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PubMed1998

Conceptualization and measurement of insight.

Insight is a complex phenomenon which has been conceptualized variously as a symptom of schizophrenia and as awareness of illness, making comparisons of studies measuring insight difficult. Furthermore, attempts to establish a correlation between insight and successful treatment outcomes are fraught with methodological problems. Specifically, categorical judgments fail to capture important information about the quality of insight; inappropriate inferential statistics have been used; and validity of instruments to measure insight has not been established. In future research, the concept of insight needs to be clarified. Nonparametric statistical analysis should be considered for small, nonnormally distributed samples. Qualitative exploratory research is needed.

Awareness↗
PubMed2003

Insight and neurocognition in schizophrenia.

The relationship between neurocognitive impairments in schizophrenia remains unclear. Recent literature was reviewed and the most consistent finding was an association between perseverative errors on the Wisconsin Card Sort Test (WCST) and poor insight. The aim was to confirm and extend this finding using a range of assessments relevant to perseveration, and different dimensions of insight, in a sample of 33 acutely psychotic subjects within 5 years of onset of schizophrenia and related disorders. Results showed a correlation (r=-0.59) between insight and perseverative errors, rather than more general measures of abstraction. A factor representing relabelling symptoms, derived from insight scale items, correlated even more strongly; however, other insight factors correlated more weakly, suggesting they are less dependent on neuropsychological deficits. The ability to monitor output and correct errors appears to be closely related to the core features of insight in psychosis.

Adolescent↗
PubMed2004

The evolution of insight, paranoia and depression during early schizophrenia.

BACKGROUND: How insight, paranoia and depression evolve in relation to each other during and after the first episode of schizophrenia is poorly understood but of clinical importance. METHOD: Serial assessments over 18 months were made using multiple instruments in a consecutive sample of 257 patients with first episode DSM-IV non-affective psychosis. Repeated measures of paranoia, insight, depression and self-esteem were analysed using structural equation modelling, to examine the direction of relationships over time after controlling for confounds. RESULTS: Depression was predicted directly by greater insight, particularly at baseline, and by greater paranoia at every stage of follow-up. Neither relationship was mediated by self-esteem, although there was a weak association of lower self-esteem with greater depression and better insight. Paranoia was not strongly associated with insight. Duration of untreated psychosis and substance use at baseline predicted depression at 18 months. CONCLUSIONS: In first-episode psychosis, good insight predicts depression. Subsequently, paranoia is the strongest predictor. Neither effect is mediated by low self-esteem. Effective treatment of positive symptoms is important in preventing and treating low mood in early schizophrenia.

Adult↗
PubMed1997

Prodromes, coping strategies, insight and social functioning in bipolar affective disorders.

BACKGROUND: Patients suffering from bipolar affective disorders are generally reported to be able to detect prodromes. Insight is also said to be desirable for a good outcome. However, very little is known about the effect of insight and patients' spontaneous strategies for coping with prodromes on their social functioning. METHOD: In a cross-sectional study 40 bipolar patients, who were not in an acute episode, were interviewed about their prodromes of depression and mania, their coping strategies for these prodromes, their levels of insight and their levels of social functioning. RESULTS: A quarter of subjects reported that they could not detect any early warnings of depression compared with only 7.5% of subjects who reported that they could not detect prodromes of mania. Subjects reported both spontaneous cognitive and behavioural strategies for coping with prodromes of depression but only behavioural strategies for prodromes of mania. Subjects' current levels of depression, how they coped with prodromes of mania and their ability to recognize early warnings for depression contributed significantly to their level of social functioning. Insight also had a weaker but significant contribution. CONCLUSION: No causal link was made in this study. However, it did show that patients' level of social functioning was related to their level of insight, and to how well they coped with the prodromes of mania and whether they could detect prodromes of depression. The results suggest that it is worth exploring ways of teaching patients to monitor their moods and to promote insight and good strategies for coping with their prodromes.

Adaptation, Psychological↗
PubMed1998

A comparative study of insight scales and their relationship to psychopathological and clinical variables.

BACKGROUND: Research on the subject of insight has been hampered by difficulties in definition and reliable measurement. METHODS: We compared several rating scales to measure insight on a group of 33 psychotic patients as well as assessing patients' psychopathology, clinical characteristics and cognitive functioning. RESULTS: Most currently used scales showed a high degree of inter-correlation. Measures of insight related strongly to the presence of delusions; grandiosity (inversely), and depression (positively). Higher insight scores correlated with indices of treatment compliance and inversely with substance abuse. Measures of pre-morbid IQ and impaired executive functioning, including the Wisconsin Card Sorting Test were not associated with poor insight. CONCLUSIONS: The study highlights aspects of psychopathology and clinical variables particularly related to insight and supports the continued use of standardized scales in further research in this area.

