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Insight and Psychotic Illness

Cross-sectional and Longitudinal Associations

Published online by Cambridge University Press:  02 January 2018

Anthony David ,
Jim van Os ,
Peter Jones ,
Ian Harvey ,
Alice Foerster  and
Thomas Fahy
Anthony David*
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, London
Jim van Os
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, London
Peter Jones
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, London
Ian Harvey
Affiliation:
Coventry Mental Health Unit, Coventry
Alice Foerster
Affiliation:
Department of Psychiatry, University of Berne, Switzerland
Thomas Fahy
Affiliation:
Maudsley Hospital, Denmark Hill, London
*
Dr Anthony David, Department of Psychological Medicine, King's College Hospital, 103 Denmark Hill, London SE5 8AF
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Abstract

Background

Insight has recently re-emerged as an important aspect of psychopathology amenable to empirical study. We sought to examine the relationship between various aspects of insight into illness and clinical, sociodemographic and neuropsychological variables.

Method

From an inner-London catchment area population, 150 in-patients with recent onset of psychosis were assessed on a variety of measures, including the Present State Examination (PSE). Subjects were followed up for a mean of four years and reassessed.

Results

High IQ was associated with better insight as rated on the PSE, while gender, ethnicity and a diagnosis of schizophrenia appeared to be unrelated. At follow-up, similar associations were found, as well as correlations with attitudes to treatment and a more elaborate measure of insight. Cerebral ventricular enlargement and tests of frontal lobe function did not correlate with insight, but there was a curious, strong association with left-handedness at both assessment points. Initial insight correlated significantly but weakly with insight at follow-up.

Conclusions

The assessment of insight in psychosis has concurrent validity and is a distinct aspect of psychotic phenomenology. It may, in part, have a neuropsychological basis.

Type
Papers
Information
The British Journal of Psychiatry , Volume 167 , Issue 5 , November 1995 , pp. 621 - 628
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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References

