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PubMed1999

Subjective and external assessments of quality of life in schizophrenia: relationship to insight.

OBJECTIVE: This study assessed the manner in which insight influenced schizophrenic patients' evaluation of their objective life conditions and the concurrent validity between patients' and clinicians' assessments of patients' global quality of life. METHOD: Forty out-patients who fulfilled DSM-III-R criteria for schizophrenia were independently interviewed using the Lancashire Quality of Life Profile and the Standard of Living Interview. Insight was assessed using a self-report questionnaire, the Insight Scale. RESULTS: For insightful patients there was a significant but modest correlation between objective and subjective indicators of quality of life. Likewise, a significant correlation between subjective and external evaluations of global quality of life was limited to those individuals who had good insight. CONCLUSION: Diminished insight may limit the usefulness of the self-report methodology for assessing quality of life for some individuals with schizophrenia.

Adolescent↗
PubMedDate not supplied

Insight and resistance in patients with obsessive-compulsive disorder.

The aim of this study was to evaluate the degree of insight and resistance in a sample of obsessive-compulsive patients, and the predictive value of poor insight with respect to response to treatment with serotonin reuptake inhibitors (SRIs). Ninety-three patients fulfilling DSM-IV criteria for obsessive-compulsive disorder were evaluated. Seventy patients were treated with an SRI in a 24-week open-label trial. Sixteen percent of the patients did not recognize obsessions and compulsions as unreasonable or senseless. Fifty-two percent of the patients did not try to resist, 72% had little or no control over obsessions, and 64% were not able to exercise an effective control over compulsions. Patients with poor insight had a greater severity of obsessive-compulsive symptoms, a higher rate of schizophrenia spectrum disorders in their first-degree relatives and a higher frequency of a history of psychiatric disorders during childhood. Fifty-two percent of the patients with normal insight responded to SRIs, whereas none of the patients with poor insight were found to be responders. These results suggest the utility of the assessment of insight and resistance in obsessive-compulsive patients, also for the prediction of response to treatment with SRIs.

Adolescent↗
PubMedDate not supplied

Insight, social knowledge and working memory in schizophrenia.

BACKGROUND: There is evidence that insight and social judgements are impaired in schizophrenia. The influence of these factors on the decision to treat compulsorily in schizophrenia is poorly understood. AIMS: To investigate the contribution of insight, social knowledge, and working memory to the determination to treat coercively in schizophrenia. METHOD: Insight rating scale, social knowledge questionnaire and working memory tests were administered to detained patients with schizophrenia. Results were compared with those of a control group of voluntary in-patients with schizophrenia. RESULTS: Detained patients scored worse on insight and social knowledge, yet there was no significant correlation between these scores. There was no significant difference in severity of psychopathology between the experimental and control groups. Results for working memory were inconclusive. CONCLUSION: Insight and social knowledge are significantly, but independently, associated with the determination to treat coercively in schizophrenia. This suggests that insight and social knowledge are distinct skills. The contribution of working memory remains unclear.

Adolescent↗
PubMed2004

Insight in psychosis: a systematic review of treatment interventions.

Insight into illness is often impaired in psychosis and associated with poor prognosis, yet little is known about how to improve insight. After an examination of the conceptual background of insight, we review the limited empirical studies of this topic. Six studies of psychoeducation are mixed, though suggesting a possible benefit, especially with individualized interventions. In 2 studies of psychoanalytically oriented psychotherapy, and 1 of cognitive-behavioral psychotherapy, no beneficial effect on insight was notable. Two studies each of videotaped self-observation and antipsychotic medication reported improvement in insight. The possibility that atypical antipsychotics may be especially beneficial compared to traditional antipsychotics deserves further examination. We conclude that this literature suggests potentially useful options for clinicians, but further research is needed with better validated insight scales.

Antipsychotic Agents↗
PubMed2006

Insight in psychosis and neuropsychological function: meta-analysis.

