Poor insight in psychosis and meta-representation models

Abstract

Historically, poor insight and self-awareness deficits in schizophrenia have typically been understood as stemming from psychological defenses or adaptive coping strategies. Perhaps both psychological process and neuropsychological deficit account for the phenomenon of poor insight. Different models of insight exist for different broad categories of mental disorders, like psychotic, neurotic, and neurological, but investigators have increasingly turned their attention to poor insight, as an important feature in schizophrenia. A variety of phenomena might be considered as reflecting impaired insight in psychosis, like failure to recognize signs, symptoms or disease, failure to derive appropriate cognitive representations, despite recognition of the disease, and misattribution of the source or cause of the disease. The unawareness of tardive dyskinesia symptoms in schizophrenic patients points that self-awareness deficits in schizophrenia may be domain specific. Poor insight is an independent phenomenological and a prevalent feature in psychotic disorders in general, and in schizophrenia in particular, but we don’t know yet if delusions in schizophrenia are the result of an entirely normal attempt to account for abnormal perceptual experiences or a product of abnormal experience but of normal reasoning. The theoretical approaches regarding impaired insight include the disturbed perceptual input, the impaired linkage between thought and emotion and the breakdown of the process of self-monitoring and error checking. The inability to distinguish between internally and externally generated mental events has been described by the meta- representation theory.