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PubMedDate not supplied

The 'object' of insight assessment: relationship to insight 'structure'.

Insight is a relational or 'intentional' concept, i.e., it is only understood in terms of its relation to something; and that 'something' is the 'object' of insight. In clinical practice, the 'object' of insight thus generally refers to a particular mental or physical state (e.g., mental illness, neuropsychological deficit) in relation to which insight is being assessed. It is argued in this paper that the 'object' of insight plays a crucial role in shaping or determining the sort of insight that is elicited in clinical practice (i.e., the phenomenon of insight). Three ways in which the 'object' of insight can shape the clinical phenomenon of insight are discussed. One concerns the conceptual background in which the 'object' is embedded and which is likely to impose a similar structure onto the phenomenon of insight. Another is the semantic category to which the 'object' of insight belongs and which will imprint its particular structure on the phenomenon of insight. Yet another concerns the specific nature of the 'object' which itself will shape the insight phenomenon elicited. This carries implications for research on insight, since insight tends to be explored in relation to a variety of 'objects'. Phenomena of insight in relation to different 'objects' are likely to vary in structure, and this, in turn, has consequences for mechanisms underlying insight in each case. Understanding more about the nature and contribution of the 'object' of insight in the insight-'object' relationship will help to delineate separate insight phenomena and achieve consistency in empirical studies on insight.

Awareness↗
PubMedDate not supplied

[Research into the formation of proportions of "insight vs lack of insight" in paranoid schizophrenia].

The relevant literature was reviewed, focusing on available evidence which emphasizes common occurrence of lack of insight among the sufferers of schizophrenia. The opinion has long been considered one-sided as it ignores occurrence of partial insight. Therefore, the purpose of this research was to attempt to find out to what extent the patient can afford to have insight and when he or she fails in doing so. A group of 100 paranoid schizophrenics were examined and both "insight and lack of insight" scales were applied. The results negate the hypothesis that insight does not take place in schizophrenia. A quarter of those examined displayed partial insight, with 16% of them showing pronounced insight indicating some awareness of changes in their psychic state due to "some" unidentified pathological factors. Different approaches and hypotheses were taken into consideration that would oscillate between the two extreme attitudes of insight and lack of insight. Contiguity between the examined phenomenon and that of coexistence of logically correct trains of thought with incorrect ones, as it occurs in hypomaniacal states, were indicated. An attempt to explain the so-called McEvoy's riddle was made. Final conclusion: It can be assumed that the interpenetration of the two antithetic trains of thought, where one displays partial lack of insight and the other partial insight, may be particularly characteristic of schizophrenia, more so than lack of insight.

Attitude to Health↗
PubMed2005

Insight into schizophrenia: the effects of cognitive behavioural therapy on the components of insight and association with sociodemographics--data on a previously published randomised controlled trial.

Insight in schizophrenia is an evolving concept with widespread use in clinical practice. Results are presented from a multicentre randomised trial in which patients with schizophrenia and carers received a short insight-focused Cognitive Behaviour Therapy (CBT) intervention from trained nurses in the community. The CBT group demonstrated significantly greater improvement in insight into compliance with treatment and the ability to re-label their psychotic symptoms as pathological compared with the control group at post-therapy assessment. Those participants who demonstrated improved insight into having a mental illness tended to become depressed. At the end of therapy and at 1-year follow-up, there was a statistically significantly increased dropout rate in African-Caribbean and Black African participants. The Black Caribbean group showed a significantly smaller change in insight compared to the white group. At 1-year follow-up, the result on total insight and compliance was durable. The change in insight in the Black African group was significantly lower compared to the white group. The study emphasizes the role of a short insight-focused CBT intervention in improving patients' insight into compliance and its implications. The results confirm previous findings of difficulties in engaging patients of Afro-Caribbean origin and their poor response to psychological therapies as currently delivered.

Adult↗
PubMed1999

Correlates of insight and insight change in schizophrenia.

