Insight and hopelessness in forensic patients with schizophrenia

Carroll, Andrew; Pantelis, Christos; Harvey, Carol

doi:10.1111/j.1440-1614.2004.01315.x

Cited by 18 publications

(32 citation statements)

References 43 publications

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“…It is obvious that poor insight impacts negatively on the QOL of people with schizophrenia, namely by reducing their hope. 126,128 More recently, Kurtz and Tolman, using the Lack of Judgment and Insight item on the PANSS as a measure of insight into illness, and Subjective QOL (SQOL), which targets subjective satisfaction with one's living situation, work, social contacts and psychological state, confirmed that illness insight was inversely related to SQOL as reported by Aghababian et al using the same design. [129][130][131][132] Similarly, in 1432 schizophrenia patients Mohamed et al found a small but significant correlation between higher insight and lower QOL.…”

Section: Insight and Poor Quality Of Lifesupporting

confidence: 54%

Insight in schizophrenia: From conceptualization to neuroscience

Ouzir

Azorin

Adida

et al. 2012

Psychiatry Clin Neurosci

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Lack of insight into illness is a prevalent and distinguishing feature of schizophrenia, which has a complex history and has been given a variety of definitions. Currently, insight is measured and treated as a multidimensional phenomenon, because it is believed to result from psychological, neuropsychological and organic factors. Thus, schizophrenia patients may display dramatic disorders including demoralization, depression and a higher risk of suicide, all of which are directly or indirectly related to a lack of insight into their illness, and make the treatment difficult. To improve the treatment of people with schizophrenia, it is thus crucial to advance research on insight into their illness. Insight is studied in a variety of ways. Studies may focus on the relationship between insight and psychopathology, may view behavioral outcomes or look discretely at the cognitive dysfunction versus anatomy level of insight. All have merit but they are dispersed across a wide body of literature and rarely are the findings integrated and synthesized in a meaningful way. The aim of this study was to synthesize findings across the large body of literature dealing with insight, to highlight its multidimensional nature, measurement, neuropsychology and social impact in schizophrenia. The extensive literature on the cognitive consequences of lack of insight and the contribution of neuroimaging techniques to elucidating neurological etiology of insight deficits, is also reviewed.Key words: cognition impairment, conceptualization, insight, neuroanatomy, schizophrenia.A MONG PATIENTS WITH psychiatric disorders, patients with schizophrenia more often exhibit poor insight concerning their mental disorder. 1 The World Health Organization (WHO) International Pilot Study of Schizophrenia in different cultures found that 'lack of insight' was an almost invariable feature of acute and chronic schizophrenia. That study found that 50-80% of patients lack, either partially or totally, insight into their mental disorder.2 A rich literature indicated that unawareness of illness is associated with defects in cognitive functions such as attention, memory, language, executive functioning and social cognition. [3][4][5][6][7][8][9] Furthermore, poor insight in schizophrenia has been proposed to result in poor treatment compliance, 10,11 poor social and interpersonal functioning, 12,13 poor prognosis, and higher risk of relapse.14 Other studies reported that poor insight may increase the incidence of depression, hopelessness, low self-esteem [15][16][17][18][19] and more generally poor quality of life (QOL). 13,[20][21][22] Over the past decade there has been an increase in research on the conceptualization and assessment of insight, but the relationship between insight and neurocognitive impairment, severity of psychopathology or *Correspondence: Mounir Ouzir, PhD, Laboratory of Clinical Neuroscience and Mental Health, University Hassan II, Faculty of Medicine and Pharmacy, 19 Rue Tarik Ibnou Ziad, BP: 9154 Mers Sultan, 20000 Casablanca, M...

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Section: Insight and Poor Quality Of Lifesupporting

confidence: 54%

Insight in schizophrenia: From conceptualization to neuroscience

Ouzir

Azorin

Adida

et al. 2012

Psychiatry Clin Neurosci

View full text Add to dashboard Cite

show abstract

“…However, those who did show an improvement in awareness and insight also tended to become depressed (Rathod et al 2005). Van Putten et al (1976) found a negative correlation between grandiosity and insight, depression and anxiety as did Carroll et al (2004) who found higher levels of insight in schizophrenia to be linked to an increased risk of lower mood and suicide. Birchwood et al (2000) observed depression occurring independent of schizophrenic symptoms several months post relapse and proposed that this was due to a the demoralizing impact of disability.…”

Section: Review Of the Evidencementioning

confidence: 98%

“…Paradoxically improved insight has been linked to depression and hopelessness (Carroll et al 2004, Lysaker et al 2007). Mintz et al (2003) in their meta-analysis of 40 (English language) papers determining the direction of the relationship between insight and symptom domains in schizophrenia found a small negative relationship between insight and global negative and positive symptoms and a small positive relationship between insight and depressive symptoms.…”

Section: Review Of the Evidencementioning

confidence: 99%

“…These authors suggested that a 'sealing over' approach to illness may be a valid and successful coping style for those who adopt it and that poor insight serves as a protector of self-esteem (Carroll et al 2004). Such an approach may provide the individual with some protection against the stigmatization of their illness and against a debilitating response to that stigmatization, while also enabling them to engage in treatment (Beck-Sander 1998, Bell & Zito 2005, Rathod et al 2005.…”

Section: Review Of the Evidencementioning

confidence: 99%

“…The ability to perform well in day-to-day social functioning tasks is central to long-term recovery because the negative experience of disability and social disadvantage can exacerbate a sense of hopelessness, impede compliance and the development of insight (Carroll et al 2004). Disengagement from treatment is a common problem in mental health services and is especially common with people suffering from psychotic disorders (Startup et al 2006).…”

Section: Review Of the Evidencementioning

confidence: 99%

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Comparison of recovery style and insight of patients with severe mental illness in secure services with those in community services

Fitzgerald¹

2010

Journal of Psychiatric and Mental Health Nursing

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Insight and recovery style have long been associated with Severe Mental Illness (SMI) but there remains little understanding of the relationship between how individuals comprehend and react to their illness and whether this reaction has a subsequent impact on where they receive treatment. Patients receiving treatment for SMI in two different locations, community services and long-term secure services were compared on their Recovery Style and Insight. This study hypothesizes that patients with SMI who receive treatment in secure services do so because they have poor insight into their illness and adopt a 'sealing over' recovery style. A significant difference in insight was found. The community group recorded higher insight than those in the secure group. Recovery style was found to relate to insight but not to service provision. This difference may provide an explanation of how insight and recovery style contributes to the recovery process and why some people do not respond well to the traditional medical approach to their illness. Further research is required to explore these possibilities but early indications are that services could benefit from the assessment of insight and recovery style at the baseline assessment stage to support early treatment formulation.

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