Adult↗
PubMed2006

Insight in body dysmorphic disorder with and without comorbid obsessive-compulsive disorder.

INTRODUCTION: The aim of this study was to compare the level of insight in patients with body dysmorphic disorder (BDD) with and without comorbid obsessive-compulsive disorder (OCD), and to measure its possible relationships with clinical features. METHODS: Thirty outpatients affected by BDD, according to Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition criteria, of whom 18 were also suffering from OCD, were included in the study. Clinical assessment was carried out by means of the Yale-Brown Obsessive-Compulsive Scale modified for BDD and a specially designed OCD Questionnaire. The level of insight was measured by means of the score at item 11 of the Yale-Brown Obsessive-Compulsive Scale modified for BDD. RESULTS: The insight resulted to be excellent in four cases, good in four, fair in five, poor in 15 and absent in two. Significant and positive correlations were observed between the level of insight and the following items: resistance to thoughts and to activities as well as to time spent on activities and control on activities related to the defect. The insight was significantly lower in patients affected by both BDD and OCD. CONCLUSION: The findings indicate that the majority of BDD patients in this study, and especially those with comorbid OCD, have a low degree of insight that is significantly correlated to symptoms specific of the disorder.

Adolescent↗
PubMedDate not supplied

Delusion formation and insight in the context of affective disturbance.

OBJECTIVE: Delusions and lack of insight have traditionally been viewed as the defining characteristics of insanity and in modern psychiatry continue to be central to the diagnosis of psychosis. Little is known about the mechanisms of delusion formation and much of the research into delusions and lack of insight has been focussed on schizophrenia, in spite of the fact that these symptoms are also prominent in other disorders e.g., affective psychosis. The objective of this paper is to review the literature on existing theories of delusions and insight with reference to the effects of affective disturbance on memory processes. METHOD: Narrative review supplemented by literature searches using Medline, PsycINFO and EMBASE databases for the period 1980 to present using terms "delusion", and "insight" and "affect". RESULTS: The role of affect on memory in normal psychology and delusions in psychopathology is being increasingly recognised. We sketch out a theory which gives weight to locating the formation and maintenance of mood congruent and mood incongruent delusional beliefs (and insight into such beliefs) within a model of normal memory processes. CONCLUSION: We conclude that delusional beliefs may represent false or biased memories of internal or external events modified and strengthened of by affective states. We propose that insight rests on an ability to identify these memories as internally generated or biased. In view of the growing body of knowledge accumulating from the study of memory, emotion and their neuropsychological correlates we would suggest using this as an evidence base for the further neuropsychiatric investigation of delusional beliefs.

Delusions↗
PubMed2002

Why insight fails.

Psychoanalysts rely on insight to promote therapeutic change. However, even when a great deal of insight has been attained, significant change may not be forthcoming in some patients, more often in borderline-level patients. The author examines such a case with particular reference to E. Kris' major points on insight, including the role of the ego's integrative functions in the attainment and utilization of insight. The author contends that failure to utilize insight is overdetermined and not necessarily owing to impairments in the integrative functions or to resistance in all its expressions. The author postulates that failure to make progress is due to a combination of the strength of the unmodulated drives, general ego weakness, poor early object relations, particularly preverbal experience, and constitution, in interaction. The whole of the personality is implicated in the inability to utilize insight.

Aged↗
PubMed1998

The relationship between insight, illness and treatment outcome in schizophrenia.

Lack of awareness of mental disorder in schizophrenia has been increasingly identified by researchers during recent years due to a resurgence of interest in the subject. In addition, better measurement methods have led to more valid and detailed investigations on insight in schizophrenia. Poor insight has been reported as a common phenomenon which may have both nosological and prognostic value. Specifically, due to recent studies indicating that lack of insight in schizophrenia may lead to poor treatment outcome, research focused on this phenomenon could lead to increasingly effective and efficient treatment strategies. However, many past and present studies reporting a correlation between insight and outcome in schizophrenia demonstrate significant theoretical or methodological limitations which may limit the implications and generalization of findings. This article lists and critically analyzes historical and contemporary research focusing on insight, illness, and outcome in schizophrenia. The role of insight is outlined, as are current methods for assessing awareness of mental disorder in schizophrenia. Cumulative research in this area is then reviewed, in terms of hypotheses, methods, conclusions, and limitations. Finally, suggestions for future research in this area are delineated.

Attitude to Health↗
PubMed2002

Mothers' insightfulness regarding their infants' internal experience: relations with maternal sensitivity and infant attachment.

