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Theme: Schizophrenia - Review

Poor insight into schizophrenia: contributing factors, consequences and emerging treatment approaches

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Pages 785-793 | Published online: 09 Jan 2014

References

  • Amador XF, Flaum M, Andreasen NC et al. Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch. Gen. Psychiatry 51(10), 826–836 (1994).
  • Lysaker PH, Buck KD, Salvatore G, Popolo R, Dimaggio G. Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches. Expert Rev. Neurother. 9(7), 1035–1043 (2009).
  • Schennach R, Meyer S, Seemüller F et al. Insight in schizophrenia-course and predictors during the acute treatment phase of patients suffering from a schizophrenia spectrum disorder. Eur. Psychiatry 27(8), 625–633 (2012).
  • Wang Y, Xiang YT, Wang CY et al. Insight in Chinese schizophrenia patients: a 12-month follow-up. J. Psychiatr. Ment. Health Nurs. 18(9), 751–757 (2011).
  • Chan S. Nursing education makes a difference. Int. J. Nurs. Pract. 19(Suppl. 1), 1–2 (2013).
  • Comparelli A, Savoja V, De Carolis A et al. Relationships between psychopathological variables and insight in psychosis risk syndrome and first-episode and multiepisode schizophrenia. J. Nerv. Ment. Dis. 201(3), 229–233 (2013).
  • Braw Y, Sitman R, Sela T, Erez G, Bloch Y, Levkovitz Y. Comparison of insight among schizophrenia and bipolar disorder patients in remission of affective and positive symptoms: analysis and critique. Eur. Psychiatry 27(8), 612–618 (2012).
  • Martin JM, Warman DM, Lysaker PH. Cognitive insight in non-psychiatric individuals and individuals with psychosis: an examination using the Beck Cognitive Insight Scale. Schizophr. Res. 121(1–3), 39–45 (2010).
  • Riggs SE, Grant PM, Perivoliotis D, Beck AT. Assessment of cognitive insight: a qualitative review. Schizophr. Bull. 38(2), 338–350 (2012).
  • Bayard S, Capdevielle D, Boulenger JP, Raffard S. Dissociating self-reported cognitive complaint from clinical insight in schizophrenia. Eur. Psychiatry 24(4), 251–258 (2009).
  • Bowie CR, Twamley EW, Anderson H, Halpern B, Patterson TL, Harvey PD. Self-assessment of functional status in schizophrenia. J. Psychiatr. Res. 41(12), 1012–1018 (2007).
  • Lysaker PH, Hasson-Ohayon I, Kravetz S, Kent JS, Roe D. Self perception of empathy in schizophrenia: emotion recognition, insight, and symptoms predict degree of self and interviewer agreement. Psychiatry Res. 206(2–3), 146–150 (2013).
  • Silverstein SM, Bellack AS. A scientific agenda for the concept of recovery as it applies to schizophrenia. Clin. Psychol. Rev. 28(7), 1108–1124 (2008).
  • Lysaker PH, Lysaker JT. Schizophrenia and the Fate of the Self. Oxford University Press, Oxford, UK (2008).
  • Linden M, Godemann F. The differentiation between ‘lack of insight’ and ‘dysfunctional health beliefs’ in schizophrenia. Psychopathology 40(4), 236–241 (2007).
  • Startup M. Awareness of own and others’ schizophrenic illness. Schizophr. Res. 26(2–3), 203–211 (1997).
  • Bajaj V, Sengupta S, Gupta D. Psychopathology, insight and compliance in schizophrenia. Irish J. Psychol. Med. 26(1), 12–15 (2009).
  • Medina E, Salvà J, Ampudia R, Maurino J, Larumbe J. Short-term clinical stability and lack of insight are associated with a negative attitude towards antipsychotic treatment at discharge in patients with schizophrenia and bipolar disorder. Patient Pref. Adher. 66, 23–629 (2012).
  • Ben Thabet J, Baati I, Bouzid K et al. Impact of insight on medication adherence in tunisian patients with schizophrenia. Eur. Psychiatr. 27, 1 (2012).
  • Umut G, Altun ZO, Danis¸mant BS, Küçükparlak I, Karamustafalıog ˘lu N. Relationship between treatment adherence, insight and violence among schizophrenia inpatients in a training hospital sample. J. Psychiatry Neurol. Sci. 25(3), 212–220 (2012).
  • Jónsdóttir H, Opjordsmoen S, Birkenaes AB et al. Predictors of medication adherence in patients with schizophrenia and bipolar disorder. Acta Psychiatr. Scand. 127(1), 23–33 (2013).
