Poor insight in schizophrenia

Amador, Xavier; Strauss, David H.

doi:10.1007/bf01064924

Cited by 107 publications

(60 citation statements)

References 20 publications

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“…Insight function in patient volunteers was assessed with Scale to Assess Mental Disorder (SUMD; Amador et al 1993). This scale is a widely used multidimensional instrument to assess insight.…”

Section: Methodsmentioning

confidence: 99%

“…This study was designed to examine the relationship between brain activation in response to self- versus other-referential stimuli from an fMRI paradigm for self-awareness (see figure 1 in the online supplement) and average scores on a behavioral measure of insight in schizophrenia (i.e., Scale to Assess Unawareness of Mental Disorder [SUMD; Amador et al 1993]). We predicted that insight deficits will result in anterior-to-posterior shift activation profile in cortical midline structures similar to that observed during self-reflection in patients with schizophrenia in earlier studies (Bedford et al 2012, Blackwood et al 2004; Holt et al 2011a; Raij et al 2012, Shad et al 2012a).…”

Section: Introductionmentioning

confidence: 99%

“…Here we are presenting findings from a study in which brain activation in response to self- versus other-directed stimuli in a fMRI paradigm for self-awareness was correlated with average scores on behavioral insight measures of awareness and correct attribution of symptoms to the illness assessed with a comprehensive behavioral measure of insight, Scale to Assess Unawareness of Mental Disorder (SUMD; Amador et al 1993) in patient volunteers with schizophrenia. The results in activation differences in response to self- vs. other referential stimuli between controls and patient volunteers have been published (Shad et al 2012a) (see Online Supplement for details of results and methodology.…”

Section: Introductionmentioning

confidence: 99%

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Neurobiology of insight deficits in schizophrenia: An fMRI study

Shad

Keshavan

2015

Schizophrenia Research

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Prior research has shown insight deficits in schizophrenia to be associated with specific neuroimaging changes (primarily structural) especially in the prefrontal sub-regions. However, little is known about the functional correlates of impaired insight. Seventeen patients with schizophrenia (mean age 40.0±10.3; M/F= 14/3) underwent fMRI on a Philips 3.0 T Achieva system while performing on a self-awareness task containing self- vs. other-directed sentence stimuli. SPM5 was used to process the imaging data. Preprocessing consisted of realignment, coregistration, and normalization, and smoothing. A regression analysis was used to examine the relationship between brain activation in response to self-directed versus other-directed sentence stimuli and average scores on behavioral measures of awareness of symptoms and attribution of symptoms to the illness from Scale to Assess Unawareness of Mental Disorders. Family Wise Error correction was employed in the fMRI analysis. Average scores on awareness of symptoms (1 = aware; 5 = unaware) were associated with activation of multiple brain regions, including prefrontal, parietal and limbic areas as well as basal ganglia. However, average scores on correct attribution of symptoms (1 = attribute; 5 = misattribute) were associated with relatively more localized activation of prefrontal cortex and basal ganglia. These findings suggest that unawareness and misattribution of symptoms may have different neurobiological basis in schizophrenia. While symptom unawareness may be a function of a more complex brain network, symptom misattribution may be mediated by specific brain regions.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neurobiology of insight deficits in schizophrenia: An fMRI study

Shad

Keshavan

2015

Schizophrenia Research

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“…Insight was found both to correlate [44,45,46,47,48,49,50,51,52] and not to correlate with cognition, as assessed through frontal lobe function tests [35,53,54,55,56,57]. …”

Section: Discussionmentioning

confidence: 99%

Insight and Awareness as Related to Psychopathology and Cognition

et al. 2012

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Background: Insight affects adherence and treatment outcome and relates to cognitive impairment and psychopathology. We investigated the relationship of insight with cognition in patients with major depression, schizophrenia and bipolar disorder in acute psychiatric care, long-term inpatient, and outpatient settings. Methods: Eighty-one patients (women, 59.5%; age, 45.9 ± 13.5 years; 27 in each setting group; 33.3% with DSM-IV bipolar disorder, 39.5% with unipolar major depression, and 27.2% with schizophrenia) underwent the Wisconsin Card Sorting Test (WCST) to test flexibility, clinician-rated Scale to Assess Unawareness of Mental Disorder (SUMD), and self-rated Insight Scale (IS) to assess insight/awareness. Results: Poor performance on the WCST correlated with higher SUMD scores such as current psychiatric illness unawareness, impaired symptom attribution, unawareness of medication effect, or of social consequences, but not with IS scores. The latter correlated with days on continuous treatment. Patients receiving psycho-education showed greater symptom awareness compared to patients treated with drugs alone. Cognitive flexibility and diagnostic category did not correlate. Poor insight corresponded with severe mental illness, particularly acute psychosis. Conclusions: Treatment setting specificity reflects psychopathology and severity. Insight is inversely proportional to illness severity and cognitive flexibility, which is also affected by psychopathology. Limitations comprise group heterogeneity, cross-sectional design, and limited sample size.

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“…poor awareness of illness) is a cardinal feature of schizophrenia, and indeed of psychosis in general [24]. The fundamental underpinnings of insight are the aptitude to label certain mental events as pathological, the recognition of being affected by a mental disorder, and the admission of the necessity of treatment and the consequent compliance with it [25].…”

Section: Introductionmentioning

confidence: 99%

Cognitive function and competitive employment in schizophrenia: relative contribution of insight and psychopathology

Giugiario

Crivelli

Mingrone

et al. 2011

Soc Psychiatry Psychiatr Epidemiol

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Taken together, these findings confirmed the importance of cognitive function in obtaining competitive employment. Our results also highlighted the independent role of general psychopathology and awareness of illness on occupational functioning in schizophrenia. Thus, a greater attention must be given to the systematic investigation of insight and general psychopathology in light of an amelioration of vocational functioning in stable schizophrenia.

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Poor insight in schizophrenia

Cited by 107 publications

References 20 publications

Neurobiology of insight deficits in schizophrenia: An fMRI study

Neurobiology of insight deficits in schizophrenia: An fMRI study

Insight and Awareness as Related to Psychopathology and Cognition

Cognitive function and competitive employment in schizophrenia: relative contribution of insight and psychopathology

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