PSYCHOSIS - INSIGHT AND COMPLIANCE

In the introduction, the importance of insight as a key factor in dete rmining treatment adherence and thus outcome is emphasized. Next, we b riefly review how the concept has been defined and the recently develo ped instruments to assess insight. Advances in the differentiation of insight deficits in schizophrenia from those in other disorders are de scribed. We review the data which suggest that neurocognitive deficits may be associated with poor insight in schizophrenia. The relationshi p of insight to psychotic symptoms is briefly addressed, with a descri ption of one of the first attempts to study the factors associated wit h acting on delusions. This work suggests that delusional action may b e related to the patients' attempts to test reality. Recent findings o f associations with gender and ethnicity variables are mentioned. Stud ies examining medication-refusal and factors associated with noncompli ance are reviewed, and poor insight and noncompliance are linked to fr equent rehospitalizations and worse outcome. Finally, new biobehaviour al approaches are discussed along with the development of strategies t o combat problems in treatment collaboration and to improve adaptation .