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PubMed2004

Mourning, insight, and reduction of suicide risk in schizophrenia.

Literature on the assessment of suicide risk in individuals with schizophrenia is summarized, including the risk factors shared in common with the general population, illness-specific risk factors, and times of heightened risk in the course of the illness. Because depression emerges as a significant risk factor, it is differentiated from conditions that can mimic depression: mourning, aprosodia, and negative symptoms. Because insight or awareness of illness carries risk, as does the lack of insight, the psychological and neurocognitive components of impaired and of accurate insight are described. Finally, the role of mourning in the attainment of accurate, usable insight that can reduce suicidal risk is described.

Denial, Psychological↗

PubMed1999

Insight in severe mental illness: implications for treatment decisions.

This article reviews recent research related to impaired insight in schizophrenia and its consequences for cognitive, behavioral, legal, and treatment compliance issues affecting this population. It discusses efforts to find the neurobiological basis for lack of insight and the various structures or circuits of the brain that have been implicated. In the search for a more reliable and valid measure of insight for treatment decisions, the development of various assessment instruments is summarized. Impaired insight is shown to be related to a poorer course of the illness and noncompliance with necessary treatment. The implications of these findings for treatment decisions, legal interventions, and ongoing treatment monitoring are discussed.

Adult↗

PubMedDate not supplied

Poor insight in schizophrenia: neurocognitive basis.

Poor insight in schizophrenia has been recently thought to be a reflection of prominent and enduring neurocognitive impairments. Reports supporting this theory have implicated prefrontal and parietal lobe functions, among other parameters. The results of other studies have negated the role of neuropsychological abnormalities in poor insight. The analogy between poor insight in schizophrenia and anosognosia in neurological illness as proposed by one set of workers has been elucidated in this review and it appears quite promising. However, the drawing of definite conclusions from all this work has been deferred by us, because of the need for more uniform and standardized methodologies for research on the subject. Nevertheless, attempts to improve the cognitive processes, which affect insight in schizophrenia, may be done to gain better treatment outcome in this disorder.

Awareness↗

PubMed2000

The effects of approach and avoidance motor actions on the elements of creative insight.

The authors propose that the nonaffective bodily feedback produced by arm flexion and extension informs individuals about the processing requirements of the situation, leading to the adoption of differential processing styles and thereby influencing creativity. Specifically, the authors predicted that arm flexion would elicit a heuristic processing strategy and bolster insight processes, whereas arm extension would elicit a systematic processing strategy and impair insight processes. To test these predictions, the authors assessed the effects of these motor actions on 3 central elements of creative insight: contextual set-breaking, restructuring, and mental search. As predicted, in 6 experiments, arm flexion, relative to arm extension, facilitated insight-related processes. In a 7th experiment, arm extension, relative to arm flexion, facilitated analytical reasoning, supporting a cognitive tuning interpretation of the findings.

Affect↗

PubMed2001

Information processing and insight: a process model of performance on the nine-dot and related problems.

The 9-dot problem is widely regarded as a difficult insight problem. The authors present a detailed information-processing model to explain its difficulty, based on maximization and progress-monitoring heuristics with lookahead. In Experiments 1 and 2, the model predicted performance for the 9-dot and related problems. Experiment 3 supported an extension of the model that accounts for insightful moves. Experiments 4 and 5 provided a critical test of model predictions versus those of previous accounts. On the basis of these findings, the authors claim that insight problem solving can be modeled within a means-ends analysis framework. Maximization and progress-monitoring heuristics are the source of problem difficulty, but also create the conditions necessary for insightful moves to be sought. Furthermore, they promote the discovery and retention of promising states that meet the progress-monitoring criterion and attenuate the problem space.

Adult↗

PubMed1975

The idealization of insight.

Psychoanalysts tend to idealize the classic model of technique, central to which is the development of insight through interpretation. This is so even though from Freud onward they have realized the inapplicability of this model to many kinds of people and clinical exigencies. As a consequence of this idealization, other factors which plausibly contribute to change, and other elements in the psychotherapeutic situation within and outside of the mainstream of psychoanalytic technique, have been inadequately exploited theoretically and clinically. These include the roles of affect, action, and will; the meaning of insight to the patient and insight as a defense against change; some dangers of insight; factors common to all psychotherapy; and the interpersonal relationship. In this paper I discuss these variables and issues, with reference to case examples, suggest that this sociopsychological problems for psychoanalysis can be understood with reference to some aspects of history of psychoanalysis, and suggest some options and opportunities.

