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PubMed2005

Relationships between insight and medication adherence in outpatients with schizophrenia and bipolar disorder: prospective study.

The aim of the present study was to explore the associations between insight and medication adherence at index interview and at 1-year follow-up interview in bipolar and schizophrenic outpatients. The Schedule for Assessment of Insight (SAI) and its expanded version (SAI-E) were used to provide a baseline insight score for 65 bipolar subjects and 74 schizophrenic subjects considered to be in remission or to have minimal psychopathology. Medication adherence of subjects was assessed at index interview and at 1-year follow-up interview, and the association between insight and medication adherence was analyzed cross-sectionally and prospectively. The results of the analysis reveal that in bipolar subjects, the index SAI scores for insight into treatment, mental-health status and psychotic experiences, and total SAI-E were positively correlated with medication adherence at both index and 1-year follow-up interviews. However, in schizophrenic subjects, insight into treatment and total SAI-E correlated positively with medication adherence at index interview but not at 1-year follow-up interview. Medication adherence at index interview could predict medication adherence 1 year later in both bipolar and schizophrenic subjects. These results indicate that the predictive value of insight for medication adherence differs between bipolar and schizophrenic patients, and building insight is an important step for establishing medication adherence in bipolar patients.

Adolescent↗
PubMed1997

Lack of insight among outpatients with schizophrenia.

OBJECTIVE: This study investigated the prevalence of lack of insight among outpatients with schizophrenia and the relationship between lack of insight and other variables, including whether patients received professional residential supervision. METHODS: A total of 87 stable outpatients with schizophrenia were drawn from community programs in a public-private mental health system. Subjects' clinical symptoms and insight about their illness were assessed using the Positive and Negative Syndrome Scale, a battery of neuropsychological tests, and the Social Functioning Scale. RESULTS: The illness insight of 43 subjects, or 49.5 percent, was at least moderately impaired. Twenty-one subjects, or 25 percent, had severe insight deficits. In a multiple regression analysis, 40 percent of the variance in lack of insight was predicted by ratings of the severity of delusions, difficulty with abstract thinking, lack of social activities, and absence of anxiety. Patients who received professional residential supervision had more impaired insight than those living independently or with family. CONCLUSIONS: Insight deficits are common among stable outpatients engaged in community-based care. These deficits have implications for patients' use of limited services such as residential supervision.

Activities of Daily Living↗
PubMed2006

Insight dimensions and cognitive function in psychosis: a longitudinal study.

BACKGROUND: It has been reported that lack of insight is significantly associated with cognitive disturbance in schizophrenia. This study examines the longitudinal relationships between insight dimensions and cognitive performance in psychosis. METHODS: Participants were 75 consecutively admitted inpatients with schizophrenia, affective disorder with psychotic symptoms or schizoaffective disorder. Assessments were conducted at two time points during the study: at the time of hospital discharge after an acute psychotic episode and at a follow-up time that occurred more than 6 months after discharge. A multidimensional approach of insight was chosen and three instruments for its assessment were used: the Scale to Assess Unawareness of Mental Disorder (SUMD), three items concerning insight on the Assessment and Documentation in Psychopathology (AMDP) system and the Insight and Treatment Attitudes Questionnaire. The neuropsychological battery included a wide range of tests that assessed global cognitive function, attention, memory, and executive functions. RESULTS: After conducting adequate statistical correction to avoid Type I bias, insight dimensions and cognitive performance were not found to be significantly associated at cross-sectional and longitudinal assessments. In addition, baseline cognitive performance did not explain changes in insight dimensions at follow-up. Similar results were found in the subset of patients with schizophrenia (n = 37). The possibility of a Type II error might have increased due to sample attrition at follow-up. CONCLUSION: These results suggest that lack of insight dimensions and cognitive functioning may be unrelated phenomena in psychosis.

Adult↗
PubMed1995

Insight and psychotic illness. Cross-sectional and longitudinal associations.

