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Xavier F. Amador, PhD; Michael Flaum, MD; Nancy C. Andreasen, MD, PhD; David H. Strauss, MD; Scott A. Yale, MSW; Scott C. Clark, MD; Jack M. Gorman, MD

Arch Gen Psychiatry. 1994;51(10):826-836.

Abstract
Background
The literature on insight, or selfawareness, in schizophrenia suggests that this cognitive dimension may be of nosological value. Poor insight has descriptive validity at the phenomenological and neuropsychological levels of schizophrenia and has prognostic validity in terms of the prediction of the course of illness. The lack of empirical data on the diagnostic specificity of poor insight to schizophrenia and the previous use of insight measures with questionable reliability and validity have limited this interpretation.

Methods
In the present study, we assessed insight into multiple aspects of mental disorder using a measure with demonstrated reliability and validity. A sample of 412 Patients with psychotic and mood disorders coming from geographically diverse regions of the United States and one international site was studied. The main aims were to determine the prevalence of self-awareness deficits in patients in whom schizophrenia was diagnosed, to examine the relative severity of self-awareness deficits associated with schizophrenia compared with that of schizoaffective and mood disorders with and without psychosis, and to evaluate the clinical correlates of selfawareness in patients with schizophrenia.

Results
The results indicated that poor insight is a Prevalent feature of schizophrenia. A variety of selfawareness deficits are more severe and pervasive in Patients with schizophrenia than in patients with schizoaffective or major depressive disorders with or without psychosis and are associated with poorer Psychosocial functioning.

Conclusions
The results suggest that severe self-awareness deficits are a prevalent feature of schizophrenia, perhaps stemming from the neuropsychological dysfunction associated with the disorder, and are more common in schizophrenia than in other psychotic disorders.

Author Affiliations
From the Department of Clinical Psychobiology, Schizophrenia Research Unit, New York State Psychiatric Institute (Drs Amador, Strauss, Clark, and Gorman and Mr Yale), the Department of Psychiatry, College of Physicians and Surgeons, Columbia University (Drs Amador, Strauss, Clark, and Gorman and Mr Yale), and New York University Graduate School of Arts and Sciences (Dr Amador), New York, NY; and the Mental Health Clinical Research Center, the University of Iowa Hospitals and Clinics, and the Department of Psychiatry, the University of Iowa College of Medicine, Iowa City (Drs Flaum and Andreasen).

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