Hostname: page-component-6bf8c574d5-r8w4l Total loading time: 0 Render date: 2025-03-09T15:11:57.380Z Has data issue: false hasContentIssue false
  • English
  • Français

Insight and major mental illness: an update for clinicians

Published online by Cambridge University Press:  02 January 2018

Simon Surguladze  and
Anthony David
Rights & Permissions [Opens in a new window]

Extract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This article will concentrate on insight into serious mental disorder. Not psychoanalytic insight – nor indeed, the insight all of us have, to a greater or lesser extent, into our own attitudes, motives and behaviour – but the insight which patients with psychosis have into their mental pathology. This is no longer considered an all-or-none phenomenon, but rather a dimensional one, so that subjects can have different levels of awareness into their illness. The suggestion was first mooted by Aubrey Lewis (1934) in his seminal work on insight. Conceptual exploration of insight has been activated in the past decade and is proceeding in parallel with the construction of special scales to measure insight and research into its cognitive, biological, social and cultural basis.

Type
Research Article
Information
Advances in Psychiatric Treatment , Volume 5 , Issue 3 , May 1999 , pp. 163 - 170
Copyright
Copyright © The Royal College of Psychiatrists 1999 

References

Alloy, L. B. & Abramson, L. Y. (1988) Depressive realism: Four theoretical perspectives. In Cognitive Processes in Depression (ed. Alloy, L. B.) pp. 223–265. New York: Guilford Press.Google Scholar
Amador, X. F., Flaum, M., Andreasen, N. C. et al (1994) Awareness of illness in schizophrenia, schizoaffective and mood disorders. Archives of General Psychiatry, 51, 826–836.Google Scholar
Amador, X. F. & Strauss, D. H. (1990) The Scale to Assess Unawareness of Mental Disorder (SUMD). New York: Columbia University and New York State Psychiatric Institute.Google Scholar
Amador, X. F. & Seckinger, B. A. (1997) The assessment of insight: A methodological review. Psychiatric Annals, 27, 12, 798–805.Google Scholar
Beck-Sander, A. (1998) Is insight into psychosis meaningful? Journal of Mental Health, 7, 25–34.CrossRefGoogle Scholar
Birchwood, M., Smith, J., Drury, V. et al (1994) A self-report insight scale for psychosis – reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica, 89, 62–67.CrossRefGoogle ScholarPubMed
Bleuler, E. (1911) (English edition 1950) Dementia Praecox, or The Group of Schizophrenias. New York: International Universities Press.Google Scholar
Boczkowski, J. A., Zeichner, A. & De Santo, N. (1985) Neuroleptic compliance among chronic schizophrenic outpatients: an intervention outcome report. Journal of Consulting and Clinical Psychology, 53, 666–671.CrossRefGoogle ScholarPubMed
Buchanan, A. (1992) A two-year prospective study of treatment compliance in patients with schizophrenia. Psychological Medicine, 22, 787–797.CrossRefGoogle ScholarPubMed
Chan, D. W. (1984) Medication compliance in a Chinese psychiatric out-patient setting. British Journal of Medical Psychology, 57, 81–89.Google Scholar
Collins, A. A., Remington, G. J., Coulter, K. et al (1997) Insight, neurocognitive function and symptom clusters in chronic schizophrenia. Schizophrenia Research, 27, 37–44.Google Scholar
Cuesta, M. J., Peralta, V., Caro, F. et al (1995) Is poor insight in psychotic disorders associated with poor performance on the Wisconsin Card Sorting Test? American Journal of Psychiatry, 152, 1380–1382.Google ScholarPubMed
Cuesta, M. J., Peralta, V. & Juan, J. A. (1996) Abnormal subjective experiences in schizophrenia: its relationships with neuropsychological disturbances and frontal signs. European Archives of Psychiatry and Clinical Neuroscience, 246, 101–105.CrossRefGoogle ScholarPubMed
Cuffel, B. J., Alford, J., Fischer, E. P. et al (1996) Awareness of illness in schizophrenia and outpatient treatment adherence. Journal of Nervous and Mental Disease, 184, 653–659.Google Scholar
David, A. S. (1990) Insight and psychosis. British Journal of Psychiatry, 156, 798–809.CrossRefGoogle ScholarPubMed
David, A. S. (1998) The clinical importance of insight. In Insight and Psychosis (eds Amador, X. F. & David, A. S.) pp. 332–351. New York: Oxford University Press.Google Scholar