BACKGROUND: Insight has recently re-emerged as an important aspect of psychopathology amenable to empirical study. We sought to examine the relationship between various aspects of insight into illness and clinical, sociodemographic and neuropsychological variables. METHOD: From an inner-London catchment area population, 150 in-patients with recent onset of psychosis were assessed on a variety of measures, including the Present State Examination (PSE). Subjects were followed up for a mean of four years and reassessed. RESULTS: High IQ was associated with better insight as rated on the PSE, while gender, ethnicity and a diagnosis of schizophrenia appeared to be unrelated. At follow-up, similar associations were found, as well as correlations with attitudes to treatment and a more elaborate measure of insight. Cerebral ventricular enlargement and tests of frontal lobe function did not correlate with insight, but there was a curious, strong association with left-handedness at both assessment points. Initial insight correlated significantly but weakly with insight at follow-up. CONCLUSIONS: The assessment of insight in psychosis has concurrent validity and is a distinct aspect of psychotic phenomenology. It may, in part, have a neuropsychological basis.

Adolescent↗
PubMed2000

Reappraising insight in psychosis. Multi-scale longitudinal study.

BACKGROUND: Many patients suffering from psychosis are unaware of their disorder and symptoms. AIMS: To investigate whether insight changes with time, and how it relates to patients' psychopathology, and to examine the correlations between insight scales in patients with psychoses. METHODS: Seventy-five consecutively admitted in-patients with schizophrenia, affective disorder with psychotic symptoms, or schizoaffective disorder were examined after remission of an acute episode and at follow-up (> 6 months). Three different scales were used to assess insight. RESULTS: To some extent, insight into past episodes improved over time in patients with psychosis, regardless of diagnosis. Few significant relationships between insight and psychopathology remained stable at follow-up. The higher the negative and disorganisation dimensions at baseline, the less did attitudes to treatment vary when tested at follow-up. No predictive value for variability of psychopathological dimensions was found for insight dimensions. The insight scales used were highly intercorrelated, suggesting that they measure the same construct. CONCLUSIONS: Insight and psychopathology seem to be semi-independent domains.

Adult↗
PubMed2004

Neural activity when people solve verbal problems with insight.

People sometimes solve problems with a unique process called insight, accompanied by an "Aha!" experience. It has long been unclear whether different cognitive and neural processes lead to insight versus noninsight solutions, or if solutions differ only in subsequent subjective feeling. Recent behavioral studies indicate distinct patterns of performance and suggest differential hemispheric involvement for insight and noninsight solutions. Subjects solved verbal problems, and after each correct solution indicated whether they solved with or without insight. We observed two objective neural correlates of insight. Functional magnetic resonance imaging (Experiment 1) revealed increased activity in the right hemisphere anterior superior temporal gyrus for insight relative to noninsight solutions. The same region was active during initial solving efforts. Scalp electroencephalogram recordings (Experiment 2) revealed a sudden burst of high-frequency (gamma-band) neural activity in the same area beginning 0.3 s prior to insight solutions. This right anterior temporal area is associated with making connections across distantly related information during comprehension. Although all problem solving relies on a largely shared cortical network, the sudden flash of insight occurs when solvers engage distinct neural and cognitive processes that allow them to see connections that previously eluded them.

Adolescent↗
PubMed2005

In vivo performance evaluation of the Achilles Insight QUS device.

Achilles plus (GE, Lunar) has been widely used worldwide for more than a decade, and for its precision, ability to predict fragility fractures and comparability to central DXA, it can be considered a reference standard among quantitative ultrasound devices. As a water-bath system, Achilles plus has obvious practical drawbacks. Achilles Insight is a new-generation device that gives ultrasound parameters in less than 1 min, providing real-time imaging of the os calcis. The aim of this study was to evaluate the in vivo performance of Achilles Insight in comparison to Achilles plus. The precision showed a coefficient of variation (CV) of 0.5 and 0.4%, 4.1 and 3.0%, 2.7 and 2.1%, respectively, for speed of sound (SOS), broadband ultrasound attenuation (BUA), and Stiffness obtained with Achilles plus and Achilles Insight. We also studied 117 postmenopausal women (mean age: 67.1+/-8.8 yr), 47 with and 70 without fragility fractures. Ultrasound parameters obtained by the two devices significantly (p<0.001) correlated and resulted in agreement according to the Bland and Altman method. Achilles plus and Achilles Insight showed similar values of areas under receiver operating characteristics (ROC) curves in discriminating patients with or without fractures (0.884, 0.82, and 0.879 for SOS, BUA, and Stiffness, respectively, with Achilles plus, and 0.882, 0.828, and 0.889, respectively, for Achilles Insight). In conclusion, the better precision of the Achilles Insight with respect to Achilles plus could be explained by the fact that the measurement with Achilles Insight needs less time and gives a consequent reduction in motion artifacts. The high correlation and the similar ability to identify postmenopausal women with vertebral fracture suggest the possibility of using the database of Achilles plus for Achilles Insight.

