Lack of Insight and Awareness in Schizophrenia and Neuropsychiatric Disorders

Lack of insight or awareness of illness is a major problem in the management of patients, with a range of neuropsychiatric disorders. Insight in schizophrenia has been extensively studied over the past 20 years, and much is known about its clinical associations. In this chapter, we review the literature on insight in schizophrenia and go on to describe the results of a study in which awareness of illness and impairment was compared in three clinical groups matched for premorbid IQ: patients with schizophrenia, Alzheimer's disease, and brain injury. We considered performance and awareness across a number of domains" social behavior, psychopathology, and executive function. Awareness was measured by different methods including clinician ratings and discrepancy scores between patients' own ratings and their relatives' ratings using the Dysexecutive Questionnaire. All groups showed varying levels of deficit in each domain as well as varying levels of awareness. The Alzheimer group showed the most severe lack of awareness of cognitive and behavioral problems, followed by the braininjured and schizophrenia patients. Low mood was associated with better insight in all groups. We' conclude that insight is multidimensional and domain specific but that it also has associations which are common across domains and disorders.