Insight and Explanatory Models During Illness and Remission in Patients with Schizophrenia.

Introduction: Schizophrenia is a chronic, pervasive, disabling, illness that affects a significant Proportion of the world population. It is a leading public health problem that exacts Enormous personal and economic cost worldwide (1). Schizophrenia is a devastating Mental illness that impairs mental and social functioning and often leads to the Development of co-morbid diseases. These changes disrupt the lives of patients as well as Of their families and friends. Schizophrenia is found in all societies and geographical Areas (2). One of the most common and puzzling features of schizophrenia is lack of awareness Of mental disorder. The condition has prognostic and diagnostic implications, and Even though the phenomenon has not been formally introduced as a diagnostic criterion, Future research may yield evidence supporting this phenomenon as a diagnostic symptom Related to treatment outcome(3). As DSM-IV states, "Lack of insight is common and may Be one of the best predictors of poor outcome, perhaps because it predisposes the Individual to noncompliance with treatment"(4). Insight is a complex multidimensional Construct which is shaped by individual psychology (i.e. Motivation and denial) and the Constraints of biology (as in cognitive impairment and anosognosia) , and is influenced By social constructions of illness and culturally specific explanatory models(5). The clinical significance of poor insight is well established in terms of treatment Adherence, symptom severity, and poorer global functioning . The relationship between Insight and outcome is not unidirectional; however better insight has also been Associated with more severe depressive symptoms and increased suicide rates(6). Standardised tools for the assessment and quantification of insight have been Developed over the past 15 years (e.g. The Schedule for the Assessment of Insight (SAI; David, 1990; Sanz et al al, 1998) and the Scale to Assess Unawareness of Mental Disorder (SUMD;Amador et al al, 1993) which have been found to have clinical utility For diverse populations and patient groups worldwide(7) . Studies have reported a Consistent inverse relationship between psychopathology and insight, with the exception Of anxiety and low mood,which are positively associated with insight(8). The influence of Treatment on the level of insight has been studied by workers who report that insight Improved significantly during the course of in-patient treatment However there are no Studies that have looked at insight in the same individual before and after treatment. Beliefs about illness, distress and disability profoundly influence individuals’ Experience of, and responses to such problems. Eliciting explanatory models (ems) (of Patients and their relatives) in routine clinical psychiatric practice gives a better Understanding of the subjective experience of illness(9). Such perspectives also reveal Attitudes towards and compliance with treatment, and so promote therapeutic adherence And improve clinical outcomes. Though the last few years has witnessed an increase in Literature regarding beliefs about causes of schizophrenia there is a paucity of studies Evaluating change in ems in individuals while unwell and after resolution of illness. This study seeks to assess the ems and insight in patients with schizophrenia while psychotic As well as following remission of illness and study the associated factors.