The effects of aging on insight into illness in schizophrenia: a review

Abstract

Objectives Impaired insight into illness is a prevalent feature of schizophrenia, which negatively influences treatment adherence and clinical outcomes. Little is known about the effects of aging on insight impairment. We aimed to review the available research literature on the effects of aging on insight into illness in schizophrenia, in relation to positive, negative, and cognitive symptoms. Ultimately, we propose a trajectory of insight in schizophrenia across the lifespan. Method A systematic Medline® literature search was conducted, searching for English language studies describing the relationship of insight into illness in schizophrenia with aging. Results We identified 62 studies. Insight impairment is associated with illness severity, premorbid intellectual function (i.e. IQ), executive function, and memory. Insight impairment improves modestly during midlife, worsening again in late life. It tends to fluctuate with each episode of psychosis, likely in relation to worsening positive symptoms that improve with antipsychotic treatment. The relationship between insight impairment and cognitive dysfunction appears to attenuate with age, while the relationship with lower premorbid intellectual function is preserved. The association between impaired insight and negative symptoms is unclear. Conclusions The available literature suggests that the course of insight impairment follows a U-shaped curve, where insight impairment is severe during the first episode of psychosis, modestly improves over midlife, and declines again in late life. Future studies are required to investigate the trajectory of insight into illness and its core domains across the lifespan from prodromal phase to late life.

Vestibular stimulation improves insight into illness in schizophrenia spectrum disorders

“…Although this study was designed to include participants with moderate to severe IMP-INS, for the most part, participants were clinically stable with minimal positive symptoms and good awareness of the need for treatment (Table 1). That being said, minimal symptom severity helps ensure the specificity of CVS for IMP-INS as symptom severity and IMP-INS are strongly correlated (Gerretsen et al, 2014b). Relatedly, it is difficult to determine the clinical significance of impaired illness awareness in a sample that accepts the need for treatment.…”

“…“the voices are imaginary due to my mind playing tricks on me”), awareness of need for treatment (“I need an antipsychotic in order to stay mentally healthy”), and awareness of negative consequences attributable to the illness (“I have difficulty working because of schizophrenia” or “I was in jail because I was psychotic”). For in depth reviews on the topic, the reader is directed to Gerretsen et al (2014) (Gerretsen et al, 2014b) and Chakraborty and Basu (2010) (Chakraborty and Basu, 2010). …”

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

“…Cernis et al 127 identified a subgroup with a premorbid IQ estimated as 120 or greater and found that they had better clinical insight than peers with typical levels of intellectual function. To explain these inconsistencies, it has been proposed that the relationship between insight and neurocognition may depend upon the phase of life 128,129 and that good neurocognitive function may be a necessary but not a sufficient condition for clinical insight 130 .…”

Effects of antipsychotics on insight in schizophrenia

“…Previous studies investigating insight longitudinally or comparing illness insight in firstepisode and multiepisode patients have yielded mixed results. A recent systematic review showed that the course of illness insight follows a U-shaped curve, where insight is severely impaired in first-episode patients, modestly improves over midlife and declines in later life (Gerretsen et al, 2014). However, conflicting results showed better insight in multiepisode patients in comparison with FES patients (Thompson et al, 2001) or no significant differences between both groups (Comparelli et al, 2013).…”