Schizophrenia Research
Volume 122, Issue 1 , Pages 94-103 , September 2010

Correlates, change and ‘state or trait’ properties of insight in schizophrenia

  • Benjamin D.R. Wiffen

      Affiliations

    • Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
    • ,
  • Jonathan Rabinowitz

      Affiliations

    • School of Social Work, Bar Ilan University, Ramat Gan, Israel
    • Corresponding Author InformationCorresponding author. Bar Ilan University, Ramat Gan, Israel. Tel.: +972 54 464 3889; fax: +972 9 740 1318.
    • ,
  • Alice Lex

      Affiliations

    • Janssen-Cilag EMEA, Beerse, Belgium
    • ,
  • Anthony S. David

      Affiliations

    • Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK

Received 3 December 2009 ,Revised 4 March 2010 ,Accepted 7 March 2010.

References 

  1. Aleman A, Agrawal N, Morgan KD, David AS. Insight in psychosis and neuropsychological function: meta-analysis. Br. J. Psychiatry. 2006;189(3):204–212
  2. Alloy LB, Abramson LY. Judgment of contingency in depressed and nondepressed students: sadder but wiser?. J. Exp. Psychol. Gen. 1979;108(4):441–485
  3. In:  Amador XF,  David AS editor. Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders. 2nd ed. New York, NY: Oxford University Press; 2004;
  4. Amador XF, Flaum M, Andreasen NC, Strauss DH, Yale SA, Clark SC, et al. Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch. Gen. Psychiatry. 1994;51(10):826–836
  5. American Psychiatric Association, 1994. Diagnostic and statistical manual of mental disorders. 4th Ed. APA, Washington (DC).
  6. American Psychiatric Association . Global Assessment of Functioning (GAF) Scale. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition. Washington, DC: American Psychiatric Association; 2000;p. 34
  7. Browne S, Garavan J, Gervin M, Roe M, Larkin C, O'Callaghan E. Quality of life in schizophrenia: insight and subjective response to neuroleptics. J. Nerv. Ment. Dis. 1998;186(2):74–78
  8. Buckley PF, Wirshing DA, Bhushan P, Pierre JM, Resnick SA, Wirshing WC. Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs. 2007;21(2):129–141
  9. Cannon-Spoor HE, Potkin SG, Wyatt RJ. Measurement of premorbid adjustment in chronic schizophrenia. Schizophr. Bull. 1982;8(3):470–484
  10. Cannon-Spoor HE, Potkin SG, Wyatt RJ. Measurement of premorbid adjustment in chronic schizophrenia. Schizophr. Bull. 1982;8(3):470–484
  11. Cohen J. Statistical Power Analysis for the Behavioral Sciences (2nd edn). Hillsdale, NJ: Erlbaum; 1976;
  12. Cooke MA, Peters ER, Greenwood KE, Fisher PL, Kumari V, Kuipers E. Insight in psychosis: influence of cognitive ability and self-esteem. Br. J. Psychiatry. 2007;191:234–237
  13. Cooke MA, Fannon D, Kuipers E, Peters E, Williams SC, Kumari V. Neurological basis of poor insight in psychosis: a voxel-based MRI study. Schizophr. Res. 2008;103(1–3):40–51
  14. Cuesta MJ, Peralta V, Zarzuela A. Reappraising insight in psychosis. Multi-scale longitudinal study. Br J Psychiatry. 2000;177:233–240
  15. Cuffel BJ, Alford J, Fischer EP, Owen RR. Awareness of illness in schizophrenia and outpatient treatment adherence. J. Nerv. Ment. Dis. 1996;184(11):653–659
  16. David AS. Insight and psychosis. Br. J. Psychiatry. 1990;156(6):798–808
  17. David AS. The clinical importance of insight: an overview. In:  Amador XF,  David AS editor. Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders. Oxford: Oxford University Press; 2004;
  18. David A, Buchanan A, Reed A, Almeida O. The assessment of insight in psychosis. Br. J. Psychiatry. 1992;161(5):599–602
  19. David A, van Os J, Jones P, Harvey I, Foerster A, Fahy T. Insight and psychotic illness. Cross-sectional and longitudinal associations. Br. J. Psychiatry. 1995;167(5):621–628
  20. Debowska G, Grazwa A, Kucharska-Pietura K. Insight in paranoid schizophrenia—its relationship to psychopathology and premorbid adjustment. Compr. Psychiatry. 1998;39(5):255–260
  21. Dickerson F, Boronow J, Ringel N, Parente F. Lack of insight among outpatients with schizophrenia. Psychiatr. Serv. 1997;48(2):195–199
  22. Doyle M, Flanagan S, Browne S, Clarke M, Lydon D, Larkin C, et al. Subjective and external assessments of quality of life in schizophrenia: relationship to insight. Acta Psychiatr. Scand. 1999;99(6):466–472