Various theories have been proposed to account for poor insight in schizophrenia. This study examined the relationships between insight, mood, schizophrenic symptoms and cognitive functioning. The relationship between longitudinal changes in insight and changes in symptoms and mood was also investigated. One-hundred patients with DSM-III-R schizophrenia, recently recovered from a relapse of their illness, were rated on the Insight and Treatment Attitudes Questionnaire (ITAQ), the Positive and Negative Syndrome Scale (PANSS), the Montgomery Asberg Depression Rating Scale (MADRS), the Rivermead Behavioural Memory Test and tests of current and premorbid IQ. A random sample of 53 were then given an educational package (video and booklets) designed to improve their insight. Follow-up ratings on the ITAQ, PANSS and MADRS were subsequently obtained. At baseline, better insight was significantly correlated with lower mood and fewer positive symptoms. It was not related to cognitive functioning. Improvement in insight at follow up was related to worsening of mood, but not to change in positive symptoms. The results are consistent with the concept that poor insight, at least in part, results from the psychotic disease process itself. In addition, they suggest that poor insight may protect against depression in the early stages of recovery from schizophrenia.

Adolescent↗
PubMed1999

Insight in dementia: when does it occur? Evidence for a nonlinear relationship between insight and cognitive status.

Lack of insight or impaired awareness of deficits in patients with dementia is a relatively neglected area of study. The aim of this study was to evaluate insight in a group of demented patients with two assessment scales and to assess their relationship with the cognitive level of disease severity. Sixty-nine consecutive patients affected by Alzheimer's disease (n = 37) and vascular dementia (n = 32) with a wide range of cognitive impairment (MMSE = 17.0 +/- 6.4) were recruited. Insight was evaluated with the Guidelines for the Rating of Awareness Deficits (GRAD)--specifically targeted to memory deficits--and the Clinical Insight Rating scale (CIR), evaluating a broader spectrum of insight (reason for the visit, cognitive deficits, functional deficits, and perception of the progression of the disease). In the whole sample, GRAD and CIR were significantly associated with MMSE (Spearman's coefficient = .51, p < .001; and r = -.55, p < .001) and with Clinical Dementia Rating scale (-.57, p < .001; and r = .57, p < .001) respectively. The shape of the relationship of MMSE with CIR and GRAD scales was assessed with spline smoothers suggesting that the relationship follows a trilinear pattern and is similar for both scales. Insight was uniformly high for MMSE scores > or = 24, showed a linear decrease between MMSE scores of 23 and 13, and was uniformly low for MMSE scores < or = 12. The trilinear model of the association between insight and cognitive status reflects more closely the observable decline of insight and can provide estimates of when the decline of insight begins and ends.

Activities of Daily Living↗
PubMed2001

Placebo insight: the rationality of insight-oriented psychotherapy.

It is widely believed that the insight-oriented psychotherapies provide their clients with valid methods of self-exploration that lead to bona fide self-knowledge. It also is widely believed that clients' insights must be true in order to be therapeutically effective. Both these claims are implausible. I argue that because clients face significant epistemic pressures in the therapeutic encounter, the insight-oriented psychotherapies are highly susceptible to generating placebo insights, that is, illusions, deceptions, and adaptive self-misunderstandings that convincingly mimic veridical insight but have no genuine explanatory power. The insight-oriented psychotherapies also are highly susceptible to generating therapeutic artefacts that appear to confirm the insights acquired by clients. The powerful treatment methods to which clients are subjected generate some of the very psychological and behavioral facts that clients claim to "discover" in their explorations. This impugns the scientific status of the insight-oriented psychotherapies.

Humans↗
PubMed2006

Insight in frontotemporal dementia: conceptual analysis and empirical evaluation of the consensus criterion "loss of insight" in frontotemporal dementia.

