Insight is defined as the awareness of having a mental disorder. This includes having an understanding of the social consequences associated with the disorder; the need for treatment; effects of medication; awareness of the implications; and awareness of the signs and symptoms of the disorder. Insight increases adherence to treatment as patients who lack insight may not believe they need for medication.

What is the evidence on insight in people with bipolar disorder?

Moderate to high quality evidence finds people in an acute mania phase with psychotic features who had poor or no insight prior to antipsychotic treatment showed greater improvements in symptoms with treatment than those in an acute mania phase with psychotic features who had excellent insight prior to antipsychotic administration. Review authors say this finding was unexpected, and suggest the level of insight in an acute mania episode is an important determinant of short-term treatment response.

October 2021

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Insight with regards to schizophrenia is defined as the awareness of having the disorder, including an understanding of the social consequences associated with the disorder; the need for treatment; effects of medication; awareness of the implications; and awareness of the signs and symptoms of the disorder. Clinical insight involves the awareness of the disorder and symptoms, while cognitive insight relates to the ability to question and consider one’s beliefs and judgements.

What is the evidence for insight?

Moderate quality evidence found more severe symptoms are related to lower levels of insight into the disorder and its consequences. Conversely, increased depression symptoms were related to increased levels of insight, and there was a small association between better insight and poorer quality of life.

Moderate to high quality evidence found small associations between better insight and higher IQ and better memory functioning. Moderate quality evidence found small associations between better insight and less aggression, better work and social functioning, increased treatment adherence, and fewer re-hospitalisations.

High quality evidence found a medium-size effect of more self-certainty in people at risk of psychosis compared to controls. Moderate quality evidence found no differences in self-reflectiveness or overall cognitive insight.

Moderate quality evidence found any treatment improves insight, particularly in combination with other treatments that target insight specifically.

February 2022

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