Amador, X. F., Strauss, D. H., Yale, S. A., et al (1991) Awareness of illness in schizophrenia. Schizophrenia Bulletin, 17, 113–132.Google Scholar
Amador, X. F., Flaum, M., Andreason, N. C., et al (1994) Awareness of illness in schizophrenia and schizoaffective mood disorders. Archives of General Psychiatry, 51, 826–836.Google Scholar
Amador, X. F., & David, A. S. (1996) Insight and Psychosis. New York: Oxford University Press. In press.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Annett, M. (1970) A classification of hand preference by association analysis. British Journal of Psychiatry, 61, 303–321.Google ScholarPubMed
Buchanan, A. (1992) A two-year prospective study of treatment compliance in patients with schizophrenia. Psychological Medicine, 22, 787–797.Google Scholar
Cuesta, M. J. & Peralta, V. (1994) Lack of insight in schizophrenia. Schizophrenia Bulletin, 20, 359–366.CrossRefGoogle ScholarPubMed
David, A. S. (1990) Insight and psychosis. British Journal of Psychiatry, 156, 798–808.Google Scholar
David, A. S. (1994) Dysmodularity: a neurocognitive model for schizophrenia. Schizophrenia Bulletin, 120, 249–255.CrossRefGoogle Scholar
David, A. S., Buchanan, A., Reed, A., et al (1992) The assessment of insight. British Journal of Psychiatry, 161, 599–602.Google Scholar
Faustman, W. O., Moese, J. A., Ringo, D. L., et al (1991) Left-handedness in male schizophrenic patients is associated with increased impairment on the Luria–Nebraska neuropsychological battery. Biological Psychiatry, 30, 326–334.CrossRefGoogle ScholarPubMed
Ghaemi, S. N. & Pope, H. G. (1994) Lack of insight in psychotic and affective disorders: a review of empirical studies. Harvard Review of Psychiatry, 2, 22–33.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.CrossRefGoogle ScholarPubMed
Hoge, S. K., Appelbaum, P. S., Lawlor, T., et al (1990) A prospective, multicenter study of patients' refusal of antipsychotic medication. Archives of General Psychiatry, 47, 949–956.Google Scholar
Iager, A. C., Kirch, D. G. & Wyatt, R. J. (1985) A negative symptom rating scale. Psychiatry Research, 16, 27–36.Google Scholar
Johnson, S. & Orrell, M. (1995) Insight and psychosis: a social perspective. Psychological Medicine, 25, 515–520.Google Scholar
Jones, P. B., Bebbington, P., Foerster, A., et al (1993) Premorbid social underachievement in schizophrenia. Results from the Camberwell Collaborative Psychosis Study. British Journal of Psychiatry, 162, 65–71.Google Scholar
Lewis, S. W., Owen, M. J. & Murray, R. M. (1989) Obstetric complications and schizophrenia: methodology and mechanisms. In Schizophrenia: Scientific Progress (ed. Schultz, S. C. & Tamminga, C. A.), pp. 56–68. New York: Oxford University Press.Google Scholar
Lysaker, P., Bell, M., Milstein, R., et al (1996) Insight and psychosocial treatment compliance in schizophrenia. In Insight and Psychosis (eds Amador, X. F. & David, A. S.). New York: Oxford University Press. In press.Google Scholar
Manoach, D. S. (1994) Handedness is related to formal thought disorders and language dysfunction in schizophrenia. Journal of Clinical and Experimental Neuropsychology, 16, 2–14.CrossRefGoogle ScholarPubMed
Markova, I. S. & Berrios, G. E. (1992) The meaning of insight in clinical psychiatry. British Journal of Psychiatry, 160, 850–860.Google Scholar
McEvoy, J. P., Apperson, L. J., Applebaum, P. S., et al (1989a) Insight into schizophrenia. Its relationship to acute psychopathology. Journal of Nervous and Mental Disease, 177, 43–47.CrossRefGoogle ScholarPubMed
McEvoy, J. P., Freter, S., Everett, G., et al (1989b) Insight and the clinical outcome of schizophrenic patients. Journal of Nervous and Mental Disease, 177, 48–51.Google Scholar
McEvoy, J. P., Applebaum, P. S., Apperson, L. J., et al (1989c) Why must some schizophrenic patients be involuntarily committed? The role of insight. Comprehensive Psychiatry, 30, 13–17.Google Scholar
McGlashan, T. (1981) Does attitude toward psychosis relate to outcome? American Journal of Psychiatry, 138, 797–801.Google Scholar
McGlynn, S. M. & Schacter, D. L. (1989) Unawareness of deficits in neuropsychology syndromes. Journal of Experimental and Clinical Neuropsychology, 11, 143–205.CrossRefGoogle Scholar
McGuffin, P., Farmer, A. E. & Harvey, I. (1991) A polydiagnostic application of operational criteria in psychotic illness: development and reliability of the OPCRIT system. Archives of General Psychiatry, 48, 764–770.Google Scholar
Michalakeas, A., Skoutas, C., Charalambous, A., et al (1994) Insight in schizophrenia and mood disorders and its relation to psychopathology. Acta Psychiatrica Scandinavica, 90, 46–49.Google Scholar
Nelson, H. E. (1982) National Adult Reading Test (NART): Test Manual. Windsor: NFER-Nelson.Google Scholar
Norusis, M. J./SPSS Inc. (1990) SPSS/PC+ Statistics 4.0. Chicago: SPSS Inc.Google Scholar
Peralta, V. & Cuesta, M. J. (1994) Lack of insight: its status within schizophrenic psychopathology. Biological Psychiatry, 36, 559–561.CrossRefGoogle ScholarPubMed
Perkins, R. E. & Moodley, P. (1993) Perception of problems in psychiatric inpatients: denial, race and service usage. Social Psychiatry and Psychiatric Epidemiology, 28, 189–193.Google Scholar
Phillips, L. (1953) Case history data and prognosis in schizophrenia. Journal of Nervous and Mental Disease, 117, 515–525.Google Scholar
Reitan, R. M. (1958) Validity of the trail making test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271–276.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry, 35, 773–782.Google Scholar
Takai, A., Uematsu, M., Hirofumi, U., et al (1992) Insight and its related factors in chronic schizophrenic patients: a preliminary study. European Journal of Psychiatry, 6, 159–170.Google Scholar
Tyler, M., Diamond, J. C., Lewis, S. (1995) Correlates of lefthandedness in a large sample of schizophrenic patients. Schizophrenia Research, in press.Google Scholar
Van Horn, J. & McManus, I. C. (1992) Ventricular enlargement in schizophrenia: a meta-analysis of studies of the ventricle-brain ratio. British Journal of Psychiatry, 160, 687–697.Google Scholar
Van Os, J., Fahy, T., Jones, P., et al (1995a) Psychopathological syndromes in the functional psychoses: associations with course and outcome. Psychological Medicine, in press.Google Scholar
Van Os, J., Fahy, T., Jones, P., et al (1995b) Increased intra-cerebral CSF spaces predict unemployment and negative symptoms in psychotic illness: a prospective study. British Journal of Psychiatry, 166, 750–759.Google Scholar
Wechsler, D. (1955) Wechsler Adult Intelligence Scale: Manual. New York: Psychological Corporation.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambrdidge: Cambridge University Press.Google Scholar
World Health Organization (1973) International Pilot Study for Schizophrenia. Geneva: WHO.Google Scholar
Young, D. A., Davila, R. & Scher, H. (1993) Unawareness of illness and neuropsychological performance in chronic schizophrenia. Schizophrenia Research, 10, 117–124.Google Scholar
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