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