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PubMed2000

Self-Appraisal of Illness Questionnaire (SAIQ): relationship to researcher-rated insight and neuropsychological function in schizophrenia.

The Self-Appraisal of Illness Questionnaire (SAIQ) is a self-report instrument designed to assess attitudes toward mental illness among persons receiving psychiatric treatment. This instrument was developed for use in community settings, adapted closely from the Patient's Experience of Hospitalization questionnaire. In order to examine the validity of the SAIQ, a factor analysis was first conducted on the items of this instrument in a sample of 59 outpatients with schizophrenia or schizoaffective illness. Three factors emerged: Need for Treatment, Worry, and Presence/Outcome of Illness. Next, to examine the concurrent validity of these three SAIQ subscales, they were correlated with researcher rated insight scales and neuropsychological tests. Results indicated that the Need for Treatment and Presence/Outcome subscales were significantly correlated with both researcher-rated insight scales and with neuropsychological tests of executive functioning. The Worry subscale was not associated with either researcher-rated insight scales or neuropsychological tests. It was concluded that the Need for Treatment and Presence/Outcome subscales may be used in combination as a brief screening instrument for clients with schizophrenia receiving outpatient psychiatric treatment who may be at risk for treatment non-compliance due to a lack of insight into illness.

Adult↗
PubMed2002

Body image, symptoms and insight in chronic schizophrenia.

Historically, schizophrenics' body image problems were regarded as related particularly to delusions and hallucinations. However, during the 1980s, the predominant view of the phenomenology of the disorder broadened to include negative symptoms; deviations in schizophrenics' body image underlie various behaviors or allegations concerning the body and should be refocused. The present study attempted to detect body image deviations in chronic schizophrenia using the Body Image Questionnaire (BIQ), which comprises three hypothetical components (anatomical, functional and other psychological components), and to clarify their related clinical characteristics in symptoms and insight. The BIQ was administered to 93 chronic schizophrenics (diagnosed according to DSM IV; 44 men and 49 women) and 177 normals (78 men and 99 women) adults. The combined data of the three BIQ components in schizophrenic and normal subjects were factor-analyzed separately, and factor scores obtained were compared between schizophrenic and normal groups. The factor scores that differentiated groups were further compared between schizophrenic subgroups, determined by high or low scores for positive symptoms assessed by Scale for the Assessment of Positive Symptoms, negative symptoms by Scale for the Assessment of Negative Symptoms and insight by the Schedule for Assessing Insight. Significant differences between diagnostic groups were found in five of nine factor scores. Dullness in movement, powerlessness, unusually strong gastrointestinal function, lifelessness and fragility proved to be the deviated body images in chronic schizophrenic patients. Powerlessness and lifelessness proved to be related to positive and negative symptoms, and unusually strong gastrointestinal function and fragility to insight.

Adult↗
PubMedDate not supplied

Insight and schizophrenia.

Few clinical attributes, if any, have such a profound impact on the management of schizophrenia as that associated with lack of insight. Yet, despite its importance, the clinical correlates of lack of insight are poorly understood. In one present study of long-stay patients at a state facility, lack of insight showed modest associations with positive and negative symptoms and with diminished executive function on cognitive testing. Insight did not differ between patients receiving typical and atypical antipsychotic medications.

Adult↗
PubMed2004

[The term insight in forensic practice].

The paper comments the German legal and forensic-psychiatric positions regarding the complex and yet unsolved question of insight in the context of criminal responsibility. Possible restrictions of insight are discussed. Finally a solution is suggested, which connects the assessment of insight with the ability to declare a free will: Both terms deal with the predecisional cognitive and motivational foundation of acts. Insight is closely associated with the competence to constitute a free will. Symptoms and disorders which tend to disturb this ability can be assessed by psychopathological methods. Possible restrictions concern mental retardation, dementia, organic personality disorders, mental disorders with delusional ideation and residual states of schizophrenia.

Crime↗
PubMedDate not supplied

Anosognosia in individuals with schizophrenia: toward recovery of insight.

This paper addresses the growing evidence that lack of insight, or unawareness of illness in people with schizophrenia, may actually be a medically based condition known as anosognosia. Major explanatory models and related research findings are discussed. A case scenario is presented, as well as current perspectives regarding assessment of insight and alternative treatment approaches. Implications for further research, nursing education, and practice also are included. With better understanding of the characteristics and treatment of diminished insight in individuals with schizophrenia, nurses can better assist clients to recover helpful insight that enables them to take an active role in managing their symptoms and problems.

Agnosia↗
PubMed1990

Insight for impairment in independent living skills in Alzheimer's disease and multi-infarct dementia.