  • Boyer L, Aghababian V, Richieri R et al. Insight into illness, neurocognition and quality of life in schizophrenia. Prog. Neuropsychopharmacol. Biol. Psychiatry 36(2), 271–276 (2012).
  • Beck EM, Cavelti M, Kvrgic S, Kleim B, Vauth R. Are we addressing the ‘right stuff’ to enhance adherence in schizophrenia? Understanding the role of insight and attitudes towards medication. Schizophr. Res. 132(1), 42–49 (2011).
  • Wittorf A, Jakobi U, Bechdolf A et al. The influence of baseline symptoms and insight on the therapeutic alliance early in the treatment of schizophrenia. Eur. Psychiatry 24(4), 259–267 (2009).
  • Misdrahi D, Petit M, Blanc O, Bayle F, Llorca PM. The influence of therapeutic alliance and insight on medication adherence in schizophrenia. Nord. J. Psychiatry 66(1), 49–54 (2012).
  • Premkumar P, Peters ER, Fannon D, Anilkumar AP, Kuipers E, Kumari V. Coping styles predict responsiveness to cognitive behaviour therapy in psychosis. Psychiatry Res. 187(3), 354–362 (2011).
  • De Hert MAF, Simon V, Vidovic D et al. Evaluation of the association between insight and symptoms in a large sample of patients with schizophrenia. Eur. Psychiatr. 24(8), 507–512 (2009).
  • Guerrero AG, Lysaker PH. Socially naive self-appraisal moderates the relationship between cognitive insight and positive symptoms in schizophrenia. Schizophr. Res. 143(1), 97–101 (2013).
  • Buchy L, Bodnar M, Malla A, Joober R, Lepage M. A 12-month outcome study of insight and symptom change in first-episode psychosis. Early Interv. Psychiatry 4(1), 79–88 (2010).
  • Monteiro LC, Silva VA, Louzã MR. Insight, cognitive dysfunction and symptomatology in schizophrenia. Eur. Arch. Psychiatry Clin. Neurosci. 258(7), 402–405 (2008).
  • Ekinci O, Ugurlu GK, Albayrak Y, Arslan M, Caykoylu A. The relationship between cognitive insight, clinical insight, and depression in patients with schizophrenia. Compr. Psychiatry 53(2), 195–200 (2012).
  • Lincoln TM, Hodgins S. Is lack of insight associated with physically aggressive behavior among people with schizophrenia living in the community? J. Nerv. Ment. Dis. 196(1), 62–66 (2008).
  • Bogojevic G. P-1215 – Possible consequences of insight in schizophrenia. Eur. Psychiatr. 27, 1 (2012).
  • Stefanopoulou E, Lafuente AR, Saez Fonseca JA, Huxley A. Insight, global functioning and psychopathology amongst in-patient clients with schizophrenia. Psychiatr. Q. 80(3), 155–165 (2009).
  • Giugiario M, Crivelli B, Mingrone C et al. Cognitive function and competitive employment in schizophrenia: relative contribution of insight and psychopathology. Soc. Psychiatry Psychiatr. Epidemiol. 47(4), 553–561 (2012).
  • Erickson M, Jaafari N, Lysaker P. Insight and negative symptoms as predictors of functioning in a work setting in patients with schizophrenia. Psychiatry Res. 189(2), 161–165 (2011).
  • Schaub D, Brüne M, Bierhoff HW, Juckel G. Comparison of self- and clinician’s ratings of personal and social performance in patients with schizophrenia: the role of insight. Psychopathology 45(2), 109–116 (2012).
  • Kurtz MM, Olfson RH, Rose J. Self-efficacy and functional status in schizophrenia: relationship to insight, cognition and negative symptoms. Schizophr. Res. 145(1–3), 69–74 (2013).
  • Flanagan P, Compton MT. A comparison of correlates of suicidal ideation prior to initial hospitalization for first-episode psychosis with prior research on correlates of suicide attempts prior to initial treatment seeking. Early Interv. Psychiatry 6(2), 138–144 (2012).
  • Sharaf AY, Ossman LH, Lachine OA. A cross-sectional study of the relationships between illness insight, internalized stigma, and suicide risk in individuals with schizophrenia. Int. J. Nurs. Stud. 49(12), 1512–1520 (2012).
  • Nikolic-Popovic JM, Manojlovic SD. P-1277 – insight and self esteem in patients with schizophrenia. Eur. Psychiatr. 27, 1 (2012).
  • Valiente C, Provencio M, Espinosa R, Chaves C, Fuentenebro F. Predictors of subjective well-being in patients with paranoid symptoms: is insight necessarily advantageous? Psychiatry Res. 189(2), 190–194 (2011).