This study examined the associations among mothers' insightfulness into their infants' internal experience, mothers' sensitivity to their infants' signals, and infants' security of attachment to their mothers. The insightfulness of 129 mothers of 12-month-old infants was assessed by showing mothers 3 videotaped segments of observations of their infants and themselves and interviewing them regarding their infants' and their own thoughts and feelings. Interviews were classified into 1 insightful and 3 noninsightful categories. Mothers' sensitivity was assessed during play sessions at home and at the laboratory, and infant-mother attachment was assessed with the Strange Situation. Mothers classified as positively insightful were rated as more sensitive and were more likely to have securely attached children than were mothers not classified as positively insightful. Insightfulness also accounted for variance in attachment beyond the variance explained by maternal sensitivity. These findings add an important dimension to research on caregiving, suggesting that mothers' seeking of explanations for the motives underlying their infants' behavior is related to both maternal sensitivity and infant attachment.

Attitude↗
PubMed2003

The dimensions of insight in people with dementia.

This study aims to characterize the factors determining the retention or loss of insight in dementia through: (i). a comparison of assessment procedures previously used to quantify loss of insight and (ii). a qualitative analysis of interviews with patients and carers. Semi-structured interviews were carried out with thirty-two people with dementia and their carers, which incorporated assessments via clinical interview, discrepancy ratings between patient and carer on an Activities of Daily Living scale, and prediction of performance on a memory task. The results of these were compared and supplemented with themes arising from qualitative analysis of the interviews. Significant differences were found between insight as measured by a prediction of performance paradigm and other methods of assessment. This may reflect a distinction between implicit and explicit knowledge. Analysis of interviews identified the following factors as contributing to people's awareness of their difficulties: (1). short-term frustration or distress; (2). continuous discontent; (3). lack of concern; (4). normalization of problems; (5). worry and anxiety; (6). defensiveness; (7). explicit denial; and (8). priority given to other problems. We conclude that insight in dementia is a complex, multi-dimensional, and value-laden concept. Emotional and behavioural aspects need to be considered as well as the cognitive, which is emphasized by traditional methods of assessment based on quantitative ratings. Implicit awareness may be accessible through subjects' predictions of performance on cognitive tasks and should be further investigated. An adequate account of insight in dementia should incorporate both objective and subjective measures in order to determine the interrelationships between organic changes, personality factors, and psychological mechanisms. A generally accepted, reliable protocol for the assessment of insight needs to be developed.

Activities of Daily Living↗
PubMed2004

Insight and hopelessness in forensic patients with schizophrenia.

OBJECTIVE: To quantitatively explore the level of insight in forensic patients with schizophrenia, and its relationship to symptoms and to a history of violence. In addition, to test the hypothesis that scores in the insight domains of 'compliance' and 'awareness of illness' are positively correlated with scores on a self-report scale measuring 'hopelessness'. METHOD: The study consisted of a cross-sectional survey. Subjects were inpatients and outpatients in the rehabilitation service of the Victorian Institute of Forensic Mental Health. Twenty-eight patients with a diagnosis of schizophrenia and a history of serious offending consented to take part. Twenty-two of these had committed homicide. Measures were obtained for each on the Schedule for Assessment of Insight, the Positive and Negative Syndrome Scale for Schizophrenia and the Beck Hopelessness Scale. RESULTS: The mean insight score for forensic patients was 8.39 (SD 4.88). Insight scores did not differ significantly between those subjects who had a history of violence prior to their index offence and those who did not. Awareness of illness, but not compliance, was positively correlated with level of hopelessness. A higher level of awareness of having a mental illness was thus related to feeling more hopeless about the future. CONCLUSIONS: Mean insight scores in patients with schizophrenia with a forensic history do not differ significantly from those in non-forensic populations. Being more aware of being mentally ill may be a risk factor for hopelessness about the future. The limitations of the study are the small sample size, and the fact that it is confined to a relatively clinically stable population.

Adult↗
PubMed1989

Insight in schizophrenia. Its relationship to acute psychopathology.

The relationship between insight and acute psychopathology was explored in a group of 52 acutely psychotic, schizophrenic patients. A measure of insight, reflecting patients' recognition of their illness and need for care, was validated against ratings from a semi-structured interview and against assessments of patients' compliance with medication. Contrary to expectations, degree of insight was not consistently related to the severity of acute psychopathology, as measured on two structured scales. Nor did changes in insight during hospitalization vary consistently with changes in acute psychopathology. These data suggest that very little of the deficiency in insight seen in schizophrenic patients is explainable on the basis of acute psychopathological features. The mechanism that accounts for impairment in insight in schizophrenia may be relatively resistant to treatment with neuroleptic medication.

