Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-24T10:00:10.879Z Has data issue: false hasContentIssue false
  • English
  • Français

Insight in mental illness: an educational review

Published online by Cambridge University Press:  13 June 2014

John McFarland ,
Colm McDonald  and
Brian Hallahan
John McFarland
Affiliation:
Department of Psychiatry, Clinical Science Institute, National University of Ireland Galway, Ireland
Colm McDonald
Affiliation:
University College Hospital Galway and National University of IrelandGalway
Brian Hallahan*
Affiliation:
Department of Psychiatry, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
*
*Correspondence Email: brian.hallahan@nuigalway.ie
Get access Rights & Permissions [Opens in a new window]

Abstract

Insight is an elusive concept in psychiatry with a long history of divergent definitions and methods of measurements. Although insight was previously presumed to be a binary construct that an individual could possess or lack, there is an emerging consensus that insight is a multi-dimensional construct consisting of a spectrum of phenomena. Over recent years there has been increasing interest in the topic of insight, especially in relation to psychotic disorders where insight is frequently diminished. In this educational review we will discuss the history associated with the construct of insight, current theories in relation to insight, the association of insight with clinical symptoms and prognosis with particular reference to psychosis, the various methods of measuring insight, the aetiology of insight and present deficiencies in our understanding of insight.

Keywords

InsightAwarenessPsychological defenceFrontal lobe
Type
Reviews
Information
Irish Journal of Psychological Medicine , Volume 26 , Issue 1 , March 2009 , pp. 32 - 36
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Amador, XF, David, AS (eds). Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders (2nd ed). Oxford: Oxford University Press, 2004.CrossRefGoogle Scholar
2.Prigatano, GP, Schacter, DL (eds). Awareness of Deficit After Brain Injury. Oxford University Press. New York, 1991.Google Scholar
3.Jaspers, K. General Psychopathology (Hoenig, J. and Hamilton, M.W., translation.) Manchester University Press, 1997.Google Scholar
4.David, AS. “To see ourselves as others see us’. Aubrey Lewis's insight. Br J Psychiatry 1999; 175: 210–216.CrossRefGoogle Scholar
5.Markova, IS, Berrios, GE. Insight in Clinical Psychiatry Revisited. Compr Psychiatry 1995:367–376.Google Scholar
6.David, AS. Insight and Psychosis. Br J Psychiatry 1990; 156: 798–808.CrossRefGoogle ScholarPubMed
7.Amador, XF, Flaum, M, Andreasen, NCet al.Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry 1994; 51: 826–836.CrossRefGoogle ScholarPubMed
8.Amador, XF, Strauss, DH, Yale, SA. Assessment of insight in psychosis. Am J Psychiatry 1993; 150:873–879.Google ScholarPubMed
9.Markova, IS, Berrios, GE. The assessment of Insight in clinical Psychology. Acta Psychiatr Scand 1992; 86: 159–164.CrossRefGoogle Scholar
10.McEvoy, J P, Apperson, LJ, Appelbaum, PS, Ortlip, P, Brecosky, J, Hammill, K.Insight in schizophrenia. Its relationship to acute psychopathology. J Nerv Ment Dis 1989; 177: 43–47.CrossRefGoogle ScholarPubMed
11.Sanz, M, Constable, G, Lopez-lbor, I, Kemp, R, David, AS. A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychol Med 1998;28:437–446.CrossRefGoogle ScholarPubMed
12.World Health Organization. The International Pilot Study of Schizophrenia. WHO offset publication no. 2, WHO, Geneva, 1973.Google Scholar
13.Mintz, AR, Dobson, KS, Romney, DM. Insight in Schizophrenia; a meta-analysis. Schizophr Res 2003; 61: 75–88.CrossRefGoogle ScholarPubMed
14.Kirkpatrick, B, Castle, D, Murray, RM, Carpenter, WT Jr.Risk Factors for the Deficit Syndrome of Schizophrenia. Schizophr Bull 2000; 26: 233–242.CrossRefGoogle ScholarPubMed
15.Lin, IF, Spiga, R, Fortsch, W.Insight and adherence to medication in chronic schizophrenics. J Clin Psychiatry 1979; 40: 430–432.Google ScholarPubMed
