The nature and evolution of insight in schizophrenia: A multi-informant longitudinal study of first-episode versus chronic patients
Abstract
Background and aims This study investigated a novel distinction between two possible sources of poor insight in schizophrenia: primary unawareness, in which the ill person is not aware that other people think one has a problem, and secondary unawareness (or disagreement), in which a person does appreciate that other people think one has a problem. A secondary goal was to compare the evolution of insight in first-episode and chronic schizophrenia.Methods Sixty-eight first-episode and 51 chronic patients were administered two versions of the Scale of Unawareness of Mental Disorder (SUMD) at three time points: hospital admission, discharge, and 6-month post-discharge. In the first standard SUMD version, they were asked about their own opinions, whereas in the second modified version, they were asked about their best guess of their doctor's opinion.Results While overall level of unawareness remained stable within each single episode, there were significant Type of Unawareness (primary versus secondary) by Clinical Status (admission versus discharge versus 6-month post-discharge) and Type of Unawareness by Phase of Illness (first-episode versus chronic) interaction effects. More specifically, in the first-episode group, primary unawareness steadily decreased over time. In contrast, in the chronic group, primary unawareness decreased markedly during hospitalization and returned to baseline after discharge.Conclusions These results provide preliminary support for the notion that impaired insight is an additive outcome of primary unawareness and disagreement, and that change in insight over time occurs mostly at the level of their relative proportion as opposed to their overall sum. Implications for studying and treating poor insight in schizophrenia are discussed.
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Poor insight in schizophrenia occurs across different cultures and at different phases of the illness.
“Poor insight in schizophrenia is prevalent across cultures and phases of illness.”
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 [9]
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- Authors
- Koren, D., Viksman, P., Giuliano, A. J., & Seidman, L. J.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- University of Haifa (IL)
- Corresponding author
- Koren, Danny
- Venue
- Schizophrenia Research
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 151
- Issue
- 1-3
- Pages
- 245-251
- ISSN
- 0920-9964 (ISSN-L)
- OpenAlex
- W2149177912
- Cited by
- 29
- References
- 44
- Citations by year
- 2026: 2 · 2025: 3 · 2023: 2 · 2022: 1 · 2021: 2 · 2019: 2 · 2018: 5 · 2016: 6 · 2015: 5 · 2014: 1
- FWCI
- 2.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Schizophrenia Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Pennsylvania
- 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
- insight, schizophrenia
- MeSH terms
- Adult, Analysis of Variance, Awareness, Chronic Disease, Female, Hospitalization, Humans, Intelligence Tests, Longitudinal Studies, Male, Neuropsychological Tests, Psychiatric Status Rating Scales, Schizophrenia, Schizophrenic Psychology, Antipsychotic Agents, Young Adult
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