The Multiple Dimensions of Insight in Schizophrenia-Spectrum Disorders

Abstract

The concept of insight is used to indicate the propensity of patients with schizophrenia and other severe mental disorders to recognize their illness and engage in treatment. Thus, insight may have notable consequences for the ill individual: Those who lack insight are at higher risk of nonadherence to treatments, negative clinical outcomes, and worse community functioning. Although insight is an intuitive concept, its essence remains difficult to capture. However, many rating scales are available to aid assessment, both for clinical and research purposes. Insight cannot be reduced to a symptom, a psychological mechanism, or a neuropsychological function. It is likely to have dynamic relationships with all these dimensions and with responses to personal events and contextual factors. In particular, social consequences of mental illness and explanatory models that are alternative to the medical model may fundamentally shape insight and treatment choice. Moreover, the cultural or individual stigmatization of mental illness may turn the acquisition of insight into a painful event and increase the risk of depression. Clinicians need to carefully evaluate and promote insight through a personalized approach to aid patient process of care and personal growth.

The association between insight and depressive symptoms in schizophrenia: Undirected and Bayesian network analyses

“…Lack of awareness into the illness is a common feature of schizophrenia that hampers adherence to treatment and complicates the clinical course [1,2]. Conversely, having good levels of insight may also bring about negative consequences, namely depressive symptoms [3] or even suicidal ideation [4,5].…”

“…Pooled results suggest that this phenomenon is complex and highly variable, both in terms of strength of the association and underlying psychopathological mechanisms [11]. Moreover, this relationship may depend on a number of clinical, contextual, and cultural factors, such as socioeconomic status, engagement with mental health services, stigmatization, and severity of the illness [1,6,12,13]. Moreover, several potential confounders can be identified, for example, negative and positive symptoms [14], hostility [15], cognitive abilities [16,17], levels of social cognition [18], and extrapyramidal side effects [19].…”

Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making

“…Crucially, this can lead the person to distrust the help provided by carers and professionals. It is important to gauge the baseline level of insight to provide suitable individualized PE (14,15). Although appreciation of insight prior to providing PE is beneficial, providing quality PE to all PLWS regardless of insight is beneficial.…”

Compulsory treatments in eating disorders: a systematic review and meta-analysis

“…Given these three assumptions, insight is necessarily a critical issue for patients’ treatment [ 18 , 19 ]. For example, in studies carried out on patients affected by schizophrenia spectrum disorders, a clear relationship between low insight and poorer outcomes has been demonstrated [ 20 , 21 ]; whereas for other psychiatric conditions, fewer data are available. To overcome the lack of insight, people affected by Severe Mental Illness (SMI) with impaired awareness of their health condition, when in need of care but refusing the therapies, might be legally committed to compulsory treatments.…”