Effect of video self-observation on development of insight in psychotic disorders

Many patients with psychotic disorders lack awareness of being ill. This often presents a serious impediment to treatment compliance. We hypothesized that exposing partially remitted patients to videotapes of themselves, made while they were acutely psychotic, might increase their insight into the nature of their illness. Eighteen acutely psychotic inpatients were assigned randomly to a control or experimental group and interviewed on videotape 24 to 48 hours after admission, using scales that measure insight (Insight and Treatment Attitudes Questionnaire [ITAQ]) and psychopathology (Brief Psychiatric Rating Scale [BPRS]). One to six weeks later, when judged to be significantly improved, subjects were shown either a videotape of their initial interview (experimental group) or a placebo videotape (control group) and then reinterviewed 24 to 48 hours later on videotape, using the BPRS and ITAQ scales. Evaluation of initial and final ITAQ and BPRS scores revealed significantly greater improvement in insight scores and in delusionality in the experimental group. However, no significant difference in overall psychopathology was seen for the two groups. These results suggest that exposure of hospitalized patients to videotapes of their own psychotic behavior may be a cost-effective therapeutic tool for developing personal insight into psychotic illness.