Assessment and Treatment of Anosognosia in Schizophrenia

The problem of poor insight into mental illness in patients with schizophrenia and related disorders (SMI) has been widely studied over the past thirty years 1,2 .Clinicians, policy makers, family caregivers and criminal justice professionals involved in the care and safety of persons suffering from these illnesses, intuitively understand that the assessment of insight is meaningful if not critical for personal, as well as public, health and safety reasons.In fact, the research is unequivocal in this regard.Patients with poor insight into these disorders are more likely to be involuntarily hospitalized, have more hospitalizations generally, poorer psychosocial functioning, more episodes of aggression, and are far less engaged in treatment 3 .Indeed, lack of insight, also known as anosognosia, is the top predictor of noncompliance with treatment. 3And the prevalence of poor insight is much higher than the other symptoms of these disorders such as hallucinations. 1,4,5In this paper I discuss the prevalence of the problem, terminology (how we should talk about insight), etiology, assessment, and treatment of patients with this condition.A brief word on terminology is necessary."Insight" suggests the individual has knowledge of their illness that is buried outside of conscious awareness.With effective intervention there is a possibility such a person will gain access to this information and hence gain insight.My colleagues and I have argued previously that we should not rush to judgement, in this instance that poor insight is a coping strategy or psychological defense, and instead use conceptually neutral terms like "unawareness" or "lack of awareness" until there is more conclusive evidence regarding the etiology of this common symptom. 1 For that reason, I will no longer use the term insight.