Acute Disease↗
PubMed1989

Insight and the clinical outcome of schizophrenic patients.

At the time of discharge from their index hospitalizations, 52 schizophrenic patients initially admitted for acute psychotic episodes were assessed on an Insight and Treatment Attitudes Questionnaire. When these patients were followed up 2 1/2 to 3 1/2 years later, adequate information on their clinical courses and outcomes was available in 46 cases. A global assessment of aftercare environment was made in each case, reflecting the degree to which individuals other than the patient were helpfully invested in maintaining the patient in treatment, whether these individuals were in the patient's living or treatment situations. Five factual outcome variables were also assessed: a) compliance with treatment 30 days after discharge; b) long-term compliance; c) whether or not patients were readmitted; d) readmissions per year; and e) percent of time spent in the hospital. As expected, aftercare environment was significantly related to outcome (p = .039). The overall relationship between insight and the outcome variables closely approached statistical significance (p = .053). Patients with more insight were significantly less likely to be readmitted over the course of follow-up. There was a trend for patients with more insight to be compliant with treatment 30 days after discharge. No significant interaction between aftercare environment and insight was found, suggesting that insight may influence outcome independently of aftercare environment.

Adolescent↗
PubMed1998

Insight and interpersonal function in schizophrenia.

Research has linked impaired insight in schizophrenia to poorer medication compliance and treatment outcome. It is unclear, however, whether poorer interpersonal function is also associated with impaired insight. To examine this question, subjects with schizophrenia or schizoaffective disorder were classified as having unimpaired (N = 44) or impaired (N = 57) insight, and their scores on Heinrichs et al.'s Quality of Life (QOL) Scale were compared. Multiple regressions were conducted to determine the relationship between individual components and social function. Results indicate that subjects with impaired insight had significantly poorer QOL interpersonal relation and intrapsychic foundation scores than unimpaired subjects, despite having equivalent deficit symptoms. Unawareness of the social consequences of illness was found to be the component of insight more closely linked to social dysfunction. This suggests that impairments in insight may be uniquely associated with social dysfunction.

Adult↗
PubMed2001

Correlates of insight in serious mental illness.

This study extends research into insight by examining its relationship to a variety of demographic, clinical, neurocognitive, and psychosocial variables among a broad diagnostic sample of 211 adults with serious mental illness. Participants completed a full battery of instruments measuring these variables. Results support a relationship between ratings of poor insight and a psychotic (vs. mood) diagnosis, increased psychiatric symptoms, poorer social skills, and negative medication attitudes. Minorities and those with a substance abuse diagnosis were also more likely to be rated as having poor insight. No relationship was found between level of insight and age, gender, education level, neurocognitive deficits, hospitalization history, size of one's social network, or quality of life measures. Results are discussed in the context of improving the measurement and assessment of insight, conceptualizing interventions aimed at addressing level of insight, and improving outcomes for patients with severe and persistent mental illness. Findings also support a need for continued investigation of how mental illness is understood, experienced, and expressed across diverse groups of people living with mental illness.

Adult↗
PubMed2005

Are the cognitive deficits associated with impaired insight in schizophrenia specific to executive task performance?

Although impaired insight in schizophrenia has been associated with deficits in executive task performance, the relationship remains unclear. We aimed to clarify this relationship by fractionating executive functioning into the theoretically derived functions of inhibition, working memory, set shifting, and sustained attention. We compared the performance of patients showing impaired insight, patients showing good insight, and a matched control group on measures of each of these executive functions, along with measures of current cognitive functioning and memory. We found that while patients with impaired insight performed significantly below those with good insight on our working memory task, they also performed poorly on measures of general cognitive functioning and memory. We conclude that while impaired insight does appear to be associated with executive deficits, this association may not be specific but may instead relate to cognitive deficits more generally.

Adult↗
PubMed2005

The relationship among insight, cognitive function of patients with schizophrenia and their relatives' perception.

Medically, insight is a multidimensional concept. Results of previous studies are inconclusive regarding the relationship between insight and global and cognitive functions. The aim of this study was to evaluate the relationship among insight, patients' global function, cognitive function of patients with schizophrenia and their key caregivers' perception about this disorder. Thirty-one patients with schizophrenia were recruited. Cognitive function such as memory index proved to be a significant predictor for patients' insight; environmental factors such as caregivers' perception was not. In addition to cognitive deficit, whether the other factors such as genetic variability, medication use, environmental factors, and illness severity, etc., could influence insight of patients will still be a controversial issue. Further multidimensional survey of the relationship with insight in a larger and comprehensive design is necessary.

Adult↗