Lack of insight 3years after first-episode psychosis: An unchangeable illness trait determined from first presentation?
Abstract
Background Lack of insight is recognized as a symptom that predisposes the individuals with psychosis to noncompliance with the treatment, leading to poorer course of illness. This study aimed to explore baseline predictors of disturbances on insight at follow-up.Methods Three insight dimensions (insight of: 'mental illness', 'need for treatment' and 'the social consequences of the disorder') were measured with the Scale to Assess Unawareness of Mental Disorder (SUMD) in a cohort of 224 first-episode psychosis (FEP) patients at 3-year follow-up. Subgroups, good vs. poor insight, were compared on baseline clinical, neuropsychological, premorbid and sociodemographic characteristics. Regression models tested baseline predictors for each insight dimension.Results At 3-year follow-up a high percentage of patients, 45%, 36% and 33% for each dimension, were found to remain lacking insight. Poor insight into having an illness was predicted by a diagnosis of schizophrenia and poor baseline insight of the social consequences; insight into the need for treatment was predicted by adolescent adjustment and depression at baseline; and insight into the social consequences of the disorder was determined by late adolescent adjustment and baseline insight of mental illness.Conclusions Our findings support the hypothesis that long-term insight in psychosis seems to be, to some extent, determined from first presentation, showing trait-like properties. A subgroup of 'lacking insight' patients, which is characterized by a diagnosis of schizophrenia, lower levels of premorbid adjustment and less severe depressive symptoms at baseline might benefit from special interventions targeted at enhancing insight from their first contact with psychiatric services.
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Poor insight is related to poorer premorbid function.
“Of note, poor insight has been related to poorer premorbid function 74 , and thus links with function may reflect pre-existing deficits.”
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 [74]
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 [74]
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López‐Díaz, Á., López-Moríñigo, J.-D., de la Foz, V. O., Marín-Mateo, H., Ortíz-Jiménez, M. D., Huarcaya-Victoria, J., Talavera, G. G., González‐Blanch, C., Crespo‐Facorro, B., Cuesta, M. J., et al. (2025) · BJPsych Open · doi:10.1192/bjo.2025.10850
Self-citationFekih‐Romdhane, F., Bitar, Z., Mouzakzak, F. A., Abilmona, G., Dahdouh, O., & Hallit, S. (2024) · Figshare · doi:10.6084/m9.figshare.26698745
Changes in insight and outcome over the early course of first-episode psychosis. The OPTiMiSE trial
López-Moríñigo, J.-D., Díaz‐Caneja, C. M., Galvañ, J., Fraguas, D., Moreno, C., Berger, G., Leucht, S., Rossum, I. W.-V., David, A. L., & Arango, C. (2026) · Schizophrenia Research Cognition · doi:10.1016/j.scog.2026.100441
Self-citationCapell, E. F., González-Caballero, J. L., Cid, J., Romero-López-Alberca, C., Ochoa, S., Vila‐Badia, R., Salvador‐Carulla, L., & Moreno‐Küstner, B. (2026) · Schizophrenia Research Cognition · doi:10.1016/j.scog.2026.100465
- Authors
- Ayesa-Arriola, R., Moríñigo, J. D. L., David, A. S., Pérez-Iglesias, R., Rodríguez-Sánchez, J. M., & Crespo-Facorro, B.
- Affiliations
- King's College London (GB)
- Venue
- Schizophrenia Research
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 157
- Issue
- 1-3
- Pages
- 271-277
- ISSN
- 0920-9964 (ISSN-L)
- OpenAlex
- W2100952047
- Cited by
- 35
- References
- 51
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 4 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 6 · 2017: 2 · 2016: 4 · 2015: 4
- FWCI
- 2.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Schizophrenia Research (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- 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 › Psychology and Mental Health
- Keywords
- lack of insight, first-episode psychosis
- MeSH terms
- Adolescent, Adult, Awareness, Depression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neuropsychological Tests, Patient Acceptance of Health Care, Psychiatric Status Rating Scales, Psychotic Disorders, Schizophrenia, Schizophrenic Psychology, Social Adjustment, Spain, Time Factors, Cohort Studies, Young Adult
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