Affect↗

PubMedDate not supplied

Mystery patient insight into clinical laboratory service.

Gone are the days when most patients tolerated impersonal service from their physicians and health-care providers in general. Every day, customer and patient satisfaction becomes more critical to a health-care provider's success and survival. Open communications, Internet-informed patients, and aggressive watch groups reveal those health-care providers who consistently deliver poor service. Most health-care providers employ patient satisfaction surveys to monitor their level of service; however, written and telephone surveys seldom provide the surveyor the insight necessary to provide differentiating service because of a large illiteracy rate and fear of reprisal. Toward this end, a well-trained mystery patients offers the health-care provider greater insight into how service is dispensed to its customers and patients. This article offers an aggregate of mystery patient insights into delivering clinical laboratory services both in hospital and medical practice environments, supported with insightful information into creating winning service strategies.

Benchmarking↗

PubMed1992

Assessment of "insight" understanding of mental illness in developing countries.

'Insight', which is an indication of patient's understanding about his/her illness, needs particularly sensitive measures for its assessment. A questionnaire regarding insight, and brief psychosocial profile of the patients was applied to 103 cases. The cases were categorized according to the diagnosis and initial understanding of mental illness and 'insight' by the patients in our culture. The study did not support the popular belief that neurotics have and psychotics do not have insight.

Adolescent↗

PubMed1987

[Changes in emotional insight in the course of psychoanalysis. A single case study].

The initial phase and the termination phase (8 sessions each) of a psychoanalysis are compared according to changes of emotional insight. Aspects of emotional insight are investigated using contentanalytic rating scales which allow to determine the integration of emotional and cognitive aspects of experiencing. There are significant differences of insight between initial phase and termination phase. Regarding the mean scores of single sessions, we observed in the course of the initial phase a decrease of insight and of the emotional access to experiencing, that is in contrast to the changes described before. A systematic clinical description can explain the contentanalytic results. Obviously the psychoanalytic process is influenced by a complex interaction of different factors.

Adaptation, Psychological↗

PubMed1979

Insight and adherence to medication in chronic schizophrenics.

Chronic schizophrenics are well-known for the tendency to not take medication. Clinical observation and studies indicate that insight plays a significant role in medication adherence. This study investigated the roles of insight and perceived benefits from medication by patients. Those patients who had insight, perceived benefits from medication and also perceived a relation between the 2 were more likely to take medication than those who did not have insight nor perceive benefits. A speculative model and possible methods of increasing medication adherence are suggested.

Awareness↗

PubMed1998

Otherness within: aspects of insight in psychoanalysis.

In this paper I consider moments of insight in which the subject consciously experiences the emergence of something alien within the self, usually of a drive-related, affective, and at times uncanny nature. These are crucial, yet neglected, experiences of insight within the therapeutic process. Such experiences do not fit easily into our theory, because usual descriptions of insight stress the ego's integrative capacities. I attempt to demonstrate how aspects of our theory that emphasize rational, narrative explanations, or the social construction of clinical facts, as well as those that emphasize the ego's integrative functions, may prevent our fully appreciating these experiences of insight in our patients.

Cognition↗

PubMed1997

Insight and competence to consent to psychiatric hospitalization.

Informed consent and insight are among the most important issues in medical treatment, especially for psychiatric patients. In this study, we examined the competence to consent to psychiatric hospitalization of 113 psychiatric patients who were voluntarily admitted to a mental hospital in various psychotic states and compared it with their insight. We found a significant correlation between the patients' competence and insight into their illnesses. There is a discussion of the problematic issues of informed consent, competence and psychosis and the importance of insight in the context of mental illness.

Adult↗

PubMed1998

Study population and treatment titration in the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT).