BACKGROUND: One factor contributing to impaired awareness of illness (poor insight) in psychotic disorders may be neurocognitive deficits. METHOD: A systematic review and meta-analysis were conducted after data extraction. Following an overall analysis, in which measures of different cognitive domains were taken together, more fine-grained analyses investigated whether there was a specific relation with frontal executive functioning, and whether this was influenced by diagnosis or the insight scales used. RESULTS: There was a significant mean correlation between insight ratings and neurocognitive performance (mean weighted r=0.17, 95% CI 0.13-0.21, z=8.3, P<0.0001), based on 35 studies with a total of 2354 individuals. Further analyses revealed that the effect of general intellectual impairment was smaller than the specific association with executive function. This was only the case for psychosis in general, and not in an analysis limited to schizophrenia, where all cognitive domains were associated with impaired insight to a similar degree. CONCLUSIONS: Neuropsychological dysfunction, specifically impairment of set-shifting and error monitoring, contributes to poor insight in psychosis. Specific relations with different dimensions of insight and the putative role of metacognitive functions require further study.

Cognition Disorders↗
PubMed2005

Insight into schizophrenia: a comparative study between patients and family members.

CONTEXT: Despite the recognition of the role that sociocultural factors play in the process of acquiring insight, recent research on this issue is scarce. OBJECTIVES: 1) to translate and adapt the Schedule for Assessment of Insight (SAI) to Portuguese; 2) to use a modified version of it to evaluate family members' insight into schizophrenia; 3) to compare patients' insight with family members' insight. TYPE OF STUDY: Cross-sectional study. SETTING: Schizophrenia Project Outpatient Clinic (Projesq), Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo. METHODS: 40 patients with schizophrenia (Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition-DSM-IV) undergoing outpatient treatment and members of their respective families were interviewed using the SAI and a modified version of this instrument, respectively. RESULTS: Family members performed better than patients in the total and partial SAI scores [total: 13.0 to 8.75 (p < 0.001); adherence: 3.9 to 3.4 (p < 0.005); recognition of illness: 5.5 to 3.5 (p < 0.001); relabeling of psychotic phenomena: 3.6 to 1.9 (p < 0.001)]. However, when the scores were correlated for each patient-family member pair, the only partial score that had a negative correlation was the relabeling of psychotic phenomena (r = -0.14), while the others had positive correlations (total r = 0.401; adherence r = 0.410; recognition of illness r = 0.422). DISCUSSION: There was a lack of correlation between the scores of family members and patients regarding the ability to relabel psychotic phenomena as abnormal. This might be understood as a smaller influence of sociocultural factors in this dimension than in other dimensions. The fact that family members were not assessed for the presence of psychopathology is a limitation of this study. CONCLUSIONS: Different dimensions of insight are not equally influenced by disease and sociocultural factors. The recognition of illness is more strongly influenced by sociocultural factors than the ability to relabel psychotic phenomena as abnormal.

Adolescent↗
PubMed1998

Symptomatology and insight in schizophrenia.

The phenomenon of poor insight of clients with schizophrenia has recently received a great deal of attention; however, the relationship of the symptoms of illness and of poor insight is not fully understood. This study examined the relationship between ratings of symptomatology and ratings of insight deficits for 64 clients with schizophrenia. Symptomatology and insight were evaluated using the Positive and Negative Syndrome Scale. Over-all functioning was evaluated using the Global Assessment of Functioning scale. Ratings on positive symptomatology were significantly related to ratings of poor insight. As ratings of poor insight increased, ratings on severity of positive symptoms, for example, delusions and hallucinations, also increased Implications of this finding are discussed.

Adult↗
PubMed2002

Motivational interviewing to improve insight and treatment adherence in schizophrenia.

Poor insight and low treatment adherence are common features among persons with schizophrenia that are often related to poor outcome. While insight is a multidimensional phenomenon, common measures of insight have shortcomings and do not include all items relevant for insight and compliance. Different causes of poor insight and compliance such as neurocognitive deficits and psychological coping mechanisms are considered and also the role of awareness in the context of health behavior theory and the stages of change-model. Motivational Interviewing can, with specific modifications for persons with schizophrenia, successfully increase their insight and compliance, because it allows them to explore their own goals and to take a more active role in treatment.

Adaptation, Psychological↗
PubMed2001

A multidimensional assessment of insights in schizophrenic patients.

This study aims to construct a multidimensional instrument in assessing insight of schizophrenic patients and further to examine its relationships with other factors such as psychiatric symptoms, demographic characteristics, and course of illness. An instrument (the Schedule for assessment of Insight in Psychosis, SIP) with a 4-point rating scale was constructed to assess the insight of schizophrenic patients in five dimensions. One hundred schizophrenic patients were recruited for the study and all of them received a semi-structured interview using the SIP. Their demographic variables, length of illness and severity of psychotic symptoms were analyzed for insight. The reliability and validity of the SIP were satisfactory. Significant factors related to insight were psychotic symptoms, including both positive and negative symptoms. This study showed insight was affected by a multitude of factors, and it could be assessed quantitatively in various dimensions.