  23. Drake RJ, Dunn G, Tarrier N, Bentall RP, Haddock G, Lewis SW. Insight as a predictor of the outcome of First-Episode Nonaffective Psychosis in a Prospective Cohort Study in England. J. Clin. Psychiatry. 2007;68(1):81–86
  24. Eberhard J, Levander S, Lindstrom E. Remission in schizophrenia: analysis in a naturalistic setting. Compr Psychiatry. 2009;50(3):200–208
  25. FDA. Good Clinical Practice in FDA-Regulated Clinical Trials 2005: Available from: http://www.fda.gov/oc/gcp/default.htm.
  26. Gharabawi GM, Lasser RA, Bossie CA, Zhu Y, Amador X. Insight and its relationship to clinical outcomes in patients with schizophrenia or schizoaffective disorder receiving long-acting risperidone. Int. Clin. Psychopharmacol. 2006;21(4):233–240
  27. Gharabawi G, Bossie C, Turkoz I, Kujawa M, Mahmoud R, Simpson G. The impact of insight on functioning in patients with schizophrenia or schizoaffective disorder receiving risperidone long-acting injectable. J. Nerv. Ment. Dis. 2007;195(12):976–982
  28. Goldberg RW, Green-Paden LD, Lehman AF, Gold JM. Correlates of insight in serious mental illness. J. Nerv. Ment. Dis. 2001;189(3):137–145
  29. Gray R, Wykes T, Edmonds M, Leese M, Gournay K. Effect of a medication management training package for nurses on clinical outcomes for patients with schizophrenia: cluster randomised controlled trial. Br. J. Psychiatry. 2004;185(2):157–162
  30. Hasson-Ohayon I, Kravetz S, Roe D, David AS, Weiser M. Insight into psychosis and quality of life. Compr. Psychiatry. 2006;47(4):265–269
  31. Karow A, Pajonk FG, Reimer J, Hirdes F, Osterwald C, Naber D, et al. The dilemma of insight into illness in schizophrenia: self- and expert-rated insight and quality of life. Eur. Arch. Psychiatry Clin. Neurosci. 2008;258(3):152–159
  32. Kay SR, Fiszbein A, Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr. Bull. 1987;13(2):261–276
  33. Kay SR, Opler LA, Fiszbein A. The Structured Clinical Interview for the Positive and Negative Syndromes of Schizophrenia. New York: Multi-Health Systems; 1992;
  34. Kemp R, David AS. Insight and compliance. In:  Blackwell B editors. Treatment Compliance and the Therapeutic Alliance. Amsterday: Harwood Academic Publishers; 1997;p. 61–86
  35. Kemp R, Hayward P, Applewhaite G, Everitt B, David A. Compliance therapy in psychotic patients: randomised controlled trial. BMJ. 1996;312(7027):345–349
  36. Kemp R, Kirov G, Everitt B, Hayward P, David A. Randomised controlled trial of compliance therapy. 18-month follow-up. Br. J. Psychiatry. 1998;172(5):413–419
  37. Keshavan MS, Rabinowitz J, DeSmedt G, Harvey PD, Schooler N. Correlates of insight in first episode psychosis. Schizophr. Res. 2004;70(2–3):187–194
  38. Lewis A. The psychopathology of insight. British Journal of Medical Psychology. 1934;14:332–348
  39. Lincoln TM, Lullmann E, Rief W. Correlates and long-term consequences of poor insight in patients with schizophrenia. A Systematic Review. Schizophr. Bull. 2007;33(6):1324–1342
  40. Lysaker PH, Bell MD, Bryson GJ, Kaplan E. Insight and interpersonal function in schizophrenia. J. Nerv. Ment. Dis. 1998;186(7):432–436
  41. Macpherson R, Jerrom B, Hughes A. Relationship between insight, educational background and cognition in schizophrenia. Br. J. Psychiatry. 1996;168(6):718–722
  42. Marder SR, Davis JM, Chouinard G. The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: combined results of the North American trials. J. Clin. Psychiatry. 1997;58(12):538–546
  43. Markova IS. Insight and Psychiatry. Cambridge: Cambridge University Press; 2005;
  44. McEvoy JP, Freter S, Everett G, Geller JL, Appelbaum P, Apperson LJ, et al. Insight and the clinical outcome of schizopheric patients. J. Nerv. Ment. Dis. 1989;177(1):48–51
  45. McEvoy JP, Johnson J, Perkins D, Lieberman JA, Hamer RM, Keefe RS, et al. Insight in first-episode psychosis. Psychol. Med. 2006;36(10):1385–1393
  46. Mintz AR, Dobson KS, Romney DM. Insight in schizophrenia: a meta-analysis. Schizophr. Res. 2003;61(1):75–88
  47. Mintz AR, Addington J, Addington D. Insight in early psychosis: a 1-year follow-up. Schizophr. Res. 2004;67(2–3):213–217
