An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments

Abstract

Introduction: Poor insight, or unawareness of some major aspect of mental illness, is a major barrier to wellness when it interferes with persons seeking out treatment or forming their own understanding of the challenges they face. One barrier to addressing impaired insight is the absence of a comprehensive model of how poor insight develops. Areas covered: To explore this issue we review how poor insight is the result of multiple phenomena which interfere with the construction of narrative accounts of psychiatric challenges, rather than a single social or biological cause.Expert Commentary: We propose an integrative model of poor insight in schizophrenia which involves the interaction of symptoms, deficits in neurocognition, social cognition, metacognition, and stigma. Emerging treatments for poor insight including therapies which focus on the development of metacognition are discussed.

Narrative insight in psychosis: The relationship with spiritual and religious explanatory frameworks

“…David Roe and colleagues have developed the term narrative insight to expand the insight construct to fit with an individual's personal story (e.g., Lysaker et al, 2009;Roe & Davidson, 2005;Roe, Hasson-Ohayon, Kravetz, Yanos, & Lysaker, 2008;Vohs, George, Leonhardt, & Lysaker, 2016); similarly, Tranulis and colleagues (e.g., Tranulis, Freudenreich, & Park, 2009) have independently developed the concept, maintaining a broadly similar position. Although this writing mostly maintains 'illness' terminology, the paradigm discussed is one in which the capacity and importance of developing personal narratives around psychosisand of valuing non-biomedical explanationsare placed in the foreground.…”

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

“…While social cognition focuses on the correct detection of a discrete thought or feeling of another person, metacognition focuses on the integration of those details into a coherent whole, which varies more in terms of complexity rather than accuracy 143,144 . Metacognitive deficits thus could hypothetically limit a person's abilities to recognize changes in their mental states and see disruption across the larger course of their lives 139 .…”

“…Deficits in social cognition have been proposed to contribute to poor clinical insight when they block the opportunity to use the perspectives of others to understand past and present evidence of mental illness 139 . Consistent with this, Sanchez-Torres et al 51 reported that poor lifetime insight in psychosis was related to poorer social cognition.…”

“…It then also requires the integration of information about the multifaceted consequences of each of those changes and their potential causes 139 .…”

Clinical Application of Patient-Centered Diabetes Care for People With Serious Mental Illness

“…In the SMI literature, such difficulties in acknowledging the presence of a psychiatric disorder have been addressed in an extensive body of research exploring the concept of “poor insight,” a phenomenon that has been noted to affect as many as 50–75% of people diagnosed with schizophrenia. The insight literature related to SMI is complex and not without controversy; competing models of insight have been introduced, and there are different views regarding the implications for treatment ( 20 ).…”