The objective of this study was to suggest a new formulation of the core research diagnostic consensus criterion "loss of insight" in frontotemporal dementia (FTD). Eight patients with FTD (diagnoses made by interviews, medical and neuropsychological examination, CT scan, and regional cerebral glucose metabolism measured by positron emission tomography (PET) participated in the study). The results indicated that insight was present in three out of eight patients, and that insight appears to be a heterogeneous concept. Two types of insight emerged: Emotional insight associated with frontotemporal functions, and cognitive insight, related to posterior cognitive functions. These results suggest that loss of insight should not serve as a core criterion on FTD, but serves well as a supportive criterion of the disease.

Affect↗
PubMed1984

Effects of three non-insight-oriented treatment methods on agoraphobic women suitable for insight-oriented psychotherapy.

Twenty-three agoraphobic women rated suitable for insight-oriented psychotherapy received one of three randomly assigned non-insight-oriented types of treatment for 3 months and the effect was followed up after 9 months. All patients received basal therapy (B) in the form of standardized information, self-exposure instructions and anxiolytic medication. One group received this treatment only with monthly appointments. The others, in addition, received either therapist-directed prolonged exposure in vivo (PE) or relaxation therapy (R). The effects of insight-oriented psychotherapy could not be studied due to the small numbers in this group. All groups showed clinically relevant improvement, which indicates a favourable prognosis of patients suitable for insight-oriented psychotherapy irrespective of mode of treatment. However, since the PE group was least improved in some neurotic symptoms and had two treatment drop-outs and two cases of symptom substitution this mode of treatment cannot be recommended for insight-suitable patients. R patients came out favourably, which was contrary to the poor outcome with this therapy in patients not suitable for insight-oriented psychotherapy.

Adolescent↗
PubMed2003

Toward the development of a Mood Disorders Insight Scale: modification of Birchwood's Psychosis Insight Scale.

BACKGROUND: Insight has been defined as: (1) recognition of symptomatology, (2) the ability to attribute symptoms to a mental health disorder, and (3) complying with treatment. Insight is related to medication compliance, course of illness and outcome. Current instruments for measuring insight are limited to those that have been validated primarily in hospitalized patients with psychosis. Our objectives were to develop a reliable and valid self-report scale for use in outpatients or inpatients with mood disorders. Toward this end we made extensive revisions of the Birchwood et al. Insight Scale for Psychosis. METHODS: The scale was developed by modifying items from a previous self-report scale. Specifically, assumptions of hospitalizations, psychosis, and current symptomatology were removed and items related to mood state were added. The scale was included in a battery of measures completed by outpatients and inpatients participating in a study of mood stabilizer medications. RESULTS: Subjects (n=101, 66.3% female, median age 44 years) took approximately 2-3 min each to complete the scale. Overall scores were high (Mean=10.3 out of 12). Reliability was determined using test-retests (r=0.75, n=45). Validity testing was based mainly on clinician ratings (r=0.49, n=69). CONCLUSION: The new scale shows promise as a quick method for assessing insight in patients with mood disorders.

Adult↗
PubMed1998

HAIS (Hanil Alcohol Insight Scale): validation of an insight-evaluation instrument for practical use in alcoholism.

OBJECTIVE: Numerous studies on alcoholism treatment have indicated that there are many steps the alcoholic must take before he can be alcohol free, and the admission that he is an alcoholic is the first step towards that goal. This study concerns the validation of a 20-item questionnaire, for the objective evaluation of the insight status of alcoholics. METHOD: Alcoholic men (N = 58) were interviewed by three clinicians, and the decisions of all of the interviewers were concordant in categorizing 44 out of the 58 interviewees into three insight groups: poor, fair and good. Validation of the questionnaire was made against the 44 concordant categorizations. RESULTS: The assessments of the patient's insight state by these two different methods (the interview results and the scores of this scale) were found to be highly and significantly correlated (r = .79, p < .001). CONCLUSIONS: This scale may be useful for qualitative and quantitative evaluation of the insight of alcoholics, and may provide fundamental information in establishing different therapeutic strategies based on different insight states of the alcoholics in the recovery process.

Adult↗
PubMed2006

Cognitive insight and delusion proneness: An investigation using the Beck Cognitive Insight Scale.

