Assessment of insight in psychosis

Abstract

Objective: It is frequently reported that patients with psychotic disorders have poor insight into their illness. Previous research has suggested that poor insight may have considerable power in predicting the long-term course of chronic mental disorders and an impact on pa-tients ’ compliance with treatment plans. The authors, proposing that insight is best viewed as a multidimensional phenomenon, developed the Scale to Assess Unawareness ofMental Dis-order, which samples discrete and global aspects of insight across a variety of manifestations ofillness. This article reports on a reliability and validity study ofthe scale. Method: The study subjects were 43 patients with schizophrenia and schizoaffective disorder. Various aspects of insight into illness were evaluated with the scale. In addition, ratings of psychopathology, course ofillness, and compliance with treatment were made. Results: Item variability was high and normally distributed, supporting the authors ’ contention that insight can be rated on a continuous rather than dichotomous scale. Results of the analyses examining the relations between the various dimensions of insight assessed and the psychopathology, course, and compliance variables were generally as hypothesized. Convergent validity with other global measures of insight was found, and aspects ofpoor insight were correlated with poorer com