![]() ![]() Those who are aware of their condition and who understand that this condition is due to a mental illness, but who are incapable of taking an attitude in this regard. Those who are aware that their mental condition, their acts, and their ideas are the result of a mental illness, but they behave as if they would not do so (patients presenting hallucinations and delusions of persecution, being convinced by the reality of their symptoms, but who also consider themselves to be healthy). Those who are aware that they are in an abnormal state but do not understand or admit that this condition is a mental illness. Those who are aware of their acts and who can discern whether they are good or bad but are not aware of their morbid condition. Parant classified mentally ill patients, during an episode of illness, into five groups : Patients with complete awareness (they were aware of their pathological state and recognized the falseness of their abnormal experiences).īillod also observed that insight is a good prognostic factor of the evolution of the disease and for illness recurrence. Patients with incomplete awareness (they were aware of their pathological state but, nevertheless, believed in the reality of their delusions and strange experiences). Those who were aware of their pathological state. Those who were not aware of their pathological state (they were aware of hallucinations and strange experiences but attributed those wrongly). He divided the patients into two categories: A major debate concerning awareness of mental illness (“la discussion sur les aliénés avec conscience de leur état”) and the responsibility of patients for criminal acts was held by the Société Médico-Psychologique in 1869–1870, and then in 1875 Billod observed that the number of patients who were aware about their state of madness was lower than those without the disease awareness. Baillarger separated the patients into two categories (who were and who were not insane) using insight (the patients with hallucinations, who were convinced of the reality of their hallucinations, were truly mad on the other hand, the patients with hallucinations who realized that these hallucinations were caused by some derangement in themselves, should not be considered truly mad). In the French view, Pinel (1801) referred to the patient’s “judgment” and to his capacity to correctly assess his state (“apprécie avec justesse son état”). In the history of this concept, there were differences in the approach of the most important French, German, and English authors. In 1882, Pick used the term “Krankheitseinsicht”, and in 1893, Krafft-Ebing used the term “insightlessness” (“in the later stages of insanity, where delusions have become organized or mental disintegration has ensued, the patient is completely insightless-(einsichtloss) about his disease state”) (, translated by ). In medicine, the concept of insight into madness seems to have started in early part of the nineteenth century when the clinical descriptions began to include observations about patients’ awareness of their pathological state. In the management of bipolar disorder, improving quality of life (QoL) and outcome should be one the most important goals. ![]() ![]() Also, impaired insight into treatment and a great number of previous hospitalizations are associated with poorer clinical outcomes (psychiatric hospitalization, emergency room visits, violent or suicidal behavior) among the patients with bipolar I disorder. Lack of insight is a consistent factor of non-adherence to medication in bipolar patients, along with severity of BD, side effects of medication, effectiveness, and patient-related factors. Most researchers observed that insight is more impaired during an illness episode than during remission, in mixed than in pure manic episodes, in bipolar II than in bipolar I patients, and in pure mania than in bipolar or unipolar depression. In bipolar disorder (BD), clinical insight varies substantially over time. Although insight has been studied specifically in schizophrenia and its study in mood disorders has traditionally received limited attention, the evaluation of this concept in mood disorders is also very important because of the impact on treatment compliance and outcome. Insight is a multidimensional construct, defined as the awareness of having a mental disorder, of specific symptoms and their attribution to the disorder, the awareness of social consequences, and of need for treatment. ![]()
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