The present study investigated the relationship between delusion proneness, as assessed using the Peters et al. Delusions Inventory [Peters, E.R., Joseph, S.A., Garety, P.A., 1999. The measurement of delusional ideation in the normal population: Introducing the PDI (Peters et al. Delusions Inventory). Schizophr. Bull. 25 553-576], and cognitive insight, as assessed using the Beck Cognitive Insight Scale (BCIS; [Beck, A.T., Baruch, E., Balter, J.M., Steer, R.A., Warman, D.M., 2004. A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophr. Res. 68, 319-329]. Two hundred undergraduate students with no history of psychotic disorder participated. Results indicated that, consistent with hypotheses, those higher in delusion proneness endorsed more certainty in their beliefs and judgment than those who were lower in delusion proneness (Self-Certainty subscale of the BCIS; p = .007). Contrary to hypotheses, however, those who were higher in delusion proneness were more open to external feedback and were more willing to acknowledge fallibility than those who were lower in delusion proneness (Self-Reflectiveness subscale of the BCIS; p = .002). The results are discussed in relation to theories of delusion formation.

Adolescent↗
PubMed2004

A new instrument for measuring insight: the Beck Cognitive Insight Scale.

The clinical measurements of insight have focused primarily on patients' unawareness of their having a mental disorder and of their need for treatment ([Acta Psychiatr. Scand. 89 (1994) 62; Am. J. Psychiatry 150 (1993) 873]; etc.). A complementary approach focuses on some of the cognitive processes involved in patients' re-evaluation of their anomalous experiences and of their specific misinterpretations: distancing, objectivity, perspective, and self-correction. The Beck Cognitive Insight Scale (BCIS) was developed to evaluate patients' self-reflectiveness and their overconfidence in their interpretations of their experiences. A 15-item self-report questionnaire was subjected to a principle components analysis, yielding a 9-item self-reflectiveness subscale and a 6-item self-certainty subscale. A composite index of the BCIS reflecting cognitive insight was calculated by subtracting the score for the self-certainty scale from that of the self-reflectiveness scale. The scale demonstrated good convergent, discriminant, and construct validity: (a) the BCIS composite index showed a significant correlation with being aware of having a mental disorder on the Scale to Assess Unawareness of Mental Disorder (SUMD; Arch. Gen. Psychiatry 51 (1994) 826) and the self-reflectiveness subscale was significantly correlated with being aware of delusions on the SUMD, (b) the composite index score of the BCIS differentiated inpatients with psychotic diagnoses from inpatients without psychotic diagnoses, and (c) in a separate study, change scores on the BCIS were significantly correlated with change scores on positive and negative symptoms. The results provided tentative support for the validity of the BCIS. Suggestions were made for further investigation of the cognitive processes involved in identifying and correcting erroneous beliefs and misinterpretations.

Adult↗
PubMed2006

Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders.

Research has paradoxically linked awareness of illness to both better function outcomes and lesser hope and self-esteem. One possible explanation for these findings is that acceptance of having schizophrenia may impact outcomes differently depending on the meanings the person attaches to this acceptance, particularly whether he or she accepts stigmatizing beliefs about mental illness. To explore this possibility we performed a cluster analysis of 75 persons with schizophrenia spectrum disorders based on single measures of insight using the Positive and Negative Syndrome Scale, internalized stigma using the Internalized Stigma of Mental Illness Scale, and compared groups on concurrent assessments of hope and self-esteem. Three groups were produced by the cluster analyses: low in sight/mild stigma (n = 23), high insight/minimal stigma (n = 25), and high insight/moderate stigma (n = 27). As predicted, analysis of variance-comparing groups revealed that the high insight/moderate stigma group had significantly the lowest levels of hope on the Beck Hopelessness Scale and self-esteem using the Multidimensional Self-esteem Inventory. As predicted, the high insight/minimal stigma group also had significantly less impaired social function than the other groups. Implications for assisting persons to come to cope with awareness of illness and stigma are discussed.

Adaptation, Psychological↗