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Tijdschrift voor Psychiatrie 52 (2010) 12, 825 - 835


Awareness of illness in patients with schizophrenia: theoretical insights and a proposal for treatment

G.A.M. Pijnenborg, A. Aleman


background The percentage of persons with schizophrenia who have only a limited insight into their illness is rather large (50–80%); this has a negative impact on specific outcomes. Up till now there has not been a universal model that can explain this limited insight. Furthermore, there is a lack of treatment options and interventions likely to improve patients’ insight into their illness.
aim To provide an overview of the literature on insight of patients into their illness and suggest a model for treatment.
method In this essay we review the literature dealing with the insight of patients with schizophrenia and thereafter we discuss the correlates of insight (illness variables as well as outcomes), theoretical models of insight and current treatment of options.
results On the basis of the literature we propose a new theoretical model which incorporates factors from earlier models and which aims to improve patients’ insight into their illness. Using the preconditions for insight specified in our models (namely, sensitivity to stigma, seeing the illness in perspective, mental flexibility and self-reflection) we have developed a new treatment (reflex) for improving the insight of persons with schizophrenia.
conclusions The treatment will be evaluated in the course of the next two years at eight centres in the Netherlands providing treatment for persons with schizophrenia; the evaluation should tell us whether the proposed treatment is effective in increasing patient’s insight into their

keywords insight into illness, schizophrenia, stigma, treatment