Depression in schizophrenia: the influence of the different dimensions of insight
Abstract
Improving insight in patients with schizophrenia appears necessary to enhance medication adherence and clinical outcome, but in some patients acquiring insight can paradoxically increase hopelessness, depression and suicidal behavior. The aim of this study is to explore the association of two dimensions of insight (cognitive and clinical) with depression, hopelessness and clinical variables in patients with psychosis. Using a cross-sectional design, 61 remitted outpatients meeting DSM-IV criteria for schizophrenia or schizoaffective disorders were included. Insight was assessed using the "Scale to Assess Unawareness of Mental Disorder" (SUMD), the PANSS-item G12 and the Beck Cognitive Insight Scale (BCIS). Overall, 41.2% of the sample had a history of suicide attempts. Patients in the high clinical insight group had significantly higher depression scores, higher hopelessness scores, greater histories of suicide attempts and were more likely to have received psychoeducation. Compared to patients with low cognitive insight, those with high overall cognitive insight were significantly more depressed and had more often received psychoeducation. Greater insight may have negative consequences in terms of depressive symptoms and therefore presents a challenge to clinicians in assessing the individual risks and benefits of strategies intended to enhance awareness of mental disorder.
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Greater levels of cognitive insight are linked to heightened levels of depression, lower self-reported subjective recovery, and lower subjective quality of life.
“Greater levels of cognitive insight have also been linked to heightened levels of depression 77,86 , as well as lower levels of self-reported subjective recovery 89 and subjective quality of life 90 .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [77]
Good insight is correlated with depression and related constructs such as hopelessness.
“Consistent with this, studies of diverse samples continue to find good insight to be correlated with depression and related constructs such as hopelessness 29,52,74,[76][77][78][79] .”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [77]
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- Authors
- Misdrahi, D., Denard, S., Swendsen, J., Jaussent, I., & Courtet, P.
- Affiliations
- Centre National de la Recherche Scientifique (FR)
- Centre Hospitalier Charles Perrens (FR)
- Inserm (FR)
- Corresponding author
- Misdrahi, David
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2014-04
- Volume
- 216
- Issue
- 1
- Pages
- 12-16
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2036188608
- Cited by
- 60
- References
- 39
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 4 · 2021: 10 · 2020: 4 · 2019: 7 · 2018: 5 · 2017: 5 · 2016: 8 · 2015: 5 · 2014: 3
- FWCI
- 5.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- schizophrenia, depression, insight, cognitive insight, clinical insight, hopelessness, suicide attempts, psychosis, psychoeducation, awareness of mental disorder, schizoaffective disorder
- MeSH terms
- Adult, Aged, Ambulatory Care, Awareness, Cross-Sectional Studies, Depression, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Schizophrenia, Schizophrenic Psychology, Suicide, Attempted
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