Lack of Insight in Schizophrenia

Psychiatric Unit of Virgen del Camino Hospital, Pamplona, Spain.
Schizophrenia Bulletin (Impact Factor: 8.45). 02/1994; 20(2):359-66. DOI: 10.1093/schbul/20.2.359
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A neuropsychological etiology has been suggested for lack of insight in schizophrenia patients, mainly based on frontal, right parietal, right hemisphere, or diffuse cerebral dysfunctions. The aim of this study ws to investigate the neuropsychological pathogeny of lack of insight in schizophrenia patients. We examined a sample of 40 DSM-III-R schizophrenia inpatients admitted because of a recrudescence of symptoms. Schizophrenic symptoms were evaluated through the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms. Neurologic explorations included an assessment of frontal neurologic signs, abnormal involuntary movements, and soft neurologic signs. Lack of insight was assessed through three items from the Manual for the Assessment and Documentation of Psychopathology (AMDP). A global index from these three items (lack of feeling ill, lack of insight, and uncooperativeness) was obtained. A neuropsychological battery composed of tests involving many functional areas of the brain was used. No correlation between bad performance and lack of insight was found on any test. On the contrary, lack of insight was associated with better performance on immediate verbal, immediate visual, and delayed visual memory tasks. Moreover, the three components of lack of insight were extracted as an independent factor when they were included together with the positive and negative symptoms, neurologic abnormalities (frontal and soft neurologic signs, and abnormal movements), and a global measure of cognitive performance. The results of the study do not support the neuropsychological hypothesis of lack of insight.(ABSTRACT TRUNCATED AT 250 WORDS)

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    • "In recent reported studies, insight is most frequently studied in schizophrenia patients (Amador et al., 1994; Cuesta and Peralta, 1994; Weiler et al., 2000; Lincoln et al., 2007). For example, patients with schizophrenia have a significant lack of insight about their personal situation and life perspectives (Amador and Gorman, 1998; Mintz et al., 2003; Sevy et al., 2004), which is closely linked to manifestation of defense mechanisms (Lysaker et al., 2003; Donohoe et al., 2004). "
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    ABSTRACT: Abstract According to recent research, disturbances of self-awareness and conscious experience have a critical role in the pathophysiology of schizophrenia, and in this context, schizophrenia is currently understood as a disorder characterized by distortions of acts of awareness, self-consciousness, and self-monitoring. Together, these studies suggest that the processes of disrupted awareness and conscious disintegration in schizophrenia might be related and represented by similar disruptions on the brain level, which, in principle, could be explained by various levels of disturbed connectivity and information disintegration that may negatively affect usual patterns of synchronous activity constituting adaptive integrative functions of consciousness. On the other hand, mental integration based on self-awareness and insight may significantly increase information integration and directly influence neural mechanisms underlying basic pathophysiological processes in schizophrenia.
    Reviews in the neurosciences 03/2015; 26(3). DOI:10.1515/revneuro-2014-0063 · 3.33 Impact Factor
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    • "Insight in schizophrenia is a multidimensional term that includes psychological, psychopathological, neurocognitive mechanisms and interpersonal relations (Dankı et al. 2007). Approximately 50-80% of schizophrenic patients have poor insight, a factor that negatively influences treatment efficacy (Cuesta and Peralta 1994, Dankı et al. 2007). While some studies have demonstrated an association between insight and violent behavior in schizophrenia (Ekinci and Ekinci 2013, Arango et al. 1999, Buckley et al. 2004) other studies have found no evidence of an association (Lincoln and Hodgins 2008, Yen et al. 2002). "
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    ABSTRACT: Objective: We aimed to investigate factors associated with violent behavior in schizophrenia and to clarify the relationship between violent behavior and insight and cognitive functions. Method: 68 patients diagnosed with schizophrenia were separated into two groups that included patients with a history of violent behavior (n = 30) and those patients without prior history of violent actions (n = 38). The Positive and Negative Syndrome Scale (PANSS), Buss-Perry Aggression Questionnaire, Schedule for Assessing the Three Components of Insight, California Verbal Learning Test (CVLT), Trail Making Test, Wisconsin Card Sorting Test, and Stroop Test were administered to patients in each group. Results: Male gender, the number of hospitalizations, noncompliance with the treatment, alcohol and substance abuse, the number of suicide attempts, PANSS positive score, PANSS general psychopathology score and PANSS total score were significantly higher in patients with schizo-phrenia with a history of violent behavior, relative to the non-violent patients. The mean score for the delayed response subsection of the CVLT was lower among patients with a history of violent behavior. Noncompliance with treatment (OR:5.927, p=0.041), alcohol and substance abuse (OR:21.089, p=0.000), and total PANSS score (OR:1.053, p=0.011) were identified as significant predictive factors for violent behavior in patients with schizophrenia. Conclusion: The absence of insight and executive function impairment are core symptoms of schizophrenia and do not appear to be associated with violent behavior. Memory impairment may be associated with violent behavior in patients with schizophrenia. Noncompliance with medical treatment , alcohol and substance abuse, and the severity of positive symptoms are the most significant factors for predicting violence behavior in patients with schizophrenia.
    Turk psikiyatri dergisi = Turkish journal of psychiatry 01/2015; DOI:10.5080/u13575 · 0.43 Impact Factor
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    • "Insight in schizophrenia is a multifaceted concept that encompasses psychological, psychopathological, and neurobiological mechanisms, and interpersonal relationships (Dankı et al. 2007). It is known that 50%-80% of schizophrenia patients have low-level insight and that this adversely affects the treatment process (Dankı et al. 2007; Cuesta and Peralta 1994). Some clinical studies on schizophrenia and insight reported that there is a linear relationship between the degree of insight and positive symptoms (Baier et al. 2000), whereas others reported that insight was associated with both negative and positive symptoms (Debowska et al. 1998), and that there wasn't a relationship between insight, and positive or negative symptoms (Schwart and Peterson 1999). "
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    ABSTRACT: Aim: The aim of this study is firstly to compare the obsessive-compulsive disorder (OCD) patients with good insight and OCD patients with poor insight in terms of socio-demographic and clinical features; to investigate the relation between insight and the level of the expressed emotion (EE) in the patients; and lastly to specify the factors that predict level of insight. Methods: OCD patients with good insight and patients with poor insight were compared in terms of clinical features and the perceived EE level of the patients and the individuals that they live with in order to specify the factors that predict the insight level, and to investigate the relationship between insight level and EE. Results: It was found that the total Expressed Emotion Scale, total Level of Expressed Emotion (LEE), LEE-Emotional Response and LEE-Tolerance/Expectation subscale scores of the group comprised of patients with poor insight are higher than the other group. The results also show that the duration of illness and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score predict insight level. Conclusions: This study shows that the level of EE perceived by the patients with poor insight and the person that he/she lives with, is higher than the group with good insight. The studies that investigate the relationship between the factors of insight level and EE level, which are indicated to determine the level of the illness severity and its chronicity, will enable the researchers to understand the importance of the role of the family on the treatment processes of OCD.
    Nordic Journal of Psychiatry 09/2014; 69(3):1-6. DOI:10.3109/08039488.2014.959996 · 1.34 Impact Factor
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