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The American Journal of Psychiatry

1993 (150):873-879

The Assessment of Insight in Psychosis
Amador XF; Strauss DH; Yale SA; Gorman JM and Endicott J.

RELEVANCE FOR EARLY INTERVENTION

This paper reports on a reliability and validity study of a new scale for assessing various aspects of insight into illness.

Five years after the publication of this article, the Scale to assess Unawareness of Mental Disorder (SUMD) has become the most widely used instrument for assessing insight into illness in psychiatric research. It has since been translated into fifteen languages by psychiatric researchers world-wide reflecting a new consensus that the scientific study of insight is possible. The study reported in this paper found that patients with schizophrenia and schizoaffective disorder had pervasive problems with awareness of being ill and that particular aspects of poor insight were strongly correlated with non-adherence to treatment while other aspects of unawareness were not. Similarly, a poorer course of illness and the number of previous hospitalizations were also correlated with various aspects of poor insight.

On the other hand, level of education and level of positive and negative symptoms of the illness were unrelated to insight suggesting that deficits in illness awareness are not a consequence of educational background or simply the byproduct of other symptoms of psychosis. The authors conclude that insight has multiple dimensions than can, and should, be measured reliably. And that deficits in insight are a separate and independent sign of the illness that affects adherence with treatment and the overall course of schizophrenia.

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