Skip to main content Accessibility help

Relationship Between Insight, Educational Background and Cognition in Schizophrenia

  • Rob Macpherson (a1), Bill Jerrom (a2) and Anthony Hughes (a3)



There is a paucity of research into the relationship between insight and variables including cognitive function, educational background and symptomatology in schizophrenia.


Sixty-four patients with DSM–III–R diagnosis schizophrenia were assessed with the Schedule for Assessment of Insight, Mini Mental State cognitive test, a new measure of knowledge about treatment (the Understanding of Medication Questionnaire), and educational background and compliance assessments.


Insight scores correlated significantly with a range of variables. In a multiple regression analysis only knowledge about treatment and number of years in education explained a significant proportion of insight.


Educational background and the intellectual ability required to learn complex concepts, such as models of mental illness, appear to be more important than previously considered. Research is limited by the lack of a generally accepted definition of insight.


Corresponding author

Dr R. Macpherson, Wotton Lawn, Horton Road, Gloucester GL1 3PX


Hide All
Amador, S. F., Strauss, D. H., Yale, S. A., et al (1991) Awareness of illness in schizophrenia. Schizophrenia Bulletin, 17, 113132.
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
Barter, J. T. (1984) Psychoeducation. In The Chronic Mental Patient (ed. Talbot, J. A.), pp. 183191. New York: Grune & Stratton.
Bazire, S. (1994) Psychotropic Drug Directory. London: Gaskell.
Benson, P. R. (1984) Informed consent: drug information disclosed to patients prescribed antipsychotics. Journal of Nervous and Mental Diseases, 173, 652653.
Birchwood, M. & Macmillan, F. (1993) Early intervention in schizophrenia. Australian and New Zealand Journal of Psychiatry, 27, 374378.
Birchwood, M. Smith, J., Drury, V., et al (1993) A self-report insight scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica, 86, 16.
Boczkowski, J. A., Zeichner, A. & Desanto, N. (1985) Neuroleptic compliance among chronic schizophrenic out-patients: An intervention outcome report Journal of Consulting and Clinical Psychology, 53, 666671.
Cuesta, M. J. & Peralta, V. (1994) Lack of insight in schizophrenia. Schizophrenia Bulletin, 20, 359361.
David, A. S. (1990) Insight and psychosis. British Journal of Psychiatry, 161, 253256.
David, A. S., Buchanan, A., Reed, A., et al (1992) The assessment of insight in psychosis. British Journal of Psychiatry, 161, 599602.
Eckman, T. A., Liberman, R. P., Phipps, C. C., et al (1990) Teaching medication management skills to schizophrenics. Journal of Clinical Psychopharmacology, 10, 3338.
Eckman, T. A., Wirshing, M. D., Marder, S. R., et al (1992) Techniques for training schizophrenics in medication management skills. American Journal of Psychiatry, 149, 15491555.
Folstein, M. D., Folstein, S. E. & McHugh, P. R. (1975) “Mini Mental State”. Journal of Psychiatric Research, 12, 189198.
Ganguli, R. & Raghu, U. (1985) Tardive dyskinesia, impaired recall and informed consent. Journal of Clinical Psychology, 46, 434435.
Geller, J. L. (1982) State hospital patients and their medication – do they know what they take? American Journal of Psychiatry, 134, 287289.
Glick, I. D., Burti, L., Okonozi, K., et al (1994) Effectiveness in psychiatric care. Psychoeducation and outcome for patients with major affective disorders and their families. British Journal of Psychiatry, 164, 104106.
Goldberg, T. E. & Weinberger, D. R. (1988) Probing prefrontal function in schizophrenia with neuropsychological paradigms. Archives of General Psychiatry, 43, 114124.
Goodman, C. R. & Quinn, F. L. (1988) Effects of a patient education program in the treatment of schizophrenia. Hospital and Community Psychiatry, 39, 282286.
Grossman, J. D. & Summers, F. (1980) A study of the capacity of schizophrenic patients to give informed consent. Hospital and Community Psychiatry, 31, 205206.
