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

Abstract

Poor insight or unawareness of illness has been commonly observed in schizophrenia and has been long recognized as a potent barrier to treatment adherence and a risk factor for a range of poorer outcomes. Paradoxically, the achievement of insight often poses a different set of problems including depression and low self-esteem. One barrier to the treatment of poor insight has been a lack of understanding of the phenomenon, which causes poor insight to develop and persist over time. Without knowing what promotes poor insight, treatment to date has had little to offer beyond the supportive provision of information. To explore these issues, this article reviews emerging literature on the correlates of poor insight in schizophrenia, and newly developing ways of conceptualizing insight. It then details a number of innovative integrative group and individual treatment approaches in the early stages of development, which take into account some of the potential causal forces behind poor insight, including deficits in neurocognition, social cognition, metacognition and heightened self-stigma. A plan for further research is presented to develop a model of the factors whose interaction influences insight, and to refine and test integrative treatments.

Keywords::

• depression
• insight
• metacognition
• neurocognition
• psychosis
• psychosocial function
• recovery
• schizophrenia
• social cognition
• stigma

Financial & competing interests disclosures

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 of financial involvement with any organization or entity with a financial interest in or financial conflict with subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.