An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments

ABSTRACT

Introduction: Poor insight, or unawareness of some major aspect of mental illness, is a major barrier to wellness when it interferes with persons seeking out treatment or forming their own understanding of the challenges they face. One barrier to addressing impaired insight is the absence of a comprehensive model of how poor insight develops.

Areas covered: To explore this issue we review how poor insight is the result of multiple phenomena which interfere with the construction of narrative accounts of psychiatric challenges, rather than a single social or biological cause.

Expert commentary: We propose an integrative model of poor insight in schizophrenia which involves the interaction of symptoms, deficits in neurocognition, social cognition, metacognition, and stigma. Emerging treatments for poor insight including therapies which focus on the development of metacognition are discussed.

KEYWORDS:

• Schizophrenia
• insight
• symptoms
• neurocognition
• social cognition
• metacognition
• stigma

Declaration of interest

JL Vohs is a current recipient of a Young Investigator Award from the Brain and Behavior Research Foundation. PH Lysaker is a current recipient of funding from NIMH and the Department of Veterans Affairs Research and Development Service. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.