  48. Mohamed S, Rosenheck R, McEvoy J, Swartz M, Stroup S, Lieberman JA. Cross-sectional and longitudinal relationships between insight and attitudes toward medication and clinical outcomes in chronic schizophrenia. Schizophr. Bull. 2009;35(2):336–346
  49. Morgan KD, David AS. Neuropsychological studies of insight in patients with psychotic disorders. In:  Amador XF,  David AS editor. Insight and Psychosis: Awareness of Illnes in Schizophrenia and Related Disorders. Oxford: Oxford University Press; 2004;
  50. Napryeyenko O, Burba B, Martinez G, Neznanov NG, Fischel T, Baylé FJ, et al. Risperidone long-acting injectable in recent-onset schizophrenia examined with clinician and patient self-report measures. J. Clin. Psychopharmacol. 2010;30(2):1–3
  51. Owen GS, David AS, Richardson G, Szmukler G, Hayward P, Hotopf M. Mental capacity, diagnosis and insight in psychiatric in-patients: a cross-sectional study. Psychol. Med. 2009;39(08):1389–1398
  52. Patel MX, de Zoysa N, M.B. , David AS. A cross-sectional study of patients' perspectives on adherence to antipsychotic medication: depot versus oral. J. Clin. Psychiatry. 2008;69(10):1548
  53. Patel M, De Zoysa N, Bernadt M, David A. Depot and oral antipsychotics: patient preferences and attitudes are not the same thing. J. Psychopharmacol. (Oxf.). 2009;23(7):789–796
  54. Rabinowitz J, Levine SZ, Brill N, Bromet EJ. The premorbid adjustment scale structured interview (PAS-SI): preliminary findings. Schizophr Res. 2007;90(1–3):255–257
  55. 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(2–3):211–219
  56. Roseman AS, Kasckow J, Fellows I, Osatuke K, Patterson TL, Mohamed S, et al. Insight, quality of life, and functional capacity in middle-aged and older adults with schizophrenia. Int. J. Geriatr. Psychiatry. 2008;23(7):760–765
  57. Rosen K, Garety P. Predicting recovery from schizophrenia: a retrospective comparison of characteristics at onset of people with single and multiple episodes. Schizophr. Bull. 2005;31(3):735–750
  58. Saeedi H, Addington J, Addington D. The association of insight with psychotic symptoms, depression, and cognition in early psychosis: a 3-year follow-up. Schizophr. Res. 2007;89(1–3):123–128
  59. Sanz M, Constable G, Lopez-Ibor I, Kemp R, David A. A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychol. Med. 1998;28(2):437–446
  60. Sapara A, Cooke M, Fannon D, Francis A, Buchanan RW, Anilkumar AP, et al. Prefrontal cortex and insight in schizophrenia: a volumetric MRI study. Schizophr. Res. 2007;89(1–3):22–34
  61. Saravanan, B., Jacob, K.S., Johnson, S., Prince, M., Bhugra, D., David, A.S., in press. A longitudinal study of outcome of first episode schizophrenia in India: the effect of insight and psychopathology. Br. J. Psychiatry.
  62. Schwartz RC. Insight and illness in chronic schizophrenia. Compr. Psychiatry. 1998;39(5):249–254
  63. Shad MU, Keshavan MS, Tamminga CA, Cullum C, David A. Neurobiological underpinnings of insight deficits in schizophrenia. Int. Rev. Psychiatry. 2007;19(4):439–448
  64. Simon AE, Berger GE, Giacomini V, Ferrero F, Mohr S. Insight, symptoms and executive functions in schizophrenia. Cognit. Neuropsychiatry. 2006;11(5):437–451
  65. Smith TE, Hull JW, Goodman M, Hedayat-Harris A, Willson DF, Israel LM, et al. The relative influences of symptoms, insight, and neurocognition on social adjustment in schizophrenia and schizoaffective disorder. J. Nerv. Ment. Dis. 1999;187(2):102–108
  66. Ware JE, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998;51(11):903–912
  67. White R, Bebbington P, Pearson J, Johnson S, Ellis D. The social context of insight in schizophrenia. Soc. Psychiatry Psychiatr. Epidemiol. 2000;35(11):500–507
  68. Wiffen, B. D. R., Rabinowitz, J., Fleischhacker, W. W., David, A. S., in press. Insight: demographic differences and associations with outcome over 1year in a large cohort of patients with schizophrenia and schizoaffective disorder. Clinical Schizophrenia & Related Psychoses.
  69. Williams CC, Collins A. Factors associated with insight among outpatients with serious mental illness. Psychiatr. Serv. 2002;53(1):96–98

PII: S0920-9964(10)01175-8

doi: 10.1016/j.schres.2010.03.005

Schizophrenia Research
Volume 122, Issue 1 , Pages 94-103 , September 2010

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