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PubMed1999

A preliminary communication of an insight scale in the assessment of lithium non-adherence among Chinese patients in Hong Kong.

BACKGROUND: Studies on the relation between insight and medication adherence are limited in Chinese populations. METHOD: Eighty Chinese outpatients with mood disorder and on lithium for at least one year were asked to complete an 11-item insight scale. Lithium adherence was determined by: (a) subjective report; (b) doctor's clinical impression; or (c) serum lithium level. RESULTS: The overall insight score (median = 9, range 1-11) exhibited no significant difference between adherent (N = 58, 72.5%) and non-adherent (N = 22, 27.5%) patients. A two-factor model emerged on factor analysis. Lithium adherent (median = 7, range 1-7) patients had a significantly higher score than non-adherent (median = 6, range 0-7) patients on the 'medical help seeking' factor (Mann-Whitney U-test Z = 2.00, P < 0.05) but not the 'perception of illness' factor. CONCLUSION: The overall conceptual structure of insight in Chinese and Western patients appears similar, but further study is required to explore the complexity of Chinese patients' explanatory models of their illness and to enhance the validity of the insight scale.

Adolescent↗
PubMed2003

Assessment of insight in psychosis: a re-standardization of a new scale.

Over the last decade, a number of tools have been developed to evaluate, in a systematic way, patients' insight into their psychotic illness. Such tools, however, capture different clinical phenomena of insight. So far, there is no indication as to which phenomenon of insight might be the most useful or predictive (e.g. clinically or therapeutically) to assess. This article reports the re-standardization of a revised self-administered insight scale in patients with psychosis, first published in 1992. It is meant to capture views held by individuals suffering from psychosis about changes occurring within themselves and in their environment. The scale was administered to 64 patients with a diagnosis of schizophrenia but with a range of symptoms and in different stages of their illnesses. This new version is simpler to use and score than the original instrument and shows good reliability, internal consistency and concurrent validity. This study forms the preliminary basis for future work examining the phenomenon of insight, its relationship to clinical variables and its predictive validity in terms of patients' behaviours and prognoses.

Adult↗
PubMed1996

Neuropsychological aspects of lack of insight in bipolar disorder: a preliminary report.

In 16 inpatients with acute mania, neuropsychological evaluation revealed a trend toward correlation between less insight (lower scores on the Insight and Treatment Attitudes Questionnaire, ITAQ) and improved delayed visual recall. This result may either reflect the absence of a relationship between neuropsychological abnormalities and lack of insight in bipolar disorder, or it may represent an indirect expression of frontal lobe dysfunction. Also, an association was found between increased number of previous hospitalizations and greater insight. Since the neuropsychological result noted above was limited to patients with more than six previous hospitalizations, an interaction may exist between number of previous hospitalizations and neuropsychological abnormalities in the development of insight.

Adult↗
PubMed2003

A comparison between an interview and a self-report method of insight assessment in chronic schizophrenia.

We examined the relationship between a researcher-rated and a self-report method of insight assessment in patients with schizophrenia. Previous research has established that a moderate correlation exists between several researcher-rated and self-report insight scales. Hence, we wanted to investigate this association using another combination of assessment techniques. Accordingly, 34 patients with chronic schizophrenia were administered the Scale to Assess Unawareness of Mental Disorder (SUMD) and the Birchwood self-report Insight Scale (IS). We found a significantly lower report of insight on the Birchwood IS, regardless of administration order. These findings suggest that inherent bias within the patient-examiner interaction may be responsible for this discrepancy. Overall, a significant positive correlation was observed between total scores on the SUMD and the Birchwood self-report IS. Unexpectedly, there was a remarkable difference in correlation with respect to the order of test administration. The "self-report first" group's scores were strongly correlated, whereas the "researcher-rated first" group's scores showed little relation. These results demonstrate the importance of investigating the effects of administration order, and also question the reliability of other correlational studies between researcher-rated and self-report insight scales that have failed to employ a counterbalanced research design.

Adult↗
PubMed1996

Insight and cognitive deficits in schizophrenia: evidence for a curvilinear relationship.