Dementing diseases cause a deterioration in the capacity for independent living skills (ILS). The present study investigated the level of insight in ILS impairment in 12 Alzheimer's disease (AD) patients, 12 multi-infarct dementia (MID) patients, and 12 normal elderly controls, using two different measurement techniques: informant report and patient self-report. Pairwise comparisons at the .05 level revealed a significantly greater loss of insight for ILS impairment in AD patients as compared to both controls and MID patients. Additional analyses revealed that loss of insight, operationally defined as the discrepancy between informant report and patient self-report, was not significantly related to age, education, mental status, or level of depression, but was significantly related to degree of caregiver burden. These results indicate that intervention strategies are needed that take into consideration the level of patient insight for ILS impairment, as well as the caregiver's perception of the patient's capabilities and the degree of burden experienced by the caregiver.

Activities of Daily Living↗
PubMed2005

Insight in people with psychosis: the influence of culture.

The assessment of insight is a part of the routine clinical examination for people with mental illness. Such assessment, by psychiatrists, is based on the current definitions of insight, which rely on western notions of health and illness. This paper discusses the recent findings of explanatory models of people with a variety of physical diseases in Vellore, India. It also summaries the results of studies on insight in schizophrenia, which examined explanatory models of illness among patients, relatives, and the general population, in Vellore. The findings argue for the fact that the assessment of insight should be against the local cultural standards rather than universal yardsticks.

Culture↗
PubMed2026

VDJ-Insights: simplifying the annotation of genomic immunoglobulin and T cell receptor regions.

MOTIVATION: Accurate annotation of germline immunoglobulin (IG) and T cell receptor (TCR) loci is critical for understanding adaptive immunity. RESULTS: VDJ-Insights provides a user-friendly software package for characterizing these complex immune regions. In addition, it assesses gene segment functionality, identifies recombination signal sequences, and annotates complementarity-determining regions 1 and 2. VDJ-Insights achieved over 99% concordance with curated annotations from multiple species, outperforming existing annotation tools. When applied to 95 haplotypes from the Human Pangenome Reference Consortium, VDJ-Insights identified 652 and 275 novel IG and TCR alleles, respectively, highlighting its scalability for large immunogenetic studies. AVAILABILITY AND IMPLEMENTATION: Datasets and software package are available in the VDJ-insights repository, https://github.com/BPRC-Bioinfo and https://doi.org/10.5281/zenodo.17588835. Additional intermediate datasets used and analyzed during the current study are available from the corresponding authors upon reasonable request.

Software↗
PubMed2001

The relationship between insight and social skill in persons with severe mental illness.

The relationship of insight with the social behaviors of outpatients with severe mental illness (SMI) was investigated. Participants' engaged in two social interactions (i.e., stigmatizing and nonstigmatizing), each with a different research confederate. The participant's behavior was later coded for the presence of various self-presentation and social skill variables. Results indicated that greater insight was associated with better overall social skill, less observed strangeness, and greater self-disclosure of one's mental illness. Furthermore, the three measures of insight, one based on self-report and two interview-based, were all highly intercorrelated, suggesting that they are measuring a similar construct. Finally, consistent with previous research in the area, greater insight was associated with less severe psychiatric symptoms. Implications of these findings for future research are discussed.

Adult↗
PubMed2002

Insight and work performance in schizophrenia.

Research has linked impaired insight in schizophrenia to poorer medication compliance and poorer treatment outcome. The current study attempts to replicate previous findings that impaired insight is related to deficits in work function. To examine this question, 121 participants with schizophrenia or schizoaffective disorder enrolled in vocational rehabilitation were classified as having unimpaired (N = 65), or impaired (N = 56) insight. Next, participants were assigned a work placement and their work performance assessed on the third, fifth, and seventh weeks of work by using the Work Behavior Inventory. Among the 85 participants who completed these weeks of work, a multivariate analysis of variance and subsequent analysis of variance showed participants with impaired insight had significantly poorer ratings of work quality, work habits, cooperativeness, and personal presentation. When measures of global intelligence and executive function were entered as covariates in individual analysis of covariance, groups differed on measures of cooperativeness and personal presentation. Implications for rehabilitation are discussed.

Adult↗
PubMed2006

Troubling 'insight': power and possibilities in mental health care.

This paper critiques the conventional concept of 'insight' within the mental status assessment, seeking to unseat its taken-for-granted definition and the status it has acquired in research and practice. Drawing on social theory, consumer perspective and interdisciplinary research, the paper focuses on the impact of 'thin' biomedical understandings of insight, in disqualifying and demoralizing persons subjected to assessment and at the same time creating punitive scrutineers out of well-intentioned practitioners. Nurses and their mental health colleagues are encouraged to reconsider their reliance on the concept of insight. We entertain the alternative idea that insight is a quality of perception that mental health practitioners can cultivate, to more deeply understand their work, culture and the self.

Attitude of Health Personnel↗
PubMed1976

Assessment of insight change in medical student doing psychiatry.

The development of 'insight' in medical students is considered a fundamental component of psychiatric undergraduate education. The use of an insight test at the beginning and end of a 6 week teaching programme in clinical psychiatry showed a significant increase in insight as measured by this test. There was also a significant correlation between the final insight score and the results of a traditional oral examination.