OBJECTIVES: To ascertain the baseline characteristics of the high-risk hypertensive patients entering the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT). To determine the success of single and combination therapy in achieving target blood pressures in such a population. DESIGN: INSIGHT is a double-blind, prospective outcome trial comparing the efficacy of the calcium channel blocker, nifedipine GITS, and the thiazide, co-amilozide, in preventing myocardial infarction and stroke. We recruited 2996 men and 3454 women, aged 55-80 years, with blood pressure during placebo run-in >150/95 mmHg or isolated systolic blood pressure >160 mmHg from nine countries. Treatment allocation to nifedipine GITS 30 mg daily or co-amilozide (hydrochlorothiazide 25 mg/amiloride 5 mg) once daily was performed by minimization rather than randomization to balance additional risk factors. This was followed by four optional increases in treatment: dose-doubling of the primary drug, addition of atenolol 25/50 mg or enalapril 5/10 mg, and then any other hypotensive drug excluding calcium blockers or diuretics. Target blood pressure was 140/90 mmHg or a fall > or = 20/10 mmHg. RESULTS: Blood pressure at randomization was 172+/-15 / 99+/-9 mmHg. Thirteen per cent of the patients were previously untreated. The proportions of each additional risk factors were: smoking > 10/day, 29%; cholesterol > 6.43 mmol/l, 52%; family history of premature myocardial infarction or stroke, 21%; diabetes mellitus 20%; left ventricular hypertrophy, 10%; previous myocardial infarction, other presentations of coronary heart disease, and peripheral vascular disease, each 6%; proteinuria, 3%. Fifty-five per cent of patients had one additional risk factor, whereas 33%, 9% and 3% had two, three or more additional risk factors, respectively. The blood pressure (and falls in blood pressure) at the end of titration and at 1 year after minimization was 139+/-12 / 82+/-7 mmHg (33+/-15 / 17+/-9) in the 5226 patients still on randomized treatment The numbers requiring the four treatment increments were, respectively, 1591, 780, 597 and 294, meaning that almost 70% of patients on randomized treatment in INSIGHT are receiving only the primary drug. At one year, 69% of patients had a blood pressure < or = 140/90 mmHg. CONCLUSION: INSIGHT is one of the first double-blind comparisons of active antihypertensive treatments, requiring high-risk patients to achieve sufficient power. Despite this requirement, it is possible to achieve good blood pressure control in most patients without the addition of multiple additional treatments that may dilute any differences between the primary agents.

Aged↗

PubMed2002

Twenty-four hour ambulatory blood pressure in the International Nifedipine GITS Study Intervention as a Goal in Hypertension Treatment (INSIGHT).

OBJECTIVES: The International Nifedipine GITS Study Intervention as a Goal in Hypertension Treatment (INSIGHT) showed, by means of office blood pressure measurements, that long-term treatment with nifedipine GITS is as effective as diuretics in preventing cardiovascular and cerebrovascular complications. However, since office blood pressure measurements reflect to a limited extent blood pressure outside the office, a side-arm INSIGHT study in which patients underwent both office measurement and 24 h ambulatory blood pressure monitoring was also performed. DESIGN AND METHODS: The study had a randomized, double-blind, parallel group design. After 4 weeks of placebo, mild-to-moderate essential hypertensive patients were randomized to nifedipine GITS 30 mg or amiloride 2.5 + hydrochlorothiazide 5 mg for 3.1 years. Dose titration was performed by dose doubling and addition of atenolol 25-50 mg or enalapril 5-10 mg, or other drugs when needed. Analysis was carried out by intention-to-treat and included computation of 24 h, day and night ambulatory blood pressure and heart rate values. Additional analyses included computation of the trough-to-peak ratio and the smoothness index (the ratio between the average of the 24-hourly blood pressure reductions after treatment and its standard deviation). RESULTS: A total of 151 patients were recruited and 149 were valid for analysis: 78 patients had 24 h ambulatory recordings both at baseline and during treatment and 134 during treatment. Office, 24 h and day and night blood pressures were all significantly and similarly reduced by both treatments. Office and ambulatory heart rate was left unchanged by diuretics, while it was slightly reduced by nifedipine. Median trough-to-peak ratios were always > 0.5 and superimposable between the two treatment groups. Similarly, smoothness indices of systolic and diastolic blood pressures were comparably high for nifedipine and diuretics, thus demonstrating a similar well-balanced antihypertensive response to both drugs. No significant differences were observed between the two treatment groups in the number of cardiovascular events (17 in the nifedipine-based and 26 in the diuretics-based treatment group). CONCLUSIONS: In the INSIGHT study, the long-term antihypertensive effect on 24 h blood pressure and the cardiovascular protection of nifedipine was similar to that of diuretics.

