Insight Into Illness and Defense Styles in Schizophrenia

Abstract

Although the psychological denial model argues that poor insight is a result of defense mechanisms, the direct relationship between the two remains unclear. This study aimed to examine the relationship between insight into illness and defense mechanisms while considering cognitive dysfunction in schizophrenia. A total of 38 patients with schizophrenia were evaluated for level of insight (Schedule for the Assessment of Insight), defense mechanisms (Defense Style Questionnaire), neurocognitive function (Brief Assessment of Cognition in Schizophrenia), and psychotic symptoms (Brief Psychiatric Rating Scale). Regarding level of insight, partial correlation analysis controlling neurocognitive and psychotic variables showed that “recognition of illness” was positively correlated with immature defense styles and negatively correlated with mature defense styles. Stepwise regression analyses revealed that “recognition of illness” was significantly predicted by immature defense styles. Our findings suggest that patients who tend to use immature defense styles are more likely to accept their own mental illness.

Improving Medication Adherence in Community-Dwelling Patients with Schizophrenia Through Therapeutic Alliance and Medication Attitude: A Serial Multiple Mediation Model

“…Importantly, insight enhancement alone may affect the protective mechanism of the patient, causing them to face the disease without adequate psychological preparation. 19 …”

“… 17 , 18 Furthermore, the unwillingness to develop insight is also a defense mechanism of patients to avoid the painful mental illness-recognizing process. 19 Improving insight regarding a disease is a crucial current clinical practice for community-dwelling schizophrenia patients. Numerous researchers have attempted to improve medication adherence by enhancing patient insight.…”

Insight Into Illness and Psychological Defense Attitudes in People With Chronic Schizophrenia Using Markova's Insight Scale

“…When combined with our results, insight, especially that assessed with non-face-to-face scales such as the IS, might partially reflect agreeableness or the desire to be accepted by the clinician. Nonetheless, in the previous results (Ogawa et al, 2019), even the patients' insights evaluated face to face by clinicians were related to psychological defenses after adjusting for cognitive dysfunction. Thus, the effect of defense mechanisms may not be overlooked as mere method bias.…”

“…The integrative model proposed by Lysaker et al (2018) assumes that acceptance of mental illness is deeply distressing and that insight into illness is multidetermined with potential contributions from cognitive and metacognitive dysfunction, as well as psychological factors (Vohs et al, 2016). A previous study that used a multidimensional insight scale (the Schedule for Assessment of Insight [SAI]; David et al, 1992) showed that one of the dimensions of insight (awareness of illness) was associated with immature defenses, after adjusting for cognitive dysfunction (Ogawa et al, 2019). This result suggests that insight, which consists of multiple dimensions, may include some dimensions that reflect integrative aspects of cognitive and psychological defensive factors and other dimensions that do not reflect such aspects.…”

Clinical Correlates of Treatment Adherence and Insight in Patients with Schizophrenia

“…Clinical course of schizophrenia is affected by several clinical factors, such as characteristics of the disorder, comorbid psychiatric disorders, and medication adherence [4]. Insight level is also a predictive factor on clinical course of schizophrenia [5].…”