Abstract
In a group of 1066 heroin addicts, who were seeking treatment for opioid agonist treatment, we looked for differences in historical, demographic, and clinical characteristics, between patients with different levels of awareness of illness (insight). The results showed that, in the cohort studied, a majority of subjects lacked insight into their heroin-use behavior. Compared with the impaired-insight group, those who possessed insight into their illness showed significantly greater awareness of past social, somatic, and psychopathological impairments, and had a greater number of past treatment-seeking events for heroin addiction. In contrast with other psychiatric illnesses, the presence of awareness appears to be related to the passing of time and to the worsening of the illness. Methodologies to improve the insight of patients should, therefore, be targeted more directly on patients early in their history of heroin dependence, because the risk of lack of insight is greatest during this period.
Highlights
Patients’ lack of insight into their mental illness is a complex and poorly investigated phenomenon which seriously influences psychosocial functioning, shows a clear correlation with the severity of psychiatric symptoms, and has been seen as related to treatment compliance, with important prognostic implications (Husted, 1999; Francis and Penn, 2001; Vender and Poloni, 2006).In psychology and psychiatry, insight can mean the ability to recognize one’s own mental illness (Markova, 2005)
Heroin addicts with and without insight significantly differed as regards education: 66.7% of with-insight heroin addicts had had over 8 years of education, whereas 72.6% of those without insight had had fewer than 8 years of education (χ2 = 4.06, p = 0.043)
On the basis of our data the awareness of illness often appears to be absent in heroin addicts, as happens in a wide range of psychiatric conditions, too, including mood disorders, psychotic disorders, and the obsessive-compulsive disorder with a prevalence of somatic obsessions (Husted, 1999; Pallanti et al, 1999; Pini et al, 2001; Dell’Osso et al, 2002; Marazziti et al, 2002; Varga et al, 2006)
Summary
Patients’ lack of insight into their mental illness is a complex and poorly investigated phenomenon which seriously influences psychosocial functioning, shows a clear correlation with the severity of psychiatric symptoms, and has been seen as related to treatment compliance, with important prognostic implications (Husted, 1999; Francis and Penn, 2001; Vender and Poloni, 2006).In psychology and psychiatry, insight can mean the ability to recognize one’s own mental illness (Markova, 2005). Patients’ lack of insight into their mental illness is a complex and poorly investigated phenomenon which seriously influences psychosocial functioning, shows a clear correlation with the severity of psychiatric symptoms, and has been seen as related to treatment compliance, with important prognostic implications (Husted, 1999; Francis and Penn, 2001; Vender and Poloni, 2006). A poor degree of insight has been associated with a poorer course of the illness and non-compliance with treatment that is necessary for patients (Husted, 1999). Deficits in insight have not been found to be more common and severe in patients with schizophrenia than in those with bipolar disorder – a finding that has strong clinical, theoretical, and nosological implications (Pini et al, 2001). In post-traumatic stress disorder as well has been shown the need to improve awareness of illness to better understand the disease and the possible complications that it could occur (Khoury et al, 2010)
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