title: The effects of aging on insight into illness in schizophrenia: a review.
abstract: OBJECTIVE
  Impaired insight into illness is a prevalent feature of schizophrenia, which negatively influences treatment adherence and clinical outcomes. Little is known about the effects of aging on insight impairment. We aimed to review the available research literature on the effects of aging on insight into illness in schizophrenia, in relation to positive, negative, and cognitive symptoms. Ultimately, we propose a trajectory of insight in schizophrenia across the lifespan.
  
  
  METHODS
  A systematic Medline® literature search was conducted, searching for English language studies describing the relationship of insight into illness in schizophrenia with aging.
  
  
  RESULTS
  We identified 62 studies. Insight impairment is associated with illness severity, premorbid intellectual function (i.e. IQ), executive function, and memory. Insight impairment improves modestly during midlife, worsening again in late life. It tends to fluctuate with each episode of psychosis, likely in relation to worsening positive symptoms that improve with antipsychotic treatment. The relationship between insight impairment and cognitive dysfunction appears to attenuate with age, while the relationship with lower premorbid intellectual function is preserved. The association between impaired insight and negative symptoms is unclear.
  
  
  CONCLUSIONS
  The available literature suggests that the course of insight impairment follows a U-shaped curve, where insight impairment is severe during the first episode of psychosis, modestly improves over midlife, and declines again in late life. Future studies are required to investigate the trajectory of insight into illness and its core domains across the lifespan from prodromal phase to late life.
authors: University of Toronto and the Centre for Addiction and Mental Health, Toronto, ON, Canada.
authors: Philip
authors: P
authors: Gerretsen
authors: Eric
authors: E
authors: Plitman
authors: Tarek K
authors: TK
authors: Rajji
authors: Ariel
authors: A
authors: Graff-Guerrero
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology*; D001364:Awareness; D003072:Cognition Disorders / Q000209:etiology*; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index
keywords: age; aging; denial; illness awareness; insight; schizophrenia