Documente Academic
Documente Profesional
Documente Cultură
Dr Ashish Debsikdar
Resident-
The Beginning
-Work on Insight was pioneered by Aubrey Lewis
(1934).
Insight
By Amador and David 1998
2.
5.
Avoidance of stigma
6. Personality- Compliance non conformity as a trait.
It is therefore recommended
that drug compliance and
awareness of illness be regarded
as separate though overlapping
constructs which contribute to
insight.
INSIGHT
self
JUDGMENT
esteem
1. Appraisal of major
2. Understanding of
social relationships
the current
circumstances
2. Understanding of
3. Ability to describe
personal,
psychological and
physical status.
ETIOLOGY OF INSIGHT
The Psychological Defense Model:-Practically the only existing school of thought about
insight prior to 1990.
-Given the high frequency of poor insight seen in firstepisode schizophrenia patients (Keshavan 2004),
progressive degeneration does not seem to be a likely
causal factor of poor insight.
Components of refractoriness in
psychosis:1. Impairment of objectivity about the cognitive
distortions.
4. Overconfidence in conclusions.
Some studies/articles
and their salient points.
after they met the eligibility criteria. 2 groups:ROP- (Recent onset psychosis)- 1 psychotic episode
Insight (G12)
2. Birchwood Insight Scale (BIS):-
- Short Questionnaire
-.- 8 questions addressing the 3 components of insight
-Worse outcomes,
-More admissions
-Worse Psycho-social functioning,
-Reduced success rates in outpatient treatment of relapses,
-Longer intervals between onset of symptoms and seeking
treatment.
Standardized
insight rating
scales
SUMD
Each of these is rated on a 4 point rating scale
0- not applicable
1-aware
2-somewhat aware
3- severly unaware
MANAGEMENT
Cognitive Behavior Therapy:CBT is one specific form of psychosocial treatment that has
recently shown some promising results.
Goldapple et al. (2004) showed that CBT can alter
metabolic brain functions in subjects with major depression.
These findings indicate not only that CBT has specific
functional effects on the brain, but also that a clinically
successful outcome may be achieved through several
distinct methods.
This is promising for the treatment of insight in
schizophrenia patients, not only because insight is a multifaceted deficit, but also because individuals with unique
case histories, lifestyles, and socio-economic standings
may require different treatment interventions for a positive
outcome.
Pseudo-insight
-Jaspers stated that listening to a patients utterances
out of context can lead to mistaken judgments about
the presence of insight.
overheard explanations.
-As mentioned, Insight requires the acceptance of a
Erik
Erikson
CASE VIGNETTES
Case Vignette 1
Mr. A, a 20-year-old college student, was involuntarily
admitted to the psychiatric inpatient unit in a florid
manic state, with rapid speech, flight of ideas, and
sleeplessness.
Before admission, he had been clocked driving at 100
mph. The intercepting police, noting his abnormal
mental status, brought A to the emergency
department.
Mood stabilizer and antipsychotic medication settled
him over a week, but he still persisted in believing the
police must have been drunk themselves, since
they assessed him as needing psychiatric help.
Im not bipolar. Everybody has mood swings! he
insisted. He added, I will take the medications while I
Case Vignette 2
Ms J, a 27-year-old with schizophrenia, stopped taking her
prescribed antipsychotic consistently. Within 2 months, her
psychotic symptoms returned with full force, and she required
hospitalization.
She told the admitting psychiatrist that the woman who brought
her to the emergency department was not her real mother, but
rather an actress playing her mother. This misperception had
likely played a role in threats she had made toward her mother
on the day of admission.
Questioned by the psychiatrist as to the plausibility of someone
resembling her mother so precisely, she responded, I dont
know how they did it, but somehow they were able to find
someone!
A week after restarting her medication, Janice allowed that her
imagination had been playing tricks on her and happily
embraced her real mother.
THANK
YOU