Aged↗

PubMed1997

Effect of patient and family insight on compliance of schizophrenic patients.

Insight on the part of both patients and their significant others is thought to be an important factor influencing compliance with medication and treatment of schizophrenic patients. Using the Scale to Assess Unawareness of Mental Disorder, the insight and the awareness of patients and of their significant others were studied with respect to symptoms, behaviors, and medication effects. The participants who were more aware of their mental illnesses and of the beneficial effects of medication were more likely to be compliant with prescribed medications. Both awareness and insight of the patient and their family members appears to have a beneficial impact on compliance. Participants whose significant others subsequently failed to cooperate with scheduled interviews had less awareness of their illnesses, and less appreciation of the beneficial effects of medications. Although not statistically significant, there was a trend for the patients who had no medication side effects to be compliant with prescribed medications. Abuse of alcohol or other substances in this population was low; only marijuana use was associated with noncompliance. Educating both patients and their family members to identify disease symptoms, drug effects and side effects has the potential to improve compliance in schizophrenic patients.

Adult↗

PubMed2003

A new model for conceptualizing insightfulness in the psychoanalysis of young children.

Traditional definitions of insight fail to take into account the cognitive and developmental limitations of young analysands, who lack the capacity to mentalize. It is suggested that insightfulness be redefined as promoting mentalization in young children. Gaining this key psychological function furthers the internal integration and self-regulation necessary to regain developmental momentum. The central importance of promoting such development in child psychoanalysis suggests that the facilitation of a mechanism for self-understanding, not the interpretation of content, is essential. Insightfulness is facilitated by employing a range of interventions beyond the interpretation of resistance and content, rendering meaningless the distinction between interpretive and relational aspects of the analyst's role.

Awareness↗

PubMed2007

Insight and regional brain volumes in schizophrenia.

We have investigated the relationship between insight impairment and regional brain volumes (gray and white matter) in schizophrenia using voxel-based morphometry (VBM). Fifty patients with schizophrenia were evaluated using the Scale for Unawareness of Mental Disorders. Magnetic resonance images were acquired, segmented and spatially normalized using optimized VBM routines. No significant inverse correlations were detected between insight impairment and gray or white matter volumes in the prefrontal region (where significant findings had been predicted a priori), or in any other brain areas. Our results do not support previous hypotheses suggesting a relationship between frontal lobe atrophy and impaired insight in patients with schizophrenia.

Adolescent↗

PubMed2006

Depression, suicidal behavior and insight in adolescents with schizophrenia.

OBJECTIVES: To investigate the interrelationships between depressive symptoms of adolescent schizophrenia, post-psychotic depression (PPD), negative signs, suicidal behavior and insights into the disease. METHODS: Three groups of 16 adolescent inpatients were assessed with regard to: Schizophrenia alone, schizophrenia with PPD and major depressive disorder (MDD). The following measures were used: DSM IV diagnostic criteria, the Calgary Depression Scale for Schizophrenia (CDSS), the PANSS (Positive and Negative Signs of Schizophrenia Scale), (BDI) Beck Depression Inventory, (CCL) Cognitive Check List, (HS) Hopelessness Scale, (SRS) Suicide Risk Scale, (CSPS) Child Suicide Potential Scale and the (SAUMD) Scale to Assess Unawareness of Mental Disorder. RESULTS: Compared with MDD adolescents, PPD adolescents showed few somatic and behavioral symptoms of depression but had equally severe cognitive and affective depressive symptomatology. Suicide risk scores and actual suicidal behavior was prominent in PPD adolescents. A positive and significant correlation was found between PPD symptoms, suicide risk and awareness of disease (insight). Negative symptoms of schizophrenia could be distinguished from PPD symptoms and there was a negative correlation between blunted affect and PPD scores. CONCLUSIONS: PPD can be diagnosed in adolescent schizophrenia. The symptom pattern is different from MDD, therefore, there may be cause to modify DSM IV provisional criteria for this condition. Adolescents with schizophrenia who have insight into their illness are at higher risk for suicidal behavior and the development of PPD.

Adolescent↗