  • Kurtz MM, Tolman A. Neurocognition, insight into illness and subjective quality-of-life in schizophrenia: what is their relationship? Schizophr. Res. 127(1–3), 157–162 (2011).
  • Buck KD, Roe D, Yanos PT et al. Challenges to assisting with the recovery of personal identity and wellness for persons with serious mental illness: considerations for mental health professionals. Psychosis 5(2), 127–133 (2013).
  • Hasson-Ohayon I, Kravetz S, Meir T, Rozencwaig S. Insight into severe mental illness, hope, and quality of life of persons with schizophrenia and schizoaffective disorders. Psychiatry Res. 167(3), 231–238 (2009).
  • Yanos PT, Roe D, Markus K, Lysaker PH. Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatr. Serv. 59(12), 1437–1442 (2008).
  • Lysaker PH, Roe D, Yanos PT. Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr. Bull. 33(1), 192–199 (2007).
  • Cavelti M, Kvrgic S, Beck EM, Rüsch N, Vauth R. Self-stigma and its relationship with insight, demoralization, and clinical outcome among people with schizophrenia spectrum disorders. Compr. Psychiatry 53(5), 468–479 (2012).
  • Ehrlich-Ben Or S, Hasson-Ohayon I, Feingold D et al. Meaning in life, insight and self-stigma among people with severe mental illness. Compr. Psychiatry 54(2), 195–200 (2013).
  • Staring AB, Van der Gaag M, Van den Berge M, Duivenvoorden HJ, Mulder CL. Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorders. Schizophr. Res. 115(2–3), 363–369 (2009).
  • Cavelti M, Beck EM, Kvrgic S, Kossowsky J, Vauth R. The role of subjective illness beliefs and attitude toward recovery within the relationship of insight and depressive symptoms among people with schizophrenia spectrum disorders. J. Clin. Psychol. doi:10.1002/jclp.20872 (2012) (Epub ahead of print).
  • Hasson-Ohayon I, Levy I, Kravetz S, Vollanski-Narkis A, Roe D. Insight into mental illness, self-stigma, and the family burden of parents of persons with a severe mental illness. Compr. Psychiatry 52(1), 75–80 (2011).
  • Lysaker PH, Dimaggio G, Buck KD et al. Poor insight in schizophrenia: links between different forms of metacognition with awareness of symptoms, treatment need, and consequences of illness. Compr. Psychiatry 52(3), 253–260 (2011).
  • Quee PJ, van der Meer L, Bruggeman R et al. Insight in psychosis: relationship with neurocognition, social cognition and clinical symptoms depends on phase of illness. Schizophr. Bull. 37(1), 29–37 (2011).
  • Tranulis C, Freudenreich O, Park L. Narrative insight: rethinking insight in psychosis. Int. J. Culture Mental Health. 2(1), 16–28 (2009).
  • Lalova M, Baylé F, Grillon ML et al. Mechanisms of insight in schizophrenia and impact of cognitive remediation therapy. Compr. Psychiatry 54(4), 369–380 (2013).
  • Pruß L, Wiedl KH, Waldorf M. Stigma as a predictor of insight in schizophrenia. Psychiatry Res. 198(2), 187–193 (2012).
  • Wiffen BD, O’Connor JA, Russo M et al. Are there specific neuropsychological deficits underlying poor insight in first episode psychosis? Schizophr. Res. 135(1–3), 46–50 (2012).
  • Raffard S, Bayard S, Gely-Nargeot MC et al. Insight and executive functioning in schizophrenia: a multidimensional approach. Psychiatry Res. 167(3), 239–250 (2009).
  • Karahan A, Tiryaki A, Iskender B, Ozkorumak E. P-1317 – evaluation of insight and fuctional recovery in patients with schizophrenia. Eur. Psychiatr. 27, 1 (2012).
  • Mingrone C, Rocca P, Castagna F et al. Insight in stable schizophrenia: relations with psychopathology and cognition. Compr. Psychiatry doi:10.1016/j.comppsych.2012.12.014 (2013) (Epub ahead of print).
  • Raij TT, Riekki TJ, Hari R. Association of poor insight in schizophrenia with structure and function of cortical midline structures and frontopolar cortex. Schizophr. Res. 139(1–3), 27–32 (2012).
  • Green MF, Leitman DI. Social cognition in schizophrenia. Schizophr. Bull. 34(4), 670–672 (2008).
  • Langon R, Ward P. Taking the perspective of the other contributes to awareness of illness in schizophrenia. Schizophr. Bull. 35(5), 1003–1011 (2009).
