An update on clinical insight, cognitive insight, and introspective accuracy in schizophrenia-spectrum disorders: symptoms, cognition, and treatment

Introduction Poor insight, or unawareness of morbid changes in cognition, emotional states, or behavior, is commonly observed among people with schizophrenia. Poor insight represents a persistent barrier to wellness because it interferes with treatment and self-direction. Paradoxically, good insight may also be a barrier to health when awareness of these changes leads to depression or self-stigma. Areas covered This paper builds upon this previous work by exploring these issues in schizophrenia separately as they have appeared in published research over the last three years in three different kinds of insight: clinical, cognition, and introspective accuracy. Specifically, studies are reviewed that address: the adverse effects of poor insight, the paradoxical effects of good insight, correlates with other forms of cognition, and emerging treatments. Expert Opinion The evidence continues to offer a nuanced picture of the complex effects of good insight in schizophrenia. Incremental improvements were also found in the development of novel integrative treatment approaches. This work also highlights the intricacy of the concept of insight, the need for further exploration of the effects of culture, and conceptual work that distinguishes the points of convergence and divergence of these forms of insight. PLAIN LANGUAGE SUMMARY Many people diagnosed with schizophrenia are unaware that they have a mental illness. This is referred to as having poor clinical insight. People struggle to form ideas about themselves or doubt what they think. This is referred to as having poor cognitive insight. Finally, many people diagnosed with schizophrenia may significantly overestimate their abilities. This is referred to as having poor introspective accuracy. This review shares research that shows that problems with these kinds of self-awareness can make it difficult for those with schizophrenia to manage their lives and the challenges of having a mental illness. At the same time, these problems with awareness may also protect people with schizophrenia from feeling depressed and at odds with the world. We discuss how these forms of unawareness result from many different factors and how new treatments may help individuals develop awareness without being vulnerable to significant emotional pain.