title: The dynamics of insight in the prodrome of schizophrenia.
abstract: BACKGROUND
  Schizophrenia is characterized by diminished insight, which fluctuates with disease progression. Insight deterioration in the prodrome of schizophrenia is poorly understood. Despite pharmacologic treatment, including early interventions, there is a high risk of relapse and need of acute care in schizophrenia patients.
  
  
  OBJECTIVE
  To study if insight deterioration occurs during the prodrome and if insight preservation early in the illness might predict a better prognosis.
  
  
  METHODS
  Data was collected retrospectively from the records of 24 patients initially diagnosed with schizophrenia during a 2-year period. Patients' progress was then tracked over a 3-year period. Insight was determined by a physician's subjective evaluation, patient interest and participation in treatment planning, and patient accuracy in reporting behaviors and symptoms when compared with reports from collaterals.
  
  
  RESULTS
  Ten patients were determined to have insight regarding the developing illness at different presentations at the hospital. Insight preservation correlated with less need for emergency visits and fewer hospitalization days (P<.005). It was also associated with more depressive and anxious mood (P<.000). Patients and family members described early, ego-dystonic perceptual disturbances followed by diminished insight. Awareness into the illness, symptoms, and attribution of symptoms to the illness fluctuated at different presentations in the insight group. In the other group, insight was nil at each presentation after the psychotic debut.
  
  
  CONCLUSIONS
  Most patients maintain insight during the perceptual disturbance phase. Insight diminishes as the early delusional phase sets in. Higher levels of preserved insight seem to correlate with less need for acute treatment. Further research in this area is warranted for determining if early insight oriented interventions in the prodromal phase can improve the prognosis of schizophrenia.
authors.affiliation: Department of Psychiatry, University of Missouri-Kansas City, Kansas City, MO 64108, USA. botar@umkc.edu
authors.forename: Robert G
authors.initials: RG
authors.lastname: Bota
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Munro
authors.forename: Walter F
authors.initials: WF
authors.lastname: Ricci
authors.forename: Daniela A
authors.initials: DA
authors.lastname: Bota
mesh_terms: D000328:Adult; D003710:Demography; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D012559:Schizophrenia / Q000175:diagnosis / Q000534:rehabilitation; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D013997:Time Factors