Our goals were to evaluate if the presence of severe delusions negatively affects insight, regardless of diagnosis, and whether or not patients gain insight into their delusions when using a third person perspective.

92 delusional patients with psychotic and psychotic mood disorders were asked to speak about their delusions and were evaluated by means of the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms (SAPS and SANS). They were then asked to state whether they thought what they said was believable for them and for the interviewer. After two weeks 79 patients were evaluated with the same scales and listened to a tape where their delusion was re-enacted. They were then asked to state if what they heard was believable for them and for the interviewer.

12 patients thought their delusions was unbelievable for the interviewer at first interview, and 17 patients did the same after the second interview; 4 patients stated what they heard from the tape after the second interview was unbelievable both for them and interviewer. Patients with better insight (patients who stated their delusion was not believable) had a lower SAPS score, a lower item delusion score and a significant improvement of item delusion score at second interview

Several patients gain partial insight when using a third person perspective. The severity of delusions negatively affects insight, regardless of the patient's diagnosis.