Both motivational and defect theories have been offered to explain variations in insight among schizophrenic individuals but the results of tests of these theories have been inconclusive and inconsistent. The present study was designed to test the hypothesis that both motivation and cognitive deficits affect insight, with a trade-off between the two processes, giving rise to quadratic relationships between insight and cognitive deficits. Twenty-six schizophrenic patients completed a battery of neuropsychological tests and participated in an interview designed to assess insight. In a multiple regression analysis predicting test results from insight scores, the linear component was non-significant while the quadratic component accounted for a highly significant 56% of the variance. Theoretical and clinical implications of this result are discussed briefly.

Adult↗
PubMed2004

What makes an insight problem? The roles of heuristics, goal conception, and solution recoding in knowledge-lean problems.

Four experiments investigated transformation problems with insight characteristics. In Experiment 1, performance on a version of the 6-coin problem that had a concrete and visualizable solution followed a hill-climbing heuristic. Experiment 2 demonstrated that the difficulty of a version of the problem that potentially required insight for solution stems from the same hill-climbing heuristic, which creates an implicit conceptual block. Experiment 3 confirmed that the difficulty of the potential insight solution is conceptual, not procedural. Experiment 4 demonstrated the same principles of move selection on the 6-coin problem and the 10-coin (triangle) problem. It is argued that hill-climbing heuristics provide a common framework for understanding transformation and insight problem solving. Postsolution receding may account for part of the phenomenology of insight.

Cognition↗
PubMed2004

Multiple causes of difficulty in insight: the case of the nine-dot problem.

Theories of insight problems are often tested by formulating hypotheses about the particular difficulties of individual insight problems. Such evaluations often implicitly assume that there is a single difficulty. We argue that the quantitatively small effects of many studies arise because the difficulty of many insight problems is determined by multiple factors, so the removal of 1 factor has limited effect on the solution rate. Difficulties can reside either in problem perception, in prior knowledge, or in the processing of the problem information. We support this multiple factors perspective through 3 experiments on the 9-dot problem (N.R.F. Maier, 1930). Our results lead to a significant reformulation of the classical hypothesis as to why this problem is difficult. The results have general implications for our understanding of insight problem solving and for the interpretation of data from studies that aim to evaluate hypotheses about the sources of difficulty of particular insight problems.

Cognition↗
PubMed1994

Insight and psychosocial treatment compliance in schizophrenia.

Research has suggested that poor insight in patients with schizophrenia is associated with poorer medication compliance and heightened levels of psychopathology. This study examined the relationship of insight to compliance with a work rehabilitation program and with levels of psychopathology and psychosocial functioning. Poor insight was found to be positively associated with fewer weeks of participation and with poorer social skills and personal presentation in the fifth week of work. Poor insight was also associated with cognitive disorganization and a lower intelligence quotient, but not with heightened levels of psychopathology. Results suggest that poor insight may predict noncompliance with psychosocial treatment and may be related to a constellation of cognitive deficits.

Adult↗
PubMed2000

Insight, symptoms, and neurocognition in schizophrenia and schizoaffective disorder.

There are conflicting reports in the literature regarding the relationships among impaired insight, symptoms, and neurocognition in schizophrenia. The inconsistent findings likely reflect the multidimensionality of insight in this population, along with variations in study design. We examined 46 individuals with chronic schizophrenia or schizoaffective disorder who were recently discharged from an inpatient unit. Insight was operationalized as awareness of having a mental disorder and awareness and attribution of both current and past symptoms. Positive, negative, disorganized, and depression symptoms were rated, and a neurocognition battery, including measures of visual processing, memory, visuo-spatial ability, and executive functions, was administered. Poor awareness of symptoms was moderately associated with core schizophrenia symptoms, and higher levels of depression were strongly associated with good awareness. Symptom misattribution, more so than symptom unawareness, was associated with deficits in frontal lobe functioning. Finally, different patterns of associations between symptoms, neurocognition, and insight were noted for current symptoms versus past symptoms. The data suggest that insight deficits in schizophrenia are multidimensional, and that investigators should pay careful attention to the choice of measures as well as to phase of illness characteristics in future studies.

