title: Assessing insight in schizophrenia: East meets West.
abstract: BACKGROUND
  Lack of insight has been observed in people with schizophrenia across cultures but assessment of insight must take into account prevailing illness models.
  
  
  OBJECTIVE
  To determine whether culturally specific and Western biomedical interpretations of insight and psychosis can be reconciled.
  
  
  METHODS
  Patients with schizophrenia (n=131) were assessed during their first contact with psychiatric services in Vellore, South India. Patients' explanatory models, psychopathology and insight were investigated using a standard schedule translated into Tamil.
  
  
  RESULTS
  Supernatural explanations of symptoms were frequent. Some insight dimensions were weakly associated (inversely) with severity of symptoms whereas preserved insight was associated with anxiety, help-seeking and perception of change. Willingness to attribute symptoms to disease, in others and in one's self, but not to supernatural forces was strongly associated with insight.
  
  
  CONCLUSIONS
  The relationship between insight, awareness of illness and other clinical variables is similar in South India to elsewhere. However, the assessment of insight might have failed to capture locally accepted explanatory frameworks. An inclusive conceptual model which emphasises help-seeking is recommended.
authors.affiliation: Section of Cognitive Neuropsychiatry, PO Box 68, Institute of Psychiatry, King's College London, Denmark Hill, London SE5 8AF, UK.
authors.forename: Balasubramanian
authors.initials: B
authors.lastname: Saravanan
authors.forename: K S
authors.initials: KS
authors.lastname: Jacob
authors.forename: Shanthi
authors.initials: S
authors.lastname: Johnson
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.forename: Dinesh
authors.initials: D
authors.lastname: Bhugra
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
mesh_terms: D000328:Adult; D001364:Awareness; D032882:Comprehension; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D008273:Magic / Q000523:psychology; D008297:Male; D012559:Schizophrenia / Q000208:ethnology*; D012565:Schizophrenic Psychology