Guy, W. (1976) ECDEU Assessment Manual for Psychopathology. Washington, DC: US Department of Health, Education and Welfare.
Helman, C. G. (1981) Disease versus illness in general practice. Journal of the Royal College of General Practitioners, 31, 548552.
Helmsley, D. R. (1992) Cognitive abnormalities and schizophrenic symptoms. Psychological Medicine, 22, 839842.
Irwin, M. (1985) Psychotic patients understanding of informed consent. American Journal of Psychiatry, 142, 13511354.
Jaffe, R. (1981) Informed consent: Recall about tardive dyskinesia. Comprehensive Psychiatry, 22, 434437.
Jones, R., Guth, L., Lewis, S., et al (1994) Low intelligence and poor educational achievement precede early onset psychosis. In The Neuropsychology of Schizophrenia (eds David, A. S. & Cathy, J. C.), pp. 131144. Hove: Lawrence Erlbaum Associates.
Kay, S. R., Fizbein, A. & Opler, L. A. (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261276.
Kay, S. R., & Sevy, S. (1990) Pyramidal model of schizophrenia. Schizophrenia Bulletin, 13, 261276.
Kleinman, I., Schachter, D., Korisar, E. (1989) Informed consent and tardive dyskinesia. American Journal of Psychiatry, 146, 902904.
Lewis, A. (1935) The psychopathology of insight. Psychiatry, 2, 4761.
Lysaker, P. & Bell, M. (1994) Insight and cognitive impairment in schizophrenia. Journal of Nervous and Mental Disorders, 182, 656660.
Macpherson, R. (1995) A Controlled Study of Patient Education in Schizophrenia. M.D. Thesis, University of Bristol.
Macpherson, R., Double, D. B., Rowlands, P. R., et al (1993) Long term psychiatric patients' understanding of neuroleptic medication. Hospital and Community Psychiatry, 44, 7173.
McDonald-Scott, P., Machigan, S. & Sotch, H. (1992) Diagnostic disclosure: A tale in two cultures. Psychological Medicine, 22, 147157.
McEvoy, J., Apperson, J., Appelbaum, P. S., et al (1989) Insight in schizophrenia – its relationship to acute psychopathology. Journal of Nervous and Mental Diseases, 177, 4347.
Munetz, M. R. & Roth, L. H. (1985) Informing patients about tardive dyskinesia. Archives of General Psychiatry, 42, 866871.
Nelson, H. E. & O'Connell, A. (1978) Dementia: the estimation of premorbid intelligence levels using the National Adult Reading Test. Cortex, 14, 234244.
Norusis, M. J. (1988) SPSS/PC. Chicago: SPSS Inc.
Royal College of Psychiatrists (1982) Consent to psychiatric treatment for informal patients: College advice to psychiatrists. Bulletin of the Royal College of Psychiatrists, 9, 228.
Schooler, N. R. & Kane, J. M. (1982) Research diagnoses for tardive dyskinesia. Archives of General Psychiatry, 39, 486487.
Seltzer, A., Runcari, I. & Garfinkel, P. (1980) Effect of patient education on medication compliance. Canadian Journal of Psychiatry, 25, 638645.
Smith, J. V. & Birchwood, M. (1990) Specific and non-specific effects of educational intervention with families living with a schizophrenic patient. British Journal of Psychiatry, 150, 645652.
Soskis, D. A. & Jaffe, R. L. (1979) Communicating with patients about antipsychotic drugs. Comprehensive Psychiatry, 20, 126131.
Sullwold, L. & Herrlich, J. (1992) Providing psychiatric patients with a concept of illness. An essential element of therapy. British Journal of Psychiatry, 161 (suppl.), 129132.
Tarrier, N. & Barrowclough, C. (1986) Providing information to relatives about schizophrenia: some comments. British Journal of Psychiatry, 149, 458463.
Van Putten, T. V. (1974) Why do schizophrenic patients refuse to take their drugs? Archives of General Psychiatry, 31, 6772.
Weiden, P., Rapkin, B., Mott, J., et al (1994) Rating of Medication Influences (ROMI), Scale in Schizophrenia. Schizophrenia Bulletin, 20, 297307.


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Relationship Between Insight, Educational Background and Cognition in Schizophrenia

  • Rob Macpherson (a1), Bill Jerrom (a2) and Anthony Hughes (a3)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *