Poor insight into schizophrenia: contributing factors, consequences and emerging treatment approaches
Abstract
Poor insight or unawareness of illness has been commonly observed in schizophrenia and has been long recognized as a potent barrier to treatment adherence and a risk factor for a range of poorer outcomes. Paradoxically, the achievement of insight often poses a different set of problems including depression and low self-esteem. One barrier to the treatment of poor insight has been a lack of understanding of the phenomenon, which causes poor insight to develop and persist over time. Without knowing what promotes poor insight, treatment to date has had little to offer beyond the supportive provision of information. To explore these issues, this article reviews emerging literature on the correlates of poor insight in schizophrenia, and newly developing ways of conceptualizing insight. It then details a number of innovative integrative group and individual treatment approaches in the early stages of development, which take into account some of the potential causal forces behind poor insight, including deficits in neurocognition, social cognition, metacognition and heightened self-stigma. A plan for further research is presented to develop a model of the factors whose interaction influences insight, and to refine and test integrative treatments.
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Poor clinical insight in schizophrenia is associated with negative attitudes towards taking antipsychotic medication and the decision to decline pharmacological treatments.
“As noted above and elsewhere 10,13,17 , poor clinical insight in schizophrenia has long been associated with negative attitudes towards taking antipsychotic medication and the decision to decline pharmacological treatments.”
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 [13]
Poor insight is linked to poorer clinical outcomes.
“Poor insight has also long been linked to poorer clinical outcomes 10,13,17,42 , with the joint possibilities that symptoms cause poor insight, and that poor insight causes less treatment adherence which may result in more symptoms.”
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 [13]
Poor insight may arise from neurocognitive deficits in attention, memory and executive functioning.
“For instance, it is possible that deficits in attention, memory and executive functioning compromise individuals' abilities to access relevant memories about the experience of mental illness, to distinguish more from less salient aspects of those memories, to place those memories in sequence and to understand causal links 10,13 .”
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 [13]
Poor insight is not addressed through simple education.
“Earlier reviews established that poor insight was not a matter to be addressed through simple education 13 .”
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 [13]
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References 86 · Cited by 124
- Authors
- Lysaker, P. H., Vohs, J., Hillis, J. D., Kukla, M., Popolo, R., Salvatore, G., & Dimaggio, G.
- Affiliations
- Richard L. Roudebush VA Medical Center (US)
- Indiana University Indianapolis (US)
- University of Indianapolis (US)
- Centro di Terapia Metacognitiva Interpersonale (IT)
- ORCID
- Venue
- Expert Review of Neurotherapeutics
- Publisher
- Informa UK Limited
- Published
- 2013-07
- Volume
- 13
- Issue
- 7
- Pages
- 785-793
- ISSN
- 1473-7175 (ISSN-L)
- 1744-8360
- OpenAlex
- W2133852455
- Cited by
- 124
- References
- 86
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 8 · 2023: 6 · 2022: 15 · 2021: 4 · 2020: 7 · 2019: 5 · 2018: 15 · 2017: 13 · 2016: 14 · 2015: 14 · 2014: 14 · 2013: 1
- FWCI
- 1.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Review of Neurotherapeutics (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
- lack of insight, schizophrenia, disease awareness, medication adherence, neurocognitive function, social cognition, metacognition, self-stigma, depression, low self-esteem, integrative therapy, group therapy
- MeSH terms
- Humans, Health Knowledge, Attitudes, Practice, Schizophrenia
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