Hospitalization↗
PubMed1993

Insight in behavior therapy.

Behavior therapists make frequent use of insight, but avoid the term because dynamic therapists have formulated it in terms of the unconscious. Insight does not necessarily imply belief in the existence of the "unconscious mind." Behavioral insight consists of making the client aware of the antecedents and consequences of target behavior. Case studies are presented in which behavioral insight was involved in therapeutic change. Implications of behavioral insight for behavior therapy are discussed.

Adolescent↗
PubMed1995

Insight in schizophrenia and its relationship to psychopathology.

A group of 29 patients with DSM-IIIR schizophrenia was studied during acute hospital admission to examine the relationship between changes in insight and positive and negative symptomatology in schizophrenia. On admission, insight scores were obtained using a modification of the SUMD (Amador et al., 1993), and of the degree of psychopathology using the PANSS (Kay et al., 1987). These measures were repeated prior to discharge between 3 and 6 weeks later. Insight improved significantly during the course of in-patient treatment. A relationship between psychopathology and insight level was evident at both assessments, though the pattern was different. Improvement in psychopathology correlated significantly with increased insight into past symptoms but not current illness. When treatment responders were examined there was a significant relationship only with negative symptom improvement and PANSS totals, but not with improvement in positive symptoms. The greater the trend towards negative symptom predominance, the less the tendency to improve in the awareness of current symptoms. This study suggests an inverse relationship with enduring negative symptoms.

Adolescent↗
PubMed2006

Event-related potential correlates of depression, insight and negative symptoms in males with recent-onset psychosis.

OBJECTIVE: The neurobiology of clinical characteristics -in particular depression, insight and negative symptoms- in recent-onset psychosis (ROP) was studied using event-related potentials (ERPs). METHODS: Twenty right-handed ROP men and 20 controls completed an auditory-oddball task. ROP men had minimum exposure to antipsychotic medication. N100, N200 and P300 were studied to ascertain the effects of (a) diagnosis (patients versus controls), and (b) clinical characteristics. RESULTS: ROP men had significantly lower anterior N100, enhanced N200 at T3, and lower P300 at Pz than controls. Lower right-anterior N100 and enhanced right-anterior N200 amplitude explained 47.7% of negative symptoms. Left-central N100 amplitude explained 30.28% of negative symptoms. Lower left-posterior and higher right-posterior P300 amplitude explained 65.99% of total symptoms. Lower left-central N100, enhanced left-central N200 and depression explained 78.8% of impairments in insight and judgement. Impaired insight/judgement correlated positively with right-anterior N200 and was identified as the most significant co-efficient for depression. CONCLUSIONS: Disturbed selective-attention and executive function indexed by N100 and N200, respectively, are associated with poor insight and negative symptoms. A complex interaction exists between insight and depression. SIGNIFICANCE: The current results demonstrate a biological basis of insight and depression and a complex interaction between the two, perhaps mediated by executive function, in early psychosis.

Acoustic Stimulation↗
PubMed2004

Symptomatological and cognitive predictors of insight in chronic schizophrenia.

Studies of schizophrenia show lack of agreement about the relationship of symptomatological and cognitive factors to insight. In this study, positive and negative symptomatology and cognitive function were assessed by the Positive and Negative Syndrome Scale (PANSS), the Wisconsin Card Sorting Test (WCST), and the Wechsler Adult Intelligence Scale Revised (WAIS-R) in male chronic schizophrenic patients in relation to level of insight measured with the Japanese version of the Schedule for the Assessment of Insight (SAI-J). Negative symptoms were significantly and negatively associated with overall insight, particularly with treatment compliance and recognition of mental illness. The present findings suggest that aspects of insight such as treatment compliance and recognition of mental illness are negatively associated with negative symptoms.

Adult↗
PubMed2004

The neuropsychological basis of insight in first-episode schizophrenia: a pilot metacognitive study.