Absorptiometry, Photon↗
PubMed1999

A descriptive study of insight into illness reported by persons with schizophrenia.

1. Four levels of insight, ranging from lack of insight to complete insight, emerged from the interview data and field notes. Insight has many dimensions although it has previously been assessed as a unidimensional indicator of illness. 2. Persons with schizophrenia differ in insight or ability to recognize that they have an illness and the ramifications of the illness. Successful participation in rehabilitation requires some degree of insight into the illness. 3. Consistent family support, medications, and cognitive efforts by the person contributed to the developing of insight by the persons interviewed. Nevertheless, these conditions were not always sufficient for developing insight.

Adult↗
PubMed2000

Impaired insight in Alzheimer disease: association with cognitive deficits, psychiatric symptoms, and behavioral disturbances.

OBJECTIVE: The purpose of this study was to evaluate symptoms associated with impaired insight in patients with Alzheimer disease (AD). BACKGROUND: Although unawareness of deficits is common in AD, the relation of awareness to psychiatric and behavioral disturbances has not been extensively studied. METHOD: We conducted a cross-sectional investigation of 91 patients with probable AD according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. Awareness of cognitive and functional deficits was measured with the Inaccurate Insight item from the Neurobehavioral Rating Scale. Psychiatric and behavioral symptoms were measured using factor scores and individual items from the Neurobehavioral Rating Scale. Global cognitive deficits were measured using the Mini-Mental State Examination (MMSE). RESULTS: Stepwise regression analysis showed that insight was associated with MMSE score, depression/anxiety factor score, and agitation/disinhibition factor score. Variables not associated with awareness of deficits included patient age, behavioral retardation factor score, verbal output disturbance factor score, and psychosis factor score. Post hoc analyses showed a positive relation (i.e., greater insight, more symptomatology) between deficit awareness and symptoms of depressed mood and anxiety. There was a negative relation (i.e., greater insight, less symptomatology) between insight and symptoms of hostility, agitation, inattention, and tension. In a follow-up stepwise regression analysis, increased deficit awareness was associated with a higher MMSE score, greater depressed mood, and decreased agitation. CONCLUSIONS: These findings suggest that patients with AD may experience symptoms of depressed mood in relation to increased awareness of decrements in functioning. The data also indicate that patients with poor insight demonstrate greater agitated behavior. Consistent with previous research, impaired insight was higher in the later stages of the illness.

Aged↗
PubMed2004

Insight and alexithymia in hospitalized psychiatric patients.

The relationship of insight to the personality dimension of alexithymia was investigated in 91 psychiatric inpatients. Insight as a global construct and three subscales: the capacity to recognize that one has a psychiatric disorder, one needs treatment, and to label one's emotional illness as pathological were empirically measured via the Birchwood Scale for Insight. Alexithymia and its three subfactors were assessed by the 26-item Toronto Alexithymia Scale. Two of the alexithymia subfactors did correlate with reduced global insight and less acceptance of the need for therapy. Insight also correlated positively with the magnitude of depressed mood. In a regression model, depressed mood best predicted global insight. Other clinical variables, such as clinical severity upon admission, change in clinical status or diagnosis, did not predict insight levels. In summary, insight is a multidimensional phenomenon that does not simply correlate with alexithymia as a global construct but does correlate with alexithymic subfactor of diminished fantasy life.

Adult↗
PubMed2005

Insight and alexithymia in adult outpatients with obsessive-compulsive disorder.

OBJECTIVE: To elucidate the relationships between insight and alexithymia in a sample of adult outpatients with obsessive-compulsive disorder (OCD). METHODS: 112 adult outpatients with OCD were tested. Severity of OCD was assessed with the first 10-items of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and score for item # 11 on the Y-BOCS was considered as a measure of insight. Alexithymia was measured with 20-item Toronto Alexithymia Scale (TAS-20). Additional measures were Maudsley Hospital Obsessive Compulsive Inventory (MOCI) and Montgomery Asberg Depression Rating Scale (MADRS). RESULTS: Of the patients, 29.5% showed poor or no insight. Patients with poor or no insight were more alexithymic than patients with excellent, good and moderate insight. TAS-20 total score and subfactors positively correlated with score for item # 11 on the Y-BOCS, severity of OCD and MADRS scores. In stepwise regression model, MADRS scores, factor 3 of TAS-20 (Externally Oriented Thinking), somatic and hoarding-saving obsessions were significantly associated with lower insight. CONCLUSIONS: Results show a relationship between poor or absent insight and high alexithymia levels in OCD patients.

