0257 the Course and Nature of Insight Change in Patients With Recent-Onset Schizophrenia: From Unawareness to Disagreement

Insight in first episode psychosis: who is measuring what?

“…Alternatively, Koren et al . suggest that traditional ratings of low insight can conflate unawareness and disagreement with clinicians 31 . Evaluating both unawareness and disagreement related to the three general SUMD items in recent admissions for psychosis, they observed that patients evolve from unawareness at the beginning of their hospitalization to active disagreement with their clinicians 6 months later 31 .…”

“…31 Evaluating both unawareness and disagreement related to the three general SUMD items in recent admissions for psychosis, they observed that patients evolve from unawareness at the beginning of their hospitalization to active disagreement with their clinicians 6 months later. 31 This 'disagreement' dimension, also supported by others, 32 is overlooked by the previously discussed clinicianrated scales which would identify both groups as uniformly lacking insight. Our sample of patients in whom treatment had been initiated recently (<1 year) was evaluated exactly during this period of changing views on insight and treatment.…”

“…suggest that traditional ratings of low insight can conflate unawareness and disagreement with clinicians 31 . Evaluating both unawareness and disagreement related to the three general SUMD items in recent admissions for psychosis, they observed that patients evolve from unawareness at the beginning of their hospitalization to active disagreement with their clinicians 6 months later 31 . This ‘disagreement’ dimension, also supported by others, 32 is overlooked by the previously discussed clinician‐rated scales which would identify both groups as uniformly lacking insight.…”

A Prototype Approach Toward Antipsychotic Medication Adherence in Schizophrenia

“…27 Sometimes the illness course involves an initial "unawareness" of the psychiatric condition (with some passive acceptance of treatment), followed by a gradually increasing and more active "disagreement" with the clinicians. 28 This difficult situation requires significant energy and skill on the clinician's part in order to create an alliance and a communication bridge with the patient. It can be helpful to involve third parties such as family members and friends, persons at school or work, or child protection agencies.…”

Narrative insight: rethinking insight in psychosis

“…The fact that traditional measures of insight are affected by the level of agreement between patient and clinician is supported by a recent study evaluating how insight develops after a psychiatric hospitalization (Koren et al, 2006). The authors observed that while patients' insight (as measured by SUMD) did not change over time, patients became increasingly aware of clinicians' opinion on their diagnosis and symptoms and they increasingly disagreed with them.…”