title: The nature and evolution of insight in schizophrenia: a multi-informant longitudinal study of first-episode versus chronic patients.
abstract: OBJECTIVE
  This study investigated a novel distinction between two possible sources of poor insight in schizophrenia: primary unawareness, in which the ill person is not aware that other people think one has a problem, and secondary unawareness (or disagreement), in which a person does appreciate that other people think one has a problem. A secondary goal was to compare the evolution of insight in first-episode and chronic schizophrenia.
  
  
  METHODS
  Sixty-eight first-episode and 51 chronic patients were administered two versions of the Scale of Unawareness of Mental Disorder (SUMD) at three time points: hospital admission, discharge, and 6-month post-discharge. In the first standard SUMD version, they were asked about their own opinions, whereas in the second modified version, they were asked about their best guess of their doctor's opinion.
  
  
  RESULTS
  While overall level of unawareness remained stable within each single episode, there were significant Type of Unawareness (primary versus secondary) by Clinical Status (admission versus discharge versus 6-month post-discharge) and Type of Unawareness by Phase of Illness (first-episode versus chronic) interaction effects. More specifically, in the first-episode group, primary unawareness steadily decreased over time. In contrast, in the chronic group, primary unawareness decreased markedly during hospitalization and returned to baseline after discharge.
  
  
  CONCLUSIONS
  These results provide preliminary support for the notion that impaired insight is an additive outcome of primary unawareness and disagreement, and that change in insight over time occurs mostly at the level of their relative proportion as opposed to their overall sum. Implications for studying and treating poor insight in schizophrenia are discussed.
authors.affiliation: Psychology Department, University of Haifa, Haifa, Israel; Psychiatry Division, Rambam Medical Center, Haifa, Israel; The Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address: dkoren@psy.haifa.ac.il.
authors.forename: Danny
authors.initials: D
authors.lastname: Koren
authors.forename: Polina
authors.initials: P
authors.lastname: Viksman
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Giuliano
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Seidman
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001364:Awareness; D002908:Chronic Disease; D005260:Female; D006760:Hospitalization; D006801:Humans; D007361:Intelligence Tests; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy; D012565:Schizophrenic Psychology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: First-episode; Insight; Schizophrenia; Unawareness