David, A. S., Buchanan, A., Reed, A. et al (1992) The assessment of insight in psychosis. British Journal of Psychiatry, 161, 599–602.CrossRefGoogle ScholarPubMed
David, A. S., van Os, J., Harvey, I. et al (1995) Insight and psychotic illness. British Journal of Psychiatry, 167, 621–628.Google Scholar
Dieci, M., Vita, A., Silenzi, C. et al (1997) Non-selective impairment of Wisconsin Card Sorting Test performance in patients with schizophrenia. Schizophrenia Research, 25, 33–42.Google Scholar
Eisen, S. V., Dill, D. L. & Grob, M. C. (1994) Reliability and validity of a brief patient-report instrument for psychiatric outcome evaluation. Hospital and Community Psychiatry, 45, 242–247.Google Scholar
Feighner, J. P., Robins, E., Guze, S. B. et al (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 57–63.Google Scholar
Ghaemi, S. N., Stoll, A. L. & Pope, H. (1995) Lack of insight in bipolar disorder – the acute manic episode. Journal of Nervous and Mental Disease, 183, 464–467.CrossRefGoogle ScholarPubMed
Ghaemi, S. N., Sachs, G. S., Baldassano, C. F. et al (1997) Insight in seasonal affective disorder. Comprehensive Psychiatry, 38, 345–348.Google Scholar
Heinrichs, D. W., Cohen, B. P. & Carpenter, W. T. (1985) Early insight and the management of schizophrenia decompensation. Journal of Nervous and Mental Disease, 173, 133–138.CrossRefGoogle ScholarPubMed
Huber, G. & Gross, G. (1997) Advances in therapy and prevention of schizophrenic disorders. Neurology Psychiatry and Brain Research, 5, 1–8.Google Scholar
Johnson, S. & Orrell, M. (1995) Insight and psychosis – a social perspective. Psychological Medicine, 25, 515–520.CrossRefGoogle ScholarPubMed
Johnson, S. & Orrell, M. (1996) Insight, psychosis and ethnicity – a case-note study. Psychological Medicine, 26, 5, 1081–1084.CrossRefGoogle ScholarPubMed
Jorgensen, P. (1995) Recovery and insight in schizophrenia. Acta Psychiatrica Scandinavica, 92, 6, 436–440.Google Scholar
Kane, J. M., Quitkin, F., Rifkin, A. et al (1983) Attitudinal changes of involuntarily committed patients following treatment. Archives of General Psychiatry, 40, 374–377.Google Scholar
Kay, S., Fiszbein, A. & Opler, L. (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.CrossRefGoogle ScholarPubMed
Kemp, R. & David, A. (1997) Insight and compliance. In Treatment Compliance and the Treatment Alliance in Serious Mental Illness (ed. Blackwell, B.) pp. 61–86. The Netherlands: Harwood Academic.Google Scholar
Kemp, R., Hayward, P. & David, A. (1997) Compliance Therapy Manual. London: The Maudsley.Google Scholar
Kemp, R., Kirov, G., Everitt, B. et al (1998) Randomised controlled trial of compliance therapy – 18-month follow-up. British Journal of Psychiatry, 172, 413–419.Google Scholar
Kim, Y., Sakamoto, K., Kamo, T. et al (1997a) Insight and clinical correlates in schizophrenia. Comprehensive Psychiatry, 38, 117–123.Google Scholar
Kim, Y., Sakamoto, K., Sakamura, Y. et al (1997b) Subjective experience and related symptoms in schizophrenia. Comprehensive Psychiatry, 38, 49–55.Google Scholar
Kirov, G., Kemp, R., Kirov, K. et al (1998) Religious faith after psychotic illness. Psychopathology, 31, 234–245.Google Scholar
Kjellin, L., Andersson, K., Candefjord, I. L. et al (1997) Ethical benefits and costs of coercion in short-term inpatient psychiatric care. Psychiatric Services, 48, 1567–1570.Google Scholar
Lam, D. & Wong, G. (1997) Prodromes, coping strategies, insight and social functioning in bipolar affective disorders. Psychological Medicine, 27, 1091–1100.Google Scholar
Laws, K. R. (1999) A meta-analytic review of Wisconsin Card sort studies in schizophrenia: a general intellectual deficit in disguise. Cognitive Neuropsychiatry, 4, 1–35.Google Scholar
Lewis, A. (1934) The psychopathology of insight. British Journal of Medical Psychology, 14, 332–348.Google Scholar
Lysaker, P. H., Bell, M. D., Bryson, G. et al (1998a) Neurocognitive function and insight in schizophrenia: support for an association with impairments in executive function but not with impairments in global function. Acta Psychiatrica Scandinavica, 97, 297–301.CrossRefGoogle Scholar
Lysaker, P. H., Bell, M. D., Bryson, G. J. et al (1998b) Insight and interpersonal function in schizophrenia. Journal of Nervous and Mental Disease, 186, 432–436.Google Scholar
