Between 50 and 80% of the patients diagnosed with schizophrenia have been shown to be partially or totally lacking insight into the presence of their mental disorder. Although a causal chain connecting poor insight with poor treatment adherence and thus with poorer outcome and functioning is straight forward, numerous studies investigating correlates and long-term impact of insight have provided differing results. In addition, higher levels of insight in schizophrenia have been associated with depression and hopelessness, but the causal direction of the relationship is unclear and the data are inconclusive. The current study provides a critical review of 88 studies on the assessment of insight and its impact on symptoms and functioning. Studies published by June 2006 were selected using a keyword search for English peer-reviewed articles in the databases PsycINFO and MEDLINE. The majority of studies support the assumption that insight is associated with adherence during treatment phase, but the association with long-term adherence remains unclear. Insight correlates with better long-term functioning, but this might be explained by its association with symptoms. There is a positive cross-sectional and longitudinal relationship between insight and depression, but the underlying processes need further clarification. In the concluding discussion, the problems relating to definition and study designs are considered responsible for many of the inconclusive findings. Suggestions for further research are derived.

Large proportions of patients in clinical practice settings benefit from CBTp. The efficacy of CBTp can be generalized to clinical practice despite the differences in patients, therapists, and deliverance.

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The purpose of this study was to investigate the association of the Theory of Mind ability to infer intentions of others and delusions in patients with schizophrenia-spectrum disorders. In a cross-sectional design, patients with acute persecutory delusions (PD) (n = 33), patients with remitted persecutory delusions (PD-rem) (n = 25), and non-clinical controls (n = 58) completed a movie task, in which they had to infer the characters' intentions and emotions and a false-belief task. Delusions were rated by observers and by the patients. Patients with PD were specifically impaired in the ability to infer intentions compared with patients with remitted delusions and controls. The ability to infer intentions predicted a significant amount of variance in delusions, even when executive functioning was controlled. Implications for models explaining the development and maintenance of delusions are discussed.