Widening the concept of insight in the treatment of schizophrenic disorder

Ampliamento del concetto di insight nella terapia del disturbo schizofrenico

S. Vender, C. Fraticelli, M. Moalli, N. Poloni

Dipartimento di Medicina Clinica- Psichiatria, Università dell'Insubria Varese, Como


In the difficult and complex task to describe and thoroughly define the concept of “insight” within the framework of schizophrenia, definitions and interpretations stemming from this concept are being analyzed: the term “insight” was introduced in psychiatric terminology to describe the degree of awareness of one’s illness, correlated with the compliance to a treatment, and, therefore, to better quality of life for the patient. Even though data confirming the important role of insight in leading to a better course and outcome of the illness is substantial, data from literature showing a high correlation between insight and development of post-psychotic depression as well as insight and risk of suicide in schizophrenia need to be taken into consideration.

Moreover, the fact that a moderate psychological well-being may be reached also by patients with low insight cannot be excluded. The authors, when studying the different illness courses linked with insight while trying to keep a clinical and therapeutic perspective, consider the possibility to broaden the scope of complexity of the condition by introducing a “bi-personal insight” of the patient and the therapist, as well as a “family insight”.
The main goal of the treatment, in this case, becomes the development of a new therapeutic relation, more functional in easing the discomfort of the person, at the meeting point of the patient’s insight vis-à-vis his/her illness, the therapist’s insight connected to the objectives of the treatment and the family’s insight vis-à-vis the patient’s condition.

The authors, in order to show how a broader perspective of the insight phenomenon may lead to a real improvement of the prognosis, describe a part of clinical history, thus showing how the topic of insight in psychosis is both concrete and important in contemporary research.

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