Psychiatric Quarterly

, Volume 90, Issue 2, pp 339–350 | Cite as

Insight and Symptom Severity in an Inpatient Psychiatric Sample

  • Vincent Rozalski
  • Gerald M. McKeegan
Original Paper


Individuals with a severe mental illness, particularly a psychotic disorder, often lack insight into having a mental illness. This study sought to examine the differences in insight and symptom severity between individuals with psychotic, bipolar, and depressive disorders in an inpatient psychiatric sample. 199 participants were interviewed and medical records were consulted. Results show that participants with a psychotic disorder had significantly less insight into their illness, more debilitating symptoms, and reported less depression symptoms after controlling for education, race, marital status, homelessness, age, gender, and history of incarceration. Insight was shown to be a mediator between having a psychotic disorder and symptom severity. Subjective quality of life did not differ by diagnosis. Substance use was not associated with insight or overall symptom severity, while homelessness was associated with having a psychotic disorder and more severe symptoms. Fostering insight during an inpatient stay may be an important part of reducing symptom severity and preventing patient relapse. However, greater insight may increase depression and suicidality, indicating a need for mood management and safety planning along with psychoeducation of symptoms.


Insight Schizophrenia Inpatient Diagnosis Severity Psychiatric 


Compliance with Ethical Standards

Conflict of Interest

Drs. Rozalski and McKeegan declare that we have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Michel P, Baumstarck K, Auquier P, Amador X, Dumas R, Fernandez J, et al. Psychometric properties of the abbreviated version of the scale to assess unawareness in mental disorder in schizophrenia. BMC Psychiatry. 2013;13:229. Scholar
  2. 2.
    Amador XF, Flaum M, Andreasen NC, Strauss DH, Yale SA, Clark SC, et al. Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry. 1994;51:826–36. Scholar
  3. 3.
    Medalia A, Thysen J. A comparison of insight into clinical symptoms versus insight into neuro-cognitive symptoms in schizophrenia. Schizophr Res. 2010;118:134–9. Scholar
  4. 4.
    David AS. Insight and psychosis. Br J Psychiatry. 1990;156:798–808. Scholar
  5. 5.
    Amador XF, David AS. Insight and psychosis: awareness of illness in schizophrenia and related disorders. 2nd ed. New York: Oxford University Press; 2004.CrossRefGoogle Scholar
  6. 6.
    Schwartz RC. The relationship between insight, illness and treatment outcome in schizophrenia. Psychiatry Q. 1998;69:1–22. Scholar
  7. 7.
    Schwartz RC, Cohen BN, Grubaugh A. Does insight affect long-term inpatient treatment outcome in chronic schizophrenia? Compr Psychiatry. 1997;38:283–8. Scholar
  8. 8.
    Boyer L, Aghababian V, Richieri R, Loundou A, Padovani R, Simeoni MC, et al. Insight into illness, neurocognition and quality of life in schizophrenia. Prog Neuro-Psychopharmacol Biol Psychiatry. 2012;36:271–6. Scholar
  9. 9.
    Buckley PF, Wirshing DA, Bhushan P, Pierre JM, Resnick SA, Wirshing WC. Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs. 2007;21:129–41. Scholar
  10. 10.
    Dassa D, Boyer L, Benoit M, Bourcet S, Raymondet P, Bottai T. Factors associated with medication non-adherence in patients suffering from schizophrenia: a cross-sectional study in a universal coverage health-care system. Aust N Z J Psychiatry. 2010;44:921–8. Scholar
  11. 11.
    Boyer L, Millier A, Perthame E, Aballea S, Auquier P, Toumi M. Quality of life is predictive of relapse in schizophrenia. BMC Psychiatry. 2013;13.
  12. 12.
    Drake RJ, Dunn G, Tarrier N, Bentall RP, Haddock G, Lewis SW. Insight as a predictor of the outcome of first-episode nonaffective psychosis in a prospective cohort study in England. J Clin Psychiatry. 2007;68:81–6. Scholar
  13. 13.
    Krupchanka D, Katliar M. The role of insight in moderating the association between depressive symptoms in people with schizophrenia and stigma among their nearest relatives: a pilot study. Schizophr Bull. 2016;42:600–7. Scholar
  14. 14.
    Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, et al. Suicide risk in schizophrenia: learning from the past to change the future. Ann General Psychiatry. 2007;6.
  15. 15.
    Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM. Assessment of insight in psychosis. Am J Psychiatry. 1993;150:873–9. Scholar
  16. 16.
    Pini S, Cassano GB, Dell’Osso L, Amador XF. Insight into illness in schizophrenia, schizoaffective disorder, and mood disorders with psychotic features. Am J Psychiatry. 2001;158:122–5. Scholar
  17. 17.
    Weiler MA, Fleisher MH, McArthur-Campbell D. Insight and symptom change in schizophrenia and other disorders. Schizophr Res. 2000;45:29–36. Scholar
  18. 18.
    Makara-Studzinska M, Wolyniak M, Partyka I. The quality of life in patients with schizophrenia in community mental health service – selected factors. J Pre-Clin Clin Res. 2011;5:31–4.Google Scholar
  19. 19.
    Kako Y, Ito K, Hashimoto N, Toyoshima K, Shimizu Y, Mitsui N, et al. The relationship between insight and subjective experience in schizophrenia. Neuropsychiatr Dis Treat. 2014;10:1415–22. Scholar
  20. 20.
    Margariti M, Ploumpidis D, Economou M, Christodoulou GN, Papadimitriou GN. Quality of life in schizophrenia spectrum disorders: associations with insight and psychopathology. Psychiatry Res. 2015;225:695–701. Scholar
  21. 21.
    Domínguez-Martínez T, Kwapil TR, Barrantes-Vidal N. Subjective quality of life in at-risk mental state for psychosis patients: relationship with symptom severity and functional impairment. Early Interv Psychiatry. 2015;9:292–9. Scholar
  22. 22.
    Aghababian V, Auquier P, Baumstarck-Barrau K, Lançon C. Influence des troubles de la conscience sur l’auto-évaluation de la qualité de vie des patients souffrant de schizophrénie. = Relationship between insight and self-reported quality of life among schizophrenic patients. L’Encéphale Rev Psychiatr Clin Biol thérapeutique. 2011;37:162–71. Scholar
  23. 23.
    Fazel S, Khosla V, Doll H, Geddes J. The prevalence of mental disorders among the homeless in Western countries: systematic review and meta-regression analysis. PLoS Med. 2008;5:e225.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Folsom DP, Hawthorne W, Lindamer L, Gilmer T, Bailey A, Golshan S, et al. Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. Am J Psychiatry. 2005;162:370–6. Scholar
  25. 25.
    Palepu A, Patterson M, Strehlau V, Moniruzzamen A, de Bibiana JT, Frankish J, et al. Daily substance use and mental health symptoms among a cohort of homeless adults in Vancouver, British Columbia. J Urban Health. 2013;90:740–6. Scholar
  26. 26.
    National Alliance on Mental Illness Jailing People with Mental Illness | NAMI: National Alliance on Mental Illness. Accessed 26 Nov 2017.
  27. 27.
    Busner J, Targum SD. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry. 2007;4:28–35.PubMedGoogle Scholar
  28. 28.
    Addington D, Addington J, Atkinson M. A psychometric comparison of the Calgary depression scale for schizophrenia and the Hamilton depression rating scale. Schizophr Res. 1996;19:205–12. Scholar
  29. 29.
    Group W. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28:551–8.CrossRefGoogle Scholar
  30. 30.
    Treatment Advocacy Center. How Many People with Serious Mental Illness Are Homeless? - Treatment Advocacy Center. 2014. Accessed 18 Dec 2017.
  31. 31.
    Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173–82.CrossRefPubMedGoogle Scholar
  32. 32.
    Varga M, Magnusson A, Flekkøy K, David AS, Opjordsmoen S. Clinical and neuropsychological correlates of insight in schizophrenia and bipolar I disorder: does diagnosis matter? Compr Psychiatry. 2007;48:583–91. Scholar
  33. 33.
    Schrank B, Amering M, Hay AG, Weber M, Sibitz I. Insight, positive and negative symptoms, hope, depression and self-stigma: a comprehensive model of mutual influences in schizophrenia spectrum disorders. Epidemiol Psychiatr Sci. 2014;23:271–9. Scholar
  34. 34.
    Melle I, Barrett EA. Insight and suicidal behavior in first-episode schizophrenia. Expert Rev Neurother. 2012;12:353–9. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University of Nevada, Las VegasLas VegasUSA
  2. 2.MartinezUSA
  3. 3.Spectrum HealthGrand RapidsUSA

Personalised recommendations