Assessing insight in schizophrenia: East meets West.
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.
Saravanan
Balasubramanian
B
Section of Cognitive Neuropsychiatry, PO Box 68, Institute of Psychiatry, King's College London, Denmark Hill, London SE5 8AF, UK.
Jacob
K S
KS
Johnson
Shanthi
S
Prince
Martin
M
Bhugra
Dinesh
D
David
Anthony S
AS
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