16.Kemp, R, David, A. Psychological predictors of insight and compliance in psychotic patients. Br J Psychiatry 1996;169:444–450.CrossRefGoogle ScholarPubMed
17.Bartko, G, Herczeg, I, Zador, G. Clinical symptomatology and drug compliance in schizophrenic patients. Acta Psychiatr Scand 1988; 77: 74–76.CrossRefGoogle ScholarPubMed
18.Kamali, M, Kelly, L, Gervin, M, Browne, S, Larkin, C, O'Callaghan, E. Insight and co-morbid substance misuse and medication compliance among patients with schizophrenia. Psychiatr Serv 2001; 52:161–166.CrossRefGoogle Scholar
19.David, A, Buchana, A, Reed, A, Almeida, O. The assessment of insight in psychosis. Br J Psychiatry 1992; 161: 599–602.CrossRefGoogle ScholarPubMed
20.Ghaemi, SN, Stoll, AL, Pope, HG. Lack of insight in bipolar disorder: the acute manic episode. J Nerv Ment Dis 1995; 183: 464–467.CrossRefGoogle ScholarPubMed
21.Palmer, BA, Pankratz, S, Bostwick, JM. The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry 2005; 62: 247–253.CrossRefGoogle ScholarPubMed
22.Schwartz, RC, Smith, SD. Suicidality and psychosis: the predictive potential of symptomatology and insight into illnessJ Psychiatr Res 2004; 185–191.Google Scholar
23.Amador, XF, Friedman, JH, Kasapis, C, Yale, SA, Flaum, M, Gorman, JM. Suicidal behaviour in schizophrenia and its relationship to awareness of illness. Am J Psychiatry 1996; 153(9):1185–8.Google ScholarPubMed
24.Michalakeas, A, Skoutas, C, Charalambous, A, Peristeris, A, Marinos, V, Keramari, E. Insight in schizophrenia and mood disorders and its relation to psychopathology. Acta Psychiatr Scand 1994; 90: 46–49.CrossRefGoogle ScholarPubMed
25.Swanson, CL, Freudenreich, O, McEvoy, JP, Nelson, L, Kamaraju, L, Wilson, WH. Insight in schizophrenia and mania. J Nerv Ment Dis 1995; 193: 752–5.CrossRefGoogle Scholar
26.Peralta, V, ,Cuesta, M. Lack of insight in mood disorders. J Affect Dis 1998; 49: 55–58.CrossRefGoogle ScholarPubMed
27.Cuesta, MJ, Peralta, V, Zarzuela, A.Reappraising insight in psychosis: multi-scale longitudinal study. Br J Psychiatry 2000; 177: 233–40.CrossRefGoogle ScholarPubMed
28.Yen, CF, Chen, CS, Ko, CHet al.Relationships between insight and medication adherence in outpatients with schizophrenia and bipolar disorder: prospective study. Psychiatr Clin Neurosci 2005; 59: 403–9.CrossRefGoogle ScholarPubMed
29.Streiker, S, Amdur, M, Dincin, J.Educating patients about psychiatric medication: failure to enhance compliance. Psychiatric Rehab J 1986; 4: 15–28.Google Scholar
30.Seltzer, A, Roncari, I, Garfunkle, P. Effect of patient education on medication compliance. Am J Psychiatry 1980; 25: 638–45.Google ScholarPubMed
31.Kemp, R, Applewhaite, G, Hayward, P, Everitt, B, David, A. Compliance Therapy in psychotic disorders: randomised controlled trial. BMJ 1996; 312: 345–9.CrossRefGoogle ScholarPubMed
32.Rathod, S, Kingdon, D, Smith, P, Turkington, D. Insight into schizophrenia: the effects of cognitive behavioural therapy on the components of insight and association with sociodemographics – data on a previously published randomised controlled trial. Schizophr Res 2005; 74: 211–219.CrossRefGoogle ScholarPubMed
33.Kemp, R, Kirov, GB, Hayward, P, David, A. Randomized controlled trial of compliance therapy- 18 month follow-up. Br J Psychiatry 1998; 172:413–19.CrossRefGoogle ScholarPubMed
34.O'Donnell, C, Donohoe, G, Sharkey, Let al.Compliance therapy: a randomised controlled trial in schizophrenia. BMJ 2003; 327: 834–837.CrossRefGoogle ScholarPubMed
35.Kress, KJ. Why Lack of Insight should have a central place in Mental Health Law. Chapter 13. Amador, XF, David, AS (eds). Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders (2nd ed). Oxford: Oxford University Press, 2004.Google Scholar
36.Van Putten, , Crumptom, TE, Yale, C. Drug refusal in schizophrenia and the wish to be crazy. Arch Gen Psychiatry 1976; 33: 1443–1446.CrossRefGoogle ScholarPubMed
37.McGlashan, TH, Carpenter, WT Jr.Postpsychotic depression in schizophrenia. Arch Gen Psychiatry 1976; 33: 231–9.CrossRefGoogle ScholarPubMed
38.Lally, SJ. Does being in here mean there is something wrong with me? Schizophr Bull 1989; 15: 253–65.Google Scholar