Australia↗
PubMed1995

Recovery and insight in schizophrenia.

A study sample of 50 patients suffering from schizophrenia was examined at readmission and thereafter every second week until each patient had been interviewed five times i.e. eight weeks in total. Three types of recovery are identified, one with full and two with partial recovery of delusional beliefs. In patients with full recovery, the delusional dimensions (conviction, extension and pressure) decrease in a parallel manner. In patients with partial recovery, decreases in pressure precede decreases in other dimensions. Two-thirds (64%) of the patients have high insight from the very start of admission, and for two-thirds (68%) the degree of insight does not change during recovery. The average degree of insight increases during recovery, irrespective of the type of recovery. It is concluded that insight operates to some degree independently of positive psychotic symptoms and may be perceived as a distinct component of recovery.

Adult↗
PubMed2005

Disease, deficit or denial? Models of poor insight in psychosis.

OBJECTIVE: To examine the evidence for the three kinds of aetiological model that dominate the current literature on poor insight in psychosis: clinical models, the neuropsychological model, and the psychological denial model. METHOD: Studies pertaining to one or more of these aetiological models were identified, reviewed and critically evaluated. RESULTS: There is little support for clinical models, partly because they lack testable hypotheses. Several studies reveal a positive relationship between insight and executive function, which may be related to frontal lobe dysfunction. However, the extent to which this relationship is specific and independent of general cognitive impairment remains unclear. There is tentative evidence to support the psychological denial model. Recent data combining the latter two approaches suggest that multiple factors contribute to poor insight. CONCLUSION: Integration of different aetiological models is necessary for a fuller understanding of insight in psychosis. Future research should assess multiple aetiological mechanisms in single investigations.

Attitude to Health↗
PubMed2005

Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder.

OBJECTIVE: To map the development of insight in the 4 years after presentation with first-episode schizophrenia and schizophreniform disorder and to determine the effects of evolving insight on depression and the likelihood of attempted suicide. METHOD: We assessed 101 individuals at presentation, 6 months and 4 years. We measured insight, including recognition of mental illness, recognition of need for treatment and ability to relabel psychotic symptoms. We measured depression and recorded all suicide attempts. RESULTS: Insight improved with time. Recognition of mental illness at 6 months predicted depression and attempted suicide at 4 years. CONCLUSION: Six months after presentation, the greater the acknowledgement by people that they had a mental illness, the more depressed they were at 4 years and the greater the likelihood that they would attempt suicide by 4 years. This may have implications for disclosure of diagnosis.

Adult↗
PubMed2005

Frontal lobe hypometabolism and impaired insight in Alzheimer disease.

OBJECTIVE: The authors examined the relationship between impaired insight regarding cognitive and functional deficits and frontal cortex hypometabolism in 41 patients with Alzheimer disease (AD). METHODS: Regional cerebral glucose metabolism was determined with (18F)fluorodeoxyglucose and positron emission tomography. Level of insight was measured with the clinician-rated Neurobehavioral Rating Scale, and severity of global cognitive impairment was determined with the Mini-Mental State Exam. RESULTS: Inaccurate insight was correlated with glucose metabolic rate in the right lateral frontal cortex (Brodmann areas 6 and 45, and the lateral aspect of Brodmann areas 8 and 9) after controlling for global cognitive dysfunction. CONCLUSIONS: The findings from this study help to further elucidate the neurobiological mechanisms underlying impaired insight in AD, indicating a link between this important clinical phenomenon and dysmetabolism in a focal region of the right prefrontal cortex.

Activities of Daily Living↗
PubMed1979

Insight and hospital adjustment.

The relationship between insight and adjustment in schizophrenics was examined. Subjects who scored higher on a paper-and-pencil insight test were rated by hospital staff as better adjusted behaviourally but described themselves as more psychologically distressed than presumably less insightful subjects. Results were discussed in relation to the notion that insight in schizophrenics may intensify subjective distress while conducing to behavioural adaptation.

Adaptation, Psychological↗
PubMed1999

"To see oursels as others see us". Aubrey Lewis's insight.

BACKGROUND: This paper takes as its starting point the paper by Aubrey Lewis entitled "The psychopathology of insight" published in 1934, unreferenced. AIMS: To attempt to explore the historical antecedents and consequences of this work. METHOD: Speculative review. RESULTS: Lewis's approach to phenomenology, contemporaneous movements in psychology and Lewis's own life and times--notably the eugenics legislation in Nazi Germany--probably shaped his conclusions. Modern concepts of insight, which emphasise neuropsychology as well as social psychology, were anticipated in Lewis's writings. CONCLUSIONS: The concept of insight has stimulated research into difficult theoretical and practical areas such as self-awareness and treatment compliance, respectively. Concern over a patient's capacity for insight has the potential to humanise psychiatry.

Cognition Disorders↗