Insight in Psychiatry

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Dedication......Page 9
Preface......Page 11
Part I Historical and clinical......Page 17
1 Historical overview......Page 19
1.1 Historical contexts......Page 20
1.1.1 General contexts......Page 21
1.1.2 Insanity and the conceptualisation of madness......Page 23
1.2 History of the word......Page 28
1.3.1 French views......Page 29
1.3.2 British views......Page 39
1.3.3 German views......Page 43
1.4 Conclusion......Page 48
2 The psychological perspective: Gestalt, cognitive and psychoanalytic......Page 50
2.1 The concept of insight in Gestalt psychology and cognitive psychology......Page 52
2.1.1 The meaning of insight......Page 56
2.1.2 Determination of insight......Page 60
2.1.3 Stages and mechanisms underlying insight......Page 61
2.1.4 Summary......Page 63
2.2 Insight in psychoanalytic psychology......Page 64
2.2.1 The concept of insight......Page 65
2.2.2 The role of insight in psychoanalytic therapy......Page 72
2.2.3 Summary......Page 78
2.3 Conclusion......Page 80
3.1 Definitions of insight and methods of assessment......Page 82
3.1.1 Categorical approaches to exploring insight......Page 83
3.1.2 Continuous approaches to exploring insight......Page 85
3.1.3.1 Definitions......Page 91
3.1.3.2 Assessments......Page 92
3.2 Relationship between insight and clinical and socio-demographic variables......Page 93
3.2.1 Insight and socio-demographic variables......Page 94
3.2.2 Insight and past psychiatric illness......Page 100
3.2.3 Insight and prognosis......Page 103
3.2.4 Insight and severity of psychopathology......Page 106
3.2.5 Insight and cognitive function......Page 119
3.2.7 Insight and brain structure......Page 126
3.2.8 Insight in relation to psychosocial functioning and quality of life......Page 127
3.2.9 Insight and psychiatric diagnosis......Page 131
3.2.10 Insight and depression......Page 136
3.2.11 Insight and compliance with treatment......Page 138
3.2.12 Insight and other clinical variables......Page 140
3.3 Conclusion......Page 142
4.1 Introduction......Page 144
4.2 Insight into neurological states......Page 145
4.2.1 Assessments of impaired insight/anosognosia in neurological states......Page 149
4.2.2.1 Neuroanatomical and neuropsychological theories......Page 152
4.2.2.2 Motivational theories......Page 156
4.2.3 Empirical studies of impaired insight in relation to neurological states......Page 158
4.3 Impaired awareness of function in neurological states......Page 160
4.4 Conclusion......Page 165
5.1 The meaning of insight in relation to dementia......Page 167
5.1.1 Terms and concepts......Page 168
5.1.2 Relational aspects of insight......Page 171
5.1.3 Methods of insight assessment in dementia......Page 173
5.1.3.1 Clinician-rated assessments......Page 174
5.1.3.2 Discrepancy measures......Page 175
5.2 Relationship between insight, clinical and socio-demographic variables......Page 180
5.2.1 Insight and socio-demographic variables......Page 181
5.2.2 Insight in different types of dementia......Page 182
5.2.3 Insight in relation to severity, stage and progression of dementia......Page 183
5.2.4 Insight in relation to specific brain dysfunction......Page 201
5.2.5 Insight in relation to psychiatric/behavioural syndromes......Page 202
5.2.6 Insight in relation to other variables......Page 206
5.3 Impaired insight/awareness into function in dementia......Page 207
5.4 Conclusion......Page 209
Part II Conceptual......Page 211
6 The conceptualisation of insight......Page 213
6.1.1 The meaning of insight: problems of content......Page 214
6.1.2 The meaning of insight: problems concerning its nature......Page 218
6.1.2.1 Insight as a symptom?......Page 219
6.1.2.2 Insight as a mental state?......Page 223
6.1.2.3 Insight as a dynamic mental state?......Page 226
6.2 The phenomenon of insight: problem of interpretation......Page 227
6.2.1 Interpretation in translation from concept to phenomenon......Page 228
6.2.2 Interpretation in clinician’s judgement......Page 229
6.2.4 Interpretation in comparative judgements......Page 230
6.2.5 Phenomenon of insight: general implications......Page 232
6.3 Conclusion......Page 233
7 The relational aspects of insight: the ‘object’ of insight assessment......Page 235
7.1 Significance of the relational aspects of insight......Page 236
7.2.1 ‘Object’ and ‘domain’......Page 239
7.2.2 ‘Object’ and phenomenon of insight......Page 240
7.2.3 Patients’ and clinicians’ ‘object’ of insight assessment......Page 241
7.3.1 ‘Object’ as determined by discipline......Page 242
7.3.1.1 General psychiatry......Page 243
7.3.1.2 Psychoanalytic psychology......Page 245
7.3.1.3 Neurosciences......Page 246
7.3.1.5 Dementia......Page 247
7.3.2 ‘Object’ as a semantic category......Page 248
7.3.3 ‘Object’ as a specific kind......Page 251
7.3.3.1 Subjective–objective dichotomy......Page 253
7.3.3.2 Negative–positive dichotomy......Page 254
7.3.3.3 Insight–insightlessness dichotomy......Page 255
7.4 Conclusion......Page 257
8 Towards a structure of insight: awareness and insight, an essential distinction?......Page 259
8.1 Theoretical grounds for distinguishing between awareness and insight......Page 260
8.1.1 Nature of the boundary between awareness and insight......Page 264
8.1.2.1 Phenomenon of awareness......Page 266
8.1.2.2 Phenomenon of insight......Page 267
8.1.2.3 Distinctions between awareness and insight......Page 269
8.2 Empirical justification for distinguishing between awareness and insight......Page 272
8.2.1 Methods and subjects......Page 273
8.2.2.1 Sociodemographic and clinical comparisons......Page 274
Total insight scores......Page 275
Grouped insight scores......Page 278
8.2.3 Discussion of results......Page 279
8.3 Conclusion......Page 284
9.1 The structure of insight......Page 287
9.1.1 Insight phenomena determined by ‘subjective mental states’......Page 294
9.1.2 Insight phenomena determined by ‘loss/impairment of function’ (‘objective’ dysfunction)......Page 297
9.1.3 Insight phenomena determined by ‘diagnostic constructs’......Page 299
9.2.1 Awareness and insight: clinical and research implications......Page 303
9.2.2 Determinants of the phenomenon of insight: clinical and research implications......Page 306
9.3 Conclusion......Page 307
References......Page 309
Index......Page 343