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.

Auditory verbal hallucinations (AVH) are complex experiences that occur in the context of various clinical disorders. AVH also occur in individuals from the general population who have no identifiable psychiatric or neurological diagnoses. This article reviews research on AVH in nonclinical individuals and provides a cross-disciplinary view of the clinical relevance of these experiences in defining the risk of mental illness and need for care. Prevalence rates of AVH vary according to measurement tool and indicate a continuum of experience in the general population. Cross-sectional comparisons of individuals with AVH with and without need for care reveal similarities in phenomenology and some underlying mechanisms but also highlight key differences in emotional valence of AVH, appraisals, and behavioral response. Longitudinal studies suggest that AVH are an antecedent of clinical disorders when combined with negative emotional states, specific cognitive difficulties and poor coping, plus family history of psychosis, and environmental exposures such as childhood adversity. However, their predictive value for specific psychiatric disorders is not entirely clear. The theoretical and clinical implications of the reviewed findings are discussed, together with directions for future research.

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Antistigma campaigns have been promoting a medical view of schizophrenia. Given the growing body of research finding negative associations between biogenetic (BG) causal attributions and stigmatizing attitudes, this approach must be reappraised. The present study investigates the impact of different psychoeducational interventions on the etiology of schizophrenia (BG and psychosocial [PS], vs a neutral condition) and on stigmatizing attitudes in medical (n = 60) and psychology students (n = 61). Information was presented via information brochures and a video presentation. Attitudes were assessed before and after the interventions on an explicit level using the stereotype questionnaire and the Social Distance Scale as well as on an implicit level, using the Implicit Association Test. Both educational interventions produced a significant decrease in several stereotype components, which was not the case in the neutral condition. The BG intervention decreased the attribution of blame in both groups. It also decreased the stereotype unpredictability/incompetence and social distance in the medical students but increased the negative outlook on prognosis in the psychology students. The PS intervention reduced the widespread stereotype of dangerousness as well as social distance in the group of medical students. While further research into antistigma interventions is necessary, the proposal for antistigma campaigns is to take a multidimensional and balanced approach, which is adapted to target groups and provides additional facts that challenge the myths maintaining stigma.

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