The aim of the present study was to explore the neuropsychological basis of insight in first-episode schizophrenia, by evaluating its differential and joint links with cognitive vs. metacognitive performance. Thirty first-episode patients were assessed with the Scale of Unawareness of Mental Disorder (SUMD) and a metacognitive version of the Wisconsin Card Sorting Test (WCST). In addition to the standard administration of the WCST, subjects were also asked to rate their level of confidence in the correctness of each sort (prior to getting the feedback), and to choose whether they wanted each sort to be "counted" toward their overall performance score on the test. Each "volunteered" sort received a bonus of 10 cents if correct, but an equal penalty if wrong. Insight into illness had higher correlations with free-choice metacognitive indices derived from confidence ratings and volunteered sorts than with the conventional scores from the WCST. Moreover, prediction of poor insight was significantly improved when adding the new, free-choice metacognitive measures to the conventional WCST measures, but not the other way around. These preliminary results suggest that metacognition is an important mediator between basic cognitive deficits and poor insight, and might be even more relevant to poor insight than cognitive deficits per se.

Adult↗
PubMed2004

Measuring cognitive insight in middle-aged and older patients with psychotic disorders.

The study examined the psychometric properties, factor structure and validity of a recently developed measure of insight, the Beck Cognitive Insight Scale (BCIS) and tested the relationship between the BCIS and psychiatric symptoms in a sample of middle-aged and older patients with schizophrenia or schizoaffective disorder. The BCIS measures the ability of respondents to observe and question their cognitive processes, whereas other insight scales focus primarily on knowledge about the presence of an illness and need for treatment. Participants were 164 middle-aged and older outpatients with schizophrenia or schizoaffective disorder who completed a battery of measures assessing insight, symptoms of schizophrenia and symptoms of depression. The results of a confirmatory factor analysis (CFA) supported the two-factor structure previously reported for the BCIS, with one factor labeled self-reflectiveness and the other labeled self-certainty. The BCIS showed adequate reliability and a moderate correlation with the Birchwood Insight Scale (IS). The BCIS correlated with some PANSS subscales measuring symptoms of schizophrenia, but did not correlate at a significant level with symptoms of depression. The findings suggest that middle-aged and older outpatients with schizophrenia or schizoaffective disorder respond on the BCIS in a manner similar to a younger inpatient population. This instrument is a promising tool for measuring the role of cognitive change in a broad range of patients experiencing psychosis.

Adult↗
PubMedDate not supplied

Insight and illness in chronic schizophrenia.

The role of insight in relation to the diagnosis and treatment of psychotic disorders has received renewed attention in psychiatric and psychological literature. Degree of insight has been found to generally associate with social and occupational functioning, prognosis, and treatment outcome. However, the relationship between insight and symptoms of illness is not known due to previous studies that yielded conflicting results. This study tested the association between general insight and symptomatology in a sample of 66 patients with chronic schizophrenia. Degree of insight was significantly related to positive symptomatology; however, it was not related to demographics, negative symptoms, general psychopathology, or global functioning. These results are supported by several other investigations in this area.

Adult↗
PubMedDate not supplied

Insight in paranoid schizophrenia--its relationship to psychopathology and premorbid adjustment.

The patient's insight in the course of a mental disease has recently become a matter of interest for psychiatrists. Various aspects of insight are examined, as well as the relationship between insight and different clinical variables. In the current study, we examined correlations between aspects of insight and intensity of psychopathological symptoms, occurrence of the various types of delusions, and the level of premorbid adjustment in patients with paranoid schizophrenia. We found significant relationships between poor insight and negative symptoms, thought-broadcasting, delusions of grandeur and sexual delusions, and worse premorbid adjustment in late adolescence and adulthood.

Adult↗
PubMedDate not supplied

Compliance with neuroleptic medication in outpatients with schizophrenia; relationship to subjective response to neuroleptics; attitudes to medication and insight.

The relationship between compliance, subjective response to neuroleptics, attitudes to medication, and insight was assessed in a selected group of individuals with schizophrenia who were attending a catchment area outpatient psychiatric service. Regular compliers with medication reported a significantly better subjective response to neuroleptics and were more frequently prescribed depot medication compared with individuals who were irregularly compliant. There was no difference between regular and irregular compliers in terms of attitudes to medication or level of insight. There was a significant correlation between the measures of insight obtained using a self-report questionnaire (the Insight Scale [IS]) and a semistructured interview (the Scale for Assessment of Insight [SAI]).

Adult↗