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The structure of insight in patients with psychosis.

Description: Failure to acknowledge their mental illness occurs in approximately half of all psychotic patients. Interest has been recently been refocused on insight (i.e., awareness of mental illness), and its associations with treatment compliance and better prognosis. Researchers have called into question the traditional factor structure of insight, instead viewing and defining it as a multidimensional and continuous construct. While factor analytic research has suggested that insight is an independent feature of psychotic disorders rather than a secondary manifestation of psychotic symptoms, several factor analytic studies have identified only one higher-order factor. Furthermore, a significant amount of the research literature has assessed insight or analyzed its relationships using only a single insight score. The current study evaluated the structural model of insight and assessed the associations between the different proposed dimensions of insight and psychotic symptoms. One hundred and six participants recruited from both inpatient and outpatient settings with a diagnosis of schizophrenia, schizoaffective disorder, psychotic disorder NOS, or bipolar disorder with psychotic features were rated on David's Schedule for Assessing Insight-Expanded Version (SAI-E), Birchwood's Insight Scale (IS), and the Brief Psychiatric Rating Scale (BPRS) or the Positive and Negative Syndrome Scale (PANSS). Structural equation modeling (SEM) was utilized to provide stringent, confirmatory statistical tests of the hypothetical factor models while accounting for measurement error. Principal findings from the current study were that the three factor model of insight was supported and that the insight factors were meaningfully correlated to the two symptom factors. Moreover, the three factor insight model provided significantly better fit than a single factor model of insight.
Date: December 2004
Creator: Gonterman, Andrea R.