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An insight on psychiatric insight

Published online by Cambridge University Press:  13 August 2021

T. Coelho Rocha ,
J. Cunha ,
S. Torres  and
A. Lopes
T. Coelho Rocha*
Affiliation:
Psychiatry And Mental Health Department, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
J. Cunha
Affiliation:
Psychiatry And Mental Health Department, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
S. Torres
Affiliation:
Psychiatry And Mental Health Department, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
A. Lopes
Affiliation:
Psychiatry And Mental Health Department, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
*
*Corresponding author.

Abstract

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Introduction

Insight is a complex and multidimensional phenomenon. Metacognition, awareness of illness or anosognosia are some of the terms used to designate this feature of the mental state exam.

Objectives

To attempt to explore the evolution of the concept of insight as a psychiatric symptom over the years and to bring up some up-to-date features on this theme.

Methods

Literature review, using the most relevant papers, with the keywords “psychiatric insight”, “awareness of illness”, “metacognition” and “phenomenology”.

Results

The term ‘insight’ has been described since 1896 when Kraepelin had noticed that patients with dementia praecox were unaware of their condition. Nowadays, it is recognized in several psychiatric disorders, with different meanings in each one. Overall, insight in psychiatry involves an attempt to see one’s thinking and behaviour ‘objectively’ and comparing it to some representation of mental health. Impaired insight has been linked to poor treatment compliance and outcomes, overall symptom severity, higher relapse, lower self-esteem, and impaired psychosocial functioning. White matter and connectivity problems may be related to poorer insight, as well as impaired frontal lobe functioning. In psychotic disorders, lack of insight is a primary symptom with poorer outcomes. Regarding affective disorders, the lower the mood the better the insight. Neuroimaging has been correlating insight with the inferior frontal gyrus, anterior insula, inferior parietal lobule, and ventromedial prefrontal cortex. In everyday practice, there are scales used to assess insight.

Conclusions

Inferences about patients’ insight are important to evaluate severity of illness, suicidal risk, compliance, and response to treatment.

Keywords

psychiatric insightmetacognitionphenomenologyawareness of illness
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S476
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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