Tuesday, November 27, 2007

Insight and schizophrenia

Drug and psychological treatments can significantly reduce symptoms in schizophrenia but the condition remains very difficult to treat compared to other mental-health problems. The long-term course of schizophrenia is frequently characterized by reduced social and occupational functioning, loss of independent living, impaired quality of life, substance abuse and an increased risk of suicidal and violent behaviour. Many clinicians believe that poor insight is partially responsible for the negative prognoses of many schizophrenia patients. Insight has been defined as the awareness of having a mental disorder and of its symptoms and implications and has been shown to be at least partly lacking in approximately 50% of schizophrenia patients. There are concerns that it affects patients' adherence to treatment as they either ascribe their symptoms to other causes or refuse to accept that they are ill at all. A review of studies into insight in schizophrenia has found that insight is associated with adherence during treatment although the link between insight and long-term adherence to medication is less clear. Insight was linked to better long-term functioning but also an increased risk of depression as patients were more aware of the nature and magnitude of their problems.

Lincoln, Tania M., Lullmann, Eva and Rief, Winfried - Correlates and long-term consequences of poor insight in patients with schizophrenia : a systematic review Schizophrenia Bulletin November 2007, 33(6), 1324-1342

1 comment:

Hopefulness said...

I totally agree, and I feel this this whole issue of Loss of insight , the consequences and impact that has, or conversely the return of insight and the worsening of depressive phases applies in exactly the same way to Bipolar Disorder.

Apparently 50% of people have a loss of insight which starts as soon as they even start to become mildly hypomnic and which gets worse as the hypomnia and mania develop.

It is a real stumbling block to getting them help, and in longterm recovery and medication adherance or the willingness to change treatments when needed, as the sufferers can not see there is any need to increase or adjust their medication as they believe they are so well, and causes tremendous damage to their relationships inadvertantly, as partners and families are rebuffed in there attempts to help the individual see they are unwell, and this notion is completely rejected. THe partner is seen as the enemy or in a hostile way. How can we help in this scenario. It seems near impossible to get help , and the mental healt teams can often reinforce the clients denial as they do not always see them at their worst, and may agree that they seem okay, the perative word beinf "Seem ", as the can often mislead the mental health teams and be very articulate and plausible when manic. How do you determine rationality if the person sounds convincing when manic and has the abilkity to be articulate and presents a good account or case of their perceived wellness? It often apperas from my experience that thecmental health team, particularly keyworkers are so taken in and, therfore do not put the client forward for an urgent psychiatric assessment with the psychiatrist. THere seems to be a reluctance to wnat to recognise symptoms or take familty acciunts or other inconsistencies into consideration. I am tearing my hair out to get my partner help, and his resistance is in no way deliberate. He does not belive he is unwell when manic, or hypomanic at any level. He just attempts to rationalise and justify all his behaviours or explein them in some ither context than his illness. What can I do to get through to him or the mental healthy team. i have written to them with full history of symptoms and sent them research and information. It apperas the mental health teams actually need educating, not families and partners over time, especially those who have gone to a lot of effort to learn about the illness themsdelves,who are only too aware and astute when it comes to identifying symptoms. Any ideas welcome.