOCS score for compulsions, OCD chronic course, and family history of OCD were positively related, while obsessive-compulsive personality disorder was negatively related. These results suggest that poor insight identifies a group of OCD patients with distinct clinical characteristics.

Adult↗
PubMed2002

Insight in persons with schizophrenia: effects of switching from conventional neuroleptics to atypical antipsychotics.

The primary aim of our study is to evaluate the level of insight during the switch from a classical antipsychotic drug to a atypical neuroleptic. Twenty-two schizophrenic patients were admitted to the study, 9 were male and 13 were female. Standardized questionnaire were: Scale for Assessment of Negative Symptoms (SANS), Scale for Assessment of Positive Symptoms (SAPS), Brief Psychiatric Rating Scale (BPRS) and Schedule for Assessing the three components of Insight (SAI). All patients were receiving haloperidol at time of recruitment. Eight patients were switched to clozapine, 3 to risperidone and 11 to olanzapine. The global function, measured with BPRS, increased after administration of atypical antipsychotics. The positive and negative symptoms were reduced. The level of insight was increased after the administration of the atypical antipsychotics. The cognitive effect of the atypical antipsychotics changed the level of insight and augmented the compliance.

Adult↗
PubMed1997

Insight, neurocognitive function and symptom clusters in chronic schizophrenia.

Only recently has there been interest in the systematic study of insight in schizophrenia. The present investigation was designed to evaluate the specific relationship between psychopathological symptoms, neurocognitive deficits and awareness of illness in chronic schizophrenia. Fifty-eight outpatients with the DSM-III-R diagnosis of schizophrenia were rated on David's Schedule for Assessing Insight, the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale and the Wisconsin Card Sorting Test (WCST). Results indicate that there is a significant association among these variables and that approximately 44% of the variance in the dependent variable could be explained by this combination of independent variables. Notably, however, negative symptoms were only moderately inversely correlated with awareness of illness, and they were not associated with scores on the WCST. Moreover, neither negative symptoms nor per cent perseverative errors contributed significantly to the prediction of insight in schizophrenia. These findings argue against the notion that unawareness of illness is the product of neuropsychological dysfunction in the frontal lobes. Instead, the most significant associations and predictors of insight were related to the positive symptoms of schizophrenia.

Adaptation, Psychological↗