Insight in psychosis: a systematic review - the constructs of insight in psychosis and their measurement & An exploration of current practices in the assessment and intervention of insight in psychosis within Scotland’s Forensic Mental Health Services: clinical psychologists’ perspective
View/ Open
Date
27/11/2015Author
Slack, Tom Gavin Hume
Metadata
Abstract
Poor insight has clinical significance as a predictor of non-adherence to treatment, increased
number of relapses, hospitalisations, recovery and risk of violence. Empirical research has led
to advances in the redefinition, knowledge and understanding of insight in psychosis.
However, the use of a wide range of definitions and measures has created difficulties in
interpreting research findings, without clarifying the concepts being measured and evaluating
the quality of their associated assessment tool. Therefore, the aim of the first piece of work, a
Systematic Review (SR), was to identify and describe the constructs of insight in psychosis
and their assessment tools and briefly evaluate their psychometric properties. Insight in
psychosis is particularly relevant to Forensic Mental Health Services, given its link with
offending behaviour and risk to others. However, outside of those provided by risk appraisal
tools, there are no current guidelines that specifically target the assessment, or intervention,
of insight. Therefore, the second piece of work, a research project (RP), aimed to explore
current practices, as described by experienced clinicians.
The SR identified twelve assessment tools and fourteen papers for detailed analysis. Twelve
theoretical constructs were identified, the most prominent being awareness of mental illness
and awareness of the need for treatment. Other prominent theoretical constructs included
awareness of negative consequences of illness and awareness of generic or specific
symptoms. However, few of the subscales associated with each theoretical construct were
supported by empirical evidence. Further work to clarify aspects of insight that are important
areas for intervention, along with the provision of data to support these, should continue to be
a focus for on-going research.
The RP was a qualitative design using Thematic Analysis. Data was collected by semi-structured
interviews from 11 qualified Clinical Psychologists working in Forensic Mental
Health Services across Scotland. The RP identified three overarching themes. The first “risk
related” illustrated the influence of risk to other when assessing and treating patients. The
second “holistic approach” illustrated that insight or mental illness was rarely looked at in
isolation. The third theme “no specific or satisfactory unified approach” illustrated the
diversity of the conceptualising, assessment and treatment of insight. Opportunities exist to
develop a more uniformed approach and to introduce or develop outcome measures for
interventions.