Psychotherapeutischer Einfluss auf Einsicht und Therapie-Compliance

Abstract

Insight is a complex phenomenon comprising an awareness of illness and its psychosocial consequences, awareness of signs and symptoms and their attribution to illness and an awareness of need for treatment. An insightful patient can be treated better, yet a lack of illness insight is a relatively frequent phenomenon. Lack of insight increases the probability of illness relapse and rehospitalisation. Insight, however, can obviously improve spontaneously in the course of the illness. Psychopathological, neurobiological and psychological models have attempted to explain insight. Generally, there is a negative correlation between insight and its components on the one hand and the extent of psychopathology on the other hand: the more ill the patient, the less insightful he or she is. Nevertheless, psychopathology does not explain the lack of insight.There exist no convincing correlations between illness insight and morphological brain findings, and also, the relationship between insight and cognitive achievements appears equivocal. Insightful patients do not feel better, and patients without insight were found to be less depressed. The lack of insight could therefore perhaps protect from negative emotions and be used as a defence mechanism (unconsciously by definition). Insight can make it easier for the patient to cope with his or her illness and it can favourably influence the therapy.Generally, insight goes hand in hand with better prognosis. In