Adult↗
PubMedDate not supplied

Insight into illness in schizophrenia.

Lack of insight of patients with schizophrenia into various aspects of their illness and treatment is an important clinical issue. Poor insight has been reported to be associated with neurocognitive deficits, particularly in the frontal and parietal functions. The aim of this study was to examine relationships between insight and cognitive and emotional function in patients with schizophrenia. Thirty-five male forensic patients suffering from chronic schizophrenia participated. The Scale for the Assessment of Unawareness of Mental Disorder was used to assess insight. Neuropsychological function was assessed with a comprehensive battery of tests. Clinical state was also assessed. Of 35 patients, 18 (51%) believed that they had a mental disorder. A similar proportion reported awareness of a need for medication and correctly attributed symptoms to illness. Measures of insight showed significant associations with visual object learning, verbal working memory, and identification of facial emotions but not with measures of frontal lobe function. Poorer insight was associated with a higher occurrence of violent events. Our findings support an association between poor insight and cognitive impairment in patients with chronic schizophrenia but suggest that the relationship may not specifically involve frontal lobe dysfunction.

Adult↗
PubMed2006

Predicting domain-specific insight of schizophrenia patients from symptomatology, multiple neurocognitive functions, and personality related traits.

This study examines the contribution of various neurocognitive functions, clinical characteristics, and personality traits to the prediction of three insight dimensions. Clinically stable schizophrenia patients (n=107) residing in the community were evaluated using the Positive and Negative Syndrome Scale, the Scale for the Assessment of Unawareness of Mental Disorder, and a comprehensive battery of instruments to measure personality related variables and neurocognitive functioning. Step-wise multivariate regression analysis indicates significant association of variability in insight dimensions with neurocognitive functioning (20-41%), personality related traits (8-18% temperament factors, 4-7% self-constructs, 10-14% coping styles), severity of symptoms (about 7%), illness duration (6%), and education (about 5%). Poor insight was attributed to impairment in visual and movement skills, sustained attention, executive functions, intensity of autistic preoccupations and positive symptoms, as well as increased novelty seeking behavior, task and emotion oriented coping styles, better self-esteem, self-efficacy, and higher education. Better awareness was related to better performance of neurocognitive tasks, reward dependence behavior, avoidant coping style, and longer illness duration. Aside from common indicators for the various insight dimensions, we defined specific indicators for each insight dimension. Thus, insight dimensions in schizophrenia patients residing in the community were attributed to neurocognitive and personality related factors rather than to psychopathological symptoms. The findings enable better understanding of the multifactorial nature of insight and highlight targets for more effective intervention and rehabilitation.

Adaptation, Psychological↗
PubMed2004

Correlates of insight in first episode psychosis.

Impaired insight is common in schizophrenia and may be related to poor treatment adherence. Few studies have examined the clinical and neurocognitive correlates of insight in early schizophrenia. Early course schizophrenia, schizoaffective, and schizophreniform disorder patients (n=535) were studied. The Positive and Negative Symptom Scale (PANSS) was used to assess psychopathology, and a broad range of neuropsychological functions was assessed. Using hierarchical stepwise multiple regression analyses, we examined the association of clinical, neurocognitive, and premorbid measures with the level of insight. Impaired insight was associated with overall symptomatology, including positive, negative, and general psychopathology and with deficits in cognitive functioning. In descending order of robustness, the significant variables were PANSS general psychopathology (p<0.0001), Rey Auditory Verbal Learning Test (p<0.0004), Clinical Global Impression (p<0.005), PANSS positive (p<0.007), and premorbid adjustment-general subscale (p=0.02). Among the PANSS general psychopathology items, unusual thought content was most robustly associated with impaired insight (p<0.00000). Insight impairment is very common in early schizophrenia, and appears to be associated with a broad range of psychopathology and deficits in multiple cognitive domains. These observations suggest that deficits in insight may be related to a generalized dysfunction of neural networks involved in memory, learning, and executive functions.