39.Alloy, LB, Abramson, LY. Judgment of contingency in depressed and non-depressed students. Sadder but wiser. J Exp Psychol Gen 1979; 4: 441–85.CrossRefGoogle Scholar
40.Heider, F. The Psychology of Interpersonal Relations. New York: John Wiley & Sons. 1958.CrossRefGoogle Scholar
41.Sackeim, HA, Wegner, AZ. Attributional patterns in depression and euthymia. Arch Gen Psychiatry 1986; 43: 553–60.CrossRefGoogle ScholarPubMed
42.Lorenzo, P, Neppi-Modona, M, Ricci, R, Berti, A. The Anatomy of Anosognosia for Hemiplegia: A Meta-analysis. Cortex 2004; 40: 367–377.Google Scholar
43.Vallar, G, Ronchi, R. Anosognosia for motor and sensory deficits after unilateral brain damage: A review. Restorative Neur Neurosci 2006; 4: 247–257.Google Scholar
44.Carpenter, K, Berti, A, Oxbury, S, Molyneux, AJ, Bisiach, E, Oxbury, JM. Awareness of and memory for arm weakness during intracarotid sodium amytal testing. Brain 1995; 118: 243–251.CrossRefGoogle ScholarPubMed
45.McGlynn, SM, Schacter, DL. Unawareness of deficits in neuropsychological syndromes. J Clin Exp Neuropsychol 1989; 11:143–205.CrossRefGoogle ScholarPubMed
46.Pierce, JMS. Misoplegia. Eur Neurol 2007; 57:62–64.CrossRefGoogle Scholar
47.Amador, XF, Strauss, DH. Poor insight in schizophrenia. Psychiatr Q 1993 ;64:305–10.CrossRefGoogle ScholarPubMed
48.Aleman, A, Agrawal, N, Morgan, KD, David, AS. Insight and psychosis and neuropsychological function. Br J Psychiatry 2006; 189: 204–212.CrossRefGoogle ScholarPubMed
49.Aleman, A, De Haan, EHF, Kahn, RS. Insight and neurocognition in schizophrenia. J Neuropsychiatry Clin Neurosci 2002; 14: 241–242.CrossRefGoogle ScholarPubMed
50.Young, DA, Davila, R, Scher, H. Unawareness of illness and neuropsychological performance in chronic schizophrenia. Schizophr Res 1993; 10: 117–124.CrossRefGoogle ScholarPubMed
51.Cuesta, MJ, Peralta, V. Lack of insight in schizophrenia. Schizophr Bull 1994; 20: 359–66.CrossRefGoogle ScholarPubMed
52.Laroi, F, Fannemel, M, Ronneberg, Uet al.Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests. Psychiatry Res 2000; 100: 49–58.CrossRefGoogle ScholarPubMed
53.Dickerson, FB, Boronow, JJ, Ringel, N, Parente, FL. Lack of insight among outpatients with schizophrenia. Psychiatr Serv 1997; 48: 195–199.Google ScholarPubMed
54.Smith, TE, Hull, JW, Israelm, LM, Wilson, DF. Insight, symptoms and neurocognition in schizophrenia and schizoaffective disorder. Schizophr Bull 2000; 26: 193–200.CrossRefGoogle ScholarPubMed
55.Takai, A, Uermatsu, M, Ueki, H, Sone, K. Insight and its related factors in chronic schizophrenic patients: a preliminary study. Eur Psychiatry 1992; 6: 159–170.Google Scholar
56.Flashman, LA, McAllister, TW, Andreasen, NC, Saykin, AJ. Smaller brain size associated with unawareness of illness in patients with schizophrenia. Am J Psychiatry 2000; 157: 1167–1169.CrossRefGoogle ScholarPubMed
57.Flashman, LA, McAllister, TW, Johnson, SC, Rick, JH, Grenn, RL, Saykin, AJ. Specific frontal lobe sub-regions correlated with unawareness of illness in schizophrenia. J Neuropsychiatry Clin Neurosci 2001; 13: 255–257.CrossRefGoogle Scholar
58.Rossell, SL, Coakes, J, Shapleske, J, Woodruff, PW, David, AS. Insight: its relationship with cognitive function, brain volume and symptoms in schizophrenia. Psychol Med 2003; 33: 111–119.CrossRefGoogle ScholarPubMed
59.Shad, MU, Muddasani, S, Keshavan, MS. Prefrontal subregions and dimensions of insight in first-episode schizophrenia - a pilot study. Psychiatry Res 2006; 146: 35–42.CrossRefGoogle ScholarPubMed
60.Shad, MU, Keshhavan, MS, Tamminga, CA, Cullum, CM, David, A.Neurobiological underpinnings of insight deficits in schizophrenia. Int Rev Psychiatry 2007; 19:439–448.CrossRefGoogle ScholarPubMed
61.Perkins, RE, Moodley, P. The arrogance of Insight. Psychiatric Bulletin 1993; 28: 233–4.CrossRefGoogle Scholar
62.Saravanan, B, Jacob, KS, Johnson, S, Prince, M, Bhugra, D, David, AS. Assessing Insight in Schizophrenia: East meets West. Br J Psychiatry 2007; 190: 243–247.CrossRefGoogle ScholarPubMed
63.Johnson, SK, Orell, M. Insight and Psychosis: A social perspective. Psychol Med 1995;25:515–20.CrossRefGoogle ScholarPubMed