  • Pijnenborg GH, Spikman JM, Jeronimus BF, Aleman A. Insight in schizophrenia: associations with empathy. Eur. Arch. Psychiatry Clin. Neurosci. doi:10.1007/s00406-012-0373-0 (2012) (Epub ahead of print).
  • Lysaker PH, Vohs JL, Ballard R et al. Metacognition, self reflection and recovery in schizophrenia: review of the literature. Future Neurol. 8(1), 103–115 (2013).
  • Lysaker PH, Vohs J, Hasson Ohayon I, Kukla M, Wierwille J, Dimaggio G. Depression and insight in schizophrenia: comparisons of internalized stigma and the presence of deficits in social cognition and metacognition across three profiles. Schizophrenia Res. doi: 10.1016/j.schres.2013.05.025 (2013) (Epub ahead of print).
  • Liemburg EJ, van der Meer L, Swart M et al. Reduced connectivity in the self-processing network of schizophrenia patients with poor insight. PLoS ONE 7(8), e42707 (2012).
  • Faget-Agius C, Boyer L, Padovani R et al. Schizophrenia with preserved insight is associated with increased perfusion of the precuneus. J. Psychiatry Neurosci. 37(5), 297–304 (2012).
  • van der Meer L, de Vos AE, Stiekema AP et al. Insight in schizophrenia: involvement of self-reflection networks? Schizophr. Bull. doi:10.1093/schbul/sbs122 (2012) (Epub ahead of print).
  • Yanos PT, Roe D, West ML, Smith SM, Lysaker PH. Group-based treatment for internalized stigma among persons with severe mental illness: findings from a randomized controlled trial. Psychol. Serv. 9(3), 248–258 (2012).
  • Pijnenborg GH, van Donkersgoed RJ, David AS, Aleman A. Changes in insight during treatment for psychotic disorders: a meta-analysis. Schizophr. Res. 144(1–3), 109–117 (2013).
  • Pijnenborg GH, Van der Gaag M, Bockting CL, Van der Meer L, Aleman A. REFLEX, a social-cognitive group treatment to improve insight in schizophrenia: study protocol of a multi-center RCT. BMC Psychiatry 11, 161 (2011).
  • Guo X, Zhai J, Liu Z et al. Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: a randomized, 1-year study. Arch. Gen. Psychiatry 67(9), 895–904 (2010).
  • Salvatore G, Lysaker PH, Gumley A, Popolo R, Mari J, Dimaggio G. Out of illness experience: metacognition-oriented therapy for promoting self-awareness in individuals with psychosis. Am. J. Psychother. 66(1), 85–106 (2012).
  • Lysaker PH, Buck KD, Carcione A et al. Addressing metacognitive capacity for self reflection in the psychotherapy for schizophrenia: a conceptual model of the key tasks and processes. Psychol. Psychother. 84(1), 58–69; discussion 98 (2011).
  • Bargenquast R, Schweitzer R. Metacognitive narrative psychotherapy for people diagnosed with schizophrenia: an outline of a principle-based treatment manual. Psychosis 1, 1–11 (2013).
  • Buck KD, Lysaker PH. Addressing metacognitive capacity in the psychotherapy for schizophrenia: a case study. Clin. Case Stud. 8(6), 463–472 (2009).
  • Lysaker PH, Buck KD, Fogley R et al. The mutual development of intersubjectivity and metacognitive capacity in the psychotherapy for persons with schizophrenia with severe paranoid delusions. J. Contem. Psychother. 43(2), 63–72 (2013).
  • de Jong S, van Donkersgoed R, van der Gaag M et al. MERIT: RCT of new treatment of metacognitive impairment in people with psychosis. Presented at: 2nd Biennial Schizophrenia International Research Conference. Florence, Italy, 10–14 April 2010.
  • David AS, Bedford N, Wiffen B, Gilleen J. Failures of metacognition and lack of insight in neuropsychiatric disorders. Philos. Trans. R. Soc. Lond., B, Biol. Sci. 367(1594), 1379–1390 (2012).
  • Brent BK, Giuliano AJ, Zimmet SV, Keshavan MS, Seidman LJ. Insight into illness in patients and caregivers during early psychosis: a pilot study. Schizophr Res. 127(1–3), 100–106 (2012).
  • Lysaker PH, Clements CA, Plascak-Hallberg CD, Knipscheer SJ, Wright DE. Insight and personal narratives of illness in schizophrenia. Psychiatry 65(3), 197–206 (2002).
  • Roe D, Hasson-Ohayon I, Kravetz S, Yanos PT, Lysaker PH. Call it a monster for lack of anything else: narrative insight in psychosis. J. Nerv. Ment. Dis. 196(12), 859–865 (2008).

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