MacPherson, R., Jerrom, B. & Hughes, A. (1996) A controlled study of education about drug treatment in schizophrenia. British Journal of Psychiatry, 168, 709–717.CrossRefGoogle ScholarPubMed
McEvoy, J. P. (1998) The relationship between insight in psychosis and compliance with medications. In Insight and Psychosis (eds Amador, X. F. & David, A. S.) pp. 289–306. New York: Oxford University Press.Google Scholar
McEvoy, J. P., Apperson, L. J., Appelbaum, P. S. et al (1989a) Insight in schizophrenia: its relationship to acute psychopathology. Journal of Nervous and Mental Disease, 177, 43–47.Google Scholar
McEvoy, J. P., Appelbaum, P. S., Geller, J. L. et al (1989b) Why must some schizophrenic patients be involuntary committed? The role of insight. Comprehensive Psychiatry, 30, 13–17.CrossRefGoogle ScholarPubMed
McEvoy, J. P., Schooler, N. J., Friedman, E. et al (1993) Use of psychopathology vignettes by patients with schizophrenia or schizoaffective disorder and by mental health professionals to judge patients' insight. American Journal of Psychiatry, 150, 1649–1653.Google Scholar
McNally, S. E. & Goldberg, J. O. (1997) Natural cognitive coping strategies in schizophrenia. British Journal of Medical Psychology, 70, 159–167.CrossRefGoogle ScholarPubMed
Markova, I. S. & Berrios, G. E. (1992) The assessement of insight in clinical psychiatry: a new scale. Acta Psychiatrica Scandinavica, 86, 159–164.Google Scholar
Michalakeas, A., Skoutas, C., Charalambous, A. et al (1994) Insight in schizophrenia and mood disorders and its relation to psychopathology. Acta Psychiatrica Scandinavica, 90, 46–49.CrossRefGoogle ScholarPubMed
Nayani, T. H. & David, A. S. (1996) The auditory hallucination – A phenomenological survey. Psychological Medicine, 26, 177–189.Google Scholar
Overall, J. & Gorham, D. (1962) The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799–812.CrossRefGoogle Scholar
Peralta, V. & Cuesta, M. J. (1998) Lack of insight in mood disorders. Journal of Affective Disorders, 49, 55–58.Google Scholar
Perkins, R. & Moodley, P. (1993) The arrogance of insight? Psychiatric Bulletin, 17, 233–234.Google Scholar
Rossell, S. & David, A. (1997) Improving performance in WCST: variations on the original procedure. Schizophrenia Research, 28, 63–76.Google Scholar
Sanz, M., Constable, G., Lopez-Ibor, I. et al (1998) A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychological Medicine, 28, 437–446.Google Scholar
Smith, C. M., Barzman, D. & Pristach, C. A. (1997) Effect of patient and family insight on compliance of schizophrenic patients. Journal of Clinical Psychopharmacology, 37, 147–154.Google Scholar
Startup, M. (1996) Insight and cognitive deficits in schizophrenia: evidence for a curvilinear relationship. Psychological Medicine, 26, 1277–1281.Google Scholar
Startup, M. (1997) Awareness of own and others' schizophrenic illness. Schizophrenia Research, 26, 203–211.Google Scholar
Sullwold, L. (1986) Frankfurt Complaints Questionnaire (3). In Schizophrenic Basic Disorders (in German) (eds Sullwold, L., Huber, G.) pp. 145–159. Berlin: Springer.Google Scholar
Swanson, C. L., Freudenreich, O., McEvoy, J. P. et al (1995) Insight in schizophrenia and mania. Journal of Nervous and Mental Disease, 183, 752–755 Google Scholar
Tan, T. (1993) Assessment of insight in Singapore. British Journal of Psychiatry, 162, 565–566.Google Scholar
Wahass, S. & Kent, G. (1997) Coping with auditory hallucinations: A cross-cultural comparison between Western (British) and Non-Western (Saudi Arabian) patients. Journal of Nervous and Mental Disease, 185, 664–668.Google Scholar
Wing, J. K., Cooper, J. E., Sartorius, N. (1974) The Description and Classification of Psychiatric Symptoms: An Instruction Manual for PSE and Catego System. London: Cambridge University Press.Google Scholar
World Health Organization (1973) Report of the International Pilot Study of Schizophrenia. Geneva: WHO.Google Scholar
Young, D. A., Zakzanis, K. K., Bailey, C. et al (1998) Further parameters of insight and neuropsychological deficit in schizophrenia and other chronic mental disease. Journal of Nervous and Mental Disease, 186, 44–50.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.