Adolescent↗
PubMed1998

Effect of video self-observation on development of insight in psychotic disorders.

Many patients with psychotic disorders lack awareness of being ill. This often presents a serious impediment to treatment compliance. We hypothesized that exposing partially remitted patients to videotapes of themselves, made while they were acutely psychotic, might increase their insight into the nature of their illness. Eighteen acutely psychotic inpatients were assigned randomly to a control or experimental group and interviewed on videotape 24 to 48 hours after admission, using scales that measure insight (Insight and Treatment Attitudes Questionnaire [ITAQ]) and psychopathology (Brief Psychiatric Rating Scale [BPRS]). One to six weeks later, when judged to be significantly improved, subjects were shown either a videotape of their initial interview (experimental group) or a placebo videotape (control group) and then reinterviewed 24 to 48 hours later on videotape, using the BPRS and ITAQ scales. Evaluation of initial and final ITAQ and BPRS scores revealed significantly greater improvement in insight scores and in delusionality in the experimental group. However, no significant difference in overall psychopathology was seen for the two groups. These results suggest that exposure of hospitalized patients to videotapes of their own psychotic behavior may be a cost-effective therapeutic tool for developing personal insight into psychotic illness.

Adult↗
PubMed2004

Evidence that health attributions and symptom severity predict insight in schizophrenia.

Although a relationship between insight and symptomatology in schizophrenia has been repeatedly demonstrated, the influence of psychological variables such as coping mechanisms and attributional style is less clear. We evaluated health attributions, subjective resources for coping, symptomatology, general cognitive functioning, and insight among 38 consecutive admissions with DSM-III-R schizophrenia from a geographically defined catchment area. Health attributions accounted for a significant amount of insight even after symptom severity was accounted for and together predicted 32% of variation in insight scores. This study emphasizes the multifactorial nature of insight and the importance of psychological variables in addition to symptomatology.

Adaptation, Psychological↗
PubMedDate not supplied

An insight-based methodology for evaluating bioinformatics visualizations.

High-throughput experiments, such as gene expression microarrays in the life sciences, result in very large data sets. In response, a wide variety of visualization tools have been created to facilitate data analysis. A primary purpose of these tools is to provide biologically relevant insight into the data. Typically, visualizations are evaluated in controlled studies that measure user performance on predetermined tasks or using heuristics and expert reviews. To evaluate and rank bioinformatics visualizations based on real-world data analysis scenarios, we developed a more relevant evaluation method that focuses on data insight. This paper presents several characteristics of insight that enabled us to recognize and quantify it in open-ended user tests. Using these characteristics, we evaluated five microarray visualization tools on the amount and types of insight they provide and the time it takes to acquire it. The results of the study guide biologists in selecting a visualization tool based on the type of their microarray data, visualization designers on the key role of user interaction techniques, and evaluators on a new approach for evaluating the effectiveness of visualizations for providing insight. Though we used the method to analyze bioinformatics visualizations, it can be applied to other domains.

Algorithms↗
PubMed2006

The prepared mind: neural activity prior to problem presentation predicts subsequent solution by sudden insight.

Insight occurs when problem solutions arise suddenly and seem obviously correct, and is associated with an "Aha!" experience. Prior theorizing concerning preparation that facilitates insight focused on solvers' problem-specific knowledge. We hypothesized that a distinct type of mental preparation, manifested in a distinct brain state, would facilitate insight problem solving independently of problem-specific knowledge. Consistent with this hypothesis, neural activity during a preparatory interval before subjects saw verbal problems predicted which problems they would subsequently solve with, versus without, self-reported insight. Specifically, electroencephalographic topography and frequency (Experiment 1) and functional magnetic resonance imaging signal (Experiment 2) both suggest that mental preparation leading to insight involves heightened activity in medial frontal areas associated with cognitive control and in temporal areas associated with semantic processing. The results for electroencephalographic topography suggest that noninsight preparation, in contrast, involves increased occipital activity consistent with an increase in externally directed visual attention. Thus, general preparatory mechanisms modulate problem-solving strategy.