Adolescent↗
PubMedDate not supplied

Insight and outcome in bipolar, unipolar, and anxiety disorders.

We performed a study to assess the relationship between impairment of insight and the long-term outcome in affective and anxiety disorders. Standardized insight assessments were made using the Scale to Assess Unawareness of Mental Disorder (SUMD) in 101 outpatients with psychiatric disorders, mostly affective and anxiety disorders, treated over 1 year in a university-based clinic. Outcome was prospectively assessed with the Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) rating scales. The mean follow-up period was 3.9 months. Initial impairment of insight did not correlate with poor outcome. However, improvement in insight correlated with good outcome, particularly in bipolar disorder type I (r = .56 to .67, P = .0005). Insight was similarly impaired in bipolar and unipolar major depressive disorders, and more so than in anxiety disorders (P = .002). An association between a lack of improvement in insight and a poor outcome, most significantly in bipolar disorder type I, was observed in this sample. We found a greater relative impairment of insight in mood versus anxiety disorders.

Adult↗
PubMed2002

Comparison of clinical characteristics in good and poor insight obsessive-compulsive disorder.

Beginning with DSM-III-R, the condition of an intact insight towards obsessive-compulsive symptoms, which was essential for the classical definition of obsessivecompulsive neurosis, has been removed, permitting inclusion of cases with poor insight. A total of 94 cases who met DSM-III-R criteria for obsessive-compulsive disorder were included in this study. The Structured Clinical Interview for DSM-III-R (SCID-P), YaleBrown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression (HRSD), Hamilton Rating Scale for Anxiety (HRSA), and State-Trait Anxiety Inventory (STAI) were administered to each patient. Two subgroups determined by DSM-IV item "poor insight" were compared for demographic variables and the scores obtained on the scales. Scores on the Y-BOCS, HRSA, HRSD and STAI-state were significantly higher in the poor insight group. Current and past major depression were also more frequent. Among personality disorders (PDs), avoidant PD was more common in the good insight group and borderline and narcissistic PDs were more common in the poor insight group. HRSA, HRSD, and STAI-state scores had weak to moderate but significant correlations with insight as defined by the item 11 of Y-BOCS. Findings are discussed in view of previous reports.

Adult↗
PubMed2003

Insight in schizophrenia: a meta-analysis.

There has been an increase in the study of insight in schizophrenia in the last 20 years. Insight is operationally defined according to five dimensions which include: the patient's awareness of mental disorder, awareness of the social consequences of disorder, awareness of the need for treatment, awareness of symptoms and attribution of symptoms to disorder. Despite the development of psychometrically sound measurement tools, the results from previous studies have been inconclusive regarding the nature of the relationship between insight and symptomatology. A meta-analysis of 40 published English-language studies was conducted to determine the magnitude and direction of the relationship, or effect size, between insight and symptom domains in schizophrenia and to determine moderator variables that were associated with the variations in effect sizes across studies. Results indicated that there was a small negative relationship between insight and global, positive and negative symptoms. There was also a small positive relationship between insight and depressive symptoms in schizophrenia. Acute patient status and mean age of onset of the disorder moderated the relationship between insight and symptom clusters. The possible reasons for the effect sizes being modest, the examination of the role of moderator variables and directions for future research are provided.

Adult↗
PubMed2000

The relationship between insight and medication adherence in severely mentally ill clients treated in the community.

OBJECTIVE: To study the relationship between aspects of insight and medication adherence and elements of psychopathology. METHOD: Clients completed insight and adherence measures in interview; doctors and case managers independently completed ratings of adherence and psychopathology. Other client information was obtained from the clinical file. RESULTS: The subscale structure of the insight scale was well reproduced. Clients endorsed items relating to need for treatment more than items relating to relabelling of symptoms and awareness of illness. Self-reported insight was lower in those clients for whom either the treating doctor or the case manager or both thought the client was non-adherent. Insight was related positively to clinician ratings of depressed mood, and negatively to clinician ratings of personal functioning. CONCLUSION: Our data support the subscale structure of the insight questionnaire used, and previous suggestions that insight is positively related to depressive affect, and inversely related to impaired psychosocial functioning.

Adult↗