Assessing insight in schizophrenia: East meets West

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Abstract

Background

Lack of insight has been observed in people with schizophrenia across cultures but assessment of insight must take into account prevailing illness models.

Aims

To determine whether culturally specific and Western biomedical interpretations of insight and psychosis can be reconciled.

Method

Patients with schizophrenia (n=131) were assessed during their first contact with psychiatric services in Vellore, South India. Patients' explanatory models, psychopathology and insight were investigated using a standard schedule translated into Tamil.

Results

Supernatural explanations of symptoms were frequent. Some insight dimensions were weakly associated (inversely) with severity of symptoms whereas preserved insight was associated with anxiety, help-seeking and perception of change. Willingness to attribute symptoms to disease, in others and in one's self, but not to supernatural forces was strongly associated with insight.

Conclusions

The relationship between insight, awareness of illness and other clinical variables is similar in South India to elsewhere. However, the assessment of insight might have failed to capture locally accepted explanatory frameworks. An inclusive conceptual model which emphasises help-seeking is recommended.

Declaration of interest

None. Funding detailed in Acknowledgements.

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