Between 50 and 80% of the patients diagnosed with schizophrenia
have been shown to be partially or totally lacking
insight into the presence of their mental disorder. Although
a causal chain connecting poor insight with poor treatment
adherence and thus with poorer outcome and functioning is
straight forward, numerous studies investigating correlates
and long-term impact of insight have provided differing
results. In addition, higher levels of insight in schizophrenia
have been associated with depression and hopelessness, but
the causal direction of the relationship is unclear and the
data are inconclusive. The current study provides a critical
review of 88 studies on the assessment of insight and its impact
on symptoms and functioning. Studies published by
June 2006 were selected using a keyword search for English
peer-reviewed articles in the databases PsycINFO and
MEDLINE. The majority of studies support the assumption
that insight is associated with adherence during treatment
phase, but the association with long-term adherence
remains unclear. Insight correlates with better long-term
functioning, but this might be explained by its association
with symptoms. There is a positive cross-sectional and longitudinal
relationship between insight and depression, but
the underlying processes need further clarification. In the
concluding discussion, the problems relating to definition
and study designs are considered responsible for many of
the inconclusive findings. Suggestions for further research
are derived.
Between 50 and 80% of the patients diagnosed with schizophreniahave been shown to be partially or totally lackinginsight into the presence of their mental disorder. Althougha causal chain connecting poor insight with poor treatmentadherence and thus with poorer outcome and functioning isstraight forward, numerous studies investigating correlatesand long-term impact of insight have provided differingresults. In addition, higher levels of insight in schizophreniahave been associated with depression and hopelessness, butthe causal direction of the relationship is unclear and thedata are inconclusive. The current study provides a criticalreview of 88 studies on the assessment of insight and its impacton symptoms and functioning. Studies published byJune 2006 were selected using a keyword search for Englishpeer-reviewed articles in the databases PsycINFO andMEDLINE. The majority of studies support the assumptionthat insight is associated with adherence during treatmentphase, but the association with long-term adherenceremains unclear. Insight correlates with better long-termfunctioning, but this might be explained by its associationwith symptoms. There is a positive cross-sectional and longitudinalrelationship between insight and depression, butthe underlying processes need further clarification. In theconcluding discussion, the problems relating to definitionand study designs are considered responsible for many ofthe inconclusive findings. Suggestions for further researchare derived.
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