Amygdala↗
PubMed1994

A self-report Insight Scale for psychosis: reliability, validity and sensitivity to change.

Lack of insight is a frequent concomitant of psychosis and has traditionally been viewed as a binary, all or none phenomenon. Recent conceptualization has formulated insight as a continuum representing the juxtaposition of 3 factors--awareness of illness, need for treatment and attribution of symptoms. Measurement of insight has been exclusively based on interview; this method does not easily lend itself to frequent repeated measurement and requires interrater reliability to be established. A self-report Insight Scale is presented, and evidence in support of its reliability, validity and sensitivity is provided that includes a sample of 30 patients monitored during recovery from an acute psychosis. The scale is a quick and acceptable measure that may find application in investigations of acute care, cognitive therapy of psychotic symptoms and as a method of augmenting clinical judgements of insight.

Adult↗
PubMed1994

Insight in schizophrenia and mood disorders and its relation to psychopathology.

The authors assessed insight on admission on the 15th, 30th and discharge day in 77 female inpatients (42 schizophrenic, 13 manic, 22 depressives) using McEvoy's Insight and Treatment Attitude Questionnaire (ITAQ) and studied its relation to psychopathology, which was assessed by completion of the Brief Psychiatric Rating Scale (18-item version). The data suggest that depressives had good initial (on admission) insight, schizophrenics the poorest, followed shortly by manics. Insight (ITAQ total score) improved significantly after treatment in both mania and schizophrenia. Moreover a constantly significant negative correlation existed between ITAQ and BPRS in mania but not in schizophrenia, indicating that other factors besides psychopathology might influence insight in schizophrenia.

Adult↗
PubMed1998

Neurocognitive function and insight in schizophrenia: support for an association with impairments in executive function but not with impairments in global function.

It remains unclear how impaired insight and neurocognitive impairment are related to one another in schizophrenia. In order to examine this relationship, subjects with schizophrenia or schizoaffective disorder were classified as having 'impaired' (n=38) or 'unimpaired' (n=43) insight based on their insight rating on the Positive and Negative Syndrome Scale (PANSS). Their performance on neuropsychological tests of global function, executive function, memory and vigilance was then compared. Multivariate analyses followed by Scheffe tests indicated that subjects with impaired insight performed less well on the Wisconsin Card Sorting Test, demonstrating poorer abstract flexibility and heightened perseveration. No differences were found between the groups with regard to global cognitive function, memory or vigilance. This suggests that insight is closely linked to deficits in executive function, and that it may be associated with the compromise of frontal lobe function.

Adult↗
PubMed1994

The role of insight in exploratory psychodynamic psychotherapy.

Psychoanalytic theory holds that dynamic insight is used for self-observation and self-analysis during and after explorative therapy. Such self-analysis is held to lead to stable dynamic change. Within a sample of 43 moderately disturbed out-patients, pre-treatment level of insight was associated with treatment length, with not being an early or late drop-out, and with receiving additional psychotherapy during a four-year follow-up period. Pre-treatment level of insight turned out to be not directly correlated with outcome two and four years after therapy. However, level of insight was significantly correlated with outcome in interaction with treatment length. Gain of insight measured at two-year follow-up was the strongest predictor of overall dynamic change four years after therapy, compared with all the other outcome assessments made at two-year follow-up.

Adult↗
PubMed1995

Is poor insight in psychotic disorders associated with poor performance on the Wisconsin Card Sorting Test?

OBJECTIVE: The purpose of this study was to test whether poor insight in patients with psychotic disorders is correlated with their performance on the Wisconsin Card Sorting Test. METHOD: The subjects included 52 psychotic patients (35 of whom had schizophrenia) given diagnoses according to DSM-III-R criteria. Their scores on the Wisconsin Card Sorting Test (number of categories and perseverative responses) were compared with those on three items measuring poor insight: lack of feeling ill, lack of insight, and uncooperativeness. RESULTS: None of the six correlations between scores on the two measures of the neuropsychological test and the three items measuring insight was significant. CONCLUSIONS: In spite of its limitations, this study suggests that poor insight may not be associated with poor performance on the Wisconsin Card Sorting Test.

Adult↗