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Lack of Insight and Awareness in Schizophrenia and Neuropsychiatric Disorders

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Neuropsychiatric Disorders

Abstract

Lack of insight or awareness of illness is a major problem in the ­management of patients with a range of neuropsychiatric disorders. Insight in schizophrenia has been extensively studied over the past 20 years, and much is known about its clinical associations. In this chapter, we review the literature on insight in schizophrenia and go on to describe the results of a study in which awareness of illness and impairment was compared in three clinical groups matched for premorbid IQ: patients with schizophrenia, Alzheimer’s disease, and brain injury. We considered performance and awareness across a number of domains: social behavior, psychopathology, and executive function. Awareness was ­measured by different methods including clinician ratings and discrepancy scores between patients’ own ratings and their relatives’ ratings using the Dysexecutive Questionnaire. All groups showed varying levels of deficit in each domain as well as varying levels of awareness. The Alzheimer group showed the most severe lack of awareness of cognitive and behavioral problems, followed by the brain-injured and schizophrenia patients. Low mood was associated with better insight in all groups. We conclude that insight is multidimensional and domain specific but that it also has associations which are common across domains and disorders.

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Acknowledgments

James Gilleen was supported by an MRC Ph.D. Studentship. We are grateful to Prof. Simon Lovestone for facilitating access to his Alzheimer cohort; Laura Bach helped with recruitment of brain injury patients, and Sandra Randell provided secretarial support. We are grateful to all the patients and carers who generously took part in our studies.

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  1. Department of Psychiatry, Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King’s College London, PO Box 68, London, SE5 8AF, UK

    James Gilleen, Kathryn Greenwood & Anthony S. David

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  1. James Gilleen
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Correspondence to Anthony S. David .

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  1. Jinmeikai Research Institute for Mental Health, 53-20 Kabutoyama-cho, Nishinomiya, Hyogo, 662-0001, Japan

    Koho Miyoshi M.D., Ph.D. (Director, The former Professor) & Yasushi Morimura M.D., Ph.D. (Chief Executive Officer) (Director, The former Professor) &  (Chief Executive Officer)

  2. Ohmura Hospital, 200 Kitayama-Ohmura, Miki, Hyogo, 673-0404, Japan

    Koho Miyoshi M.D., Ph.D. (Director, The former Professor) (Director, The former Professor)

  3. Department of Occupational Therapy, Kobe Gakuin University School of Rehabilitation, 518 Ikawadani-cho, Nishi-ku, Kobe, 651-2180, Japan

    Kiyoshi Maeda M.D., Ph.D. (Professor) (Professor)

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Gilleen, J., Greenwood, K., David, A.S. (2010). Lack of Insight and Awareness in Schizophrenia and Neuropsychiatric Disorders. In: Miyoshi, K., Morimura, Y., Maeda, K. (eds) Neuropsychiatric Disorders. Springer, Tokyo. https://doi.org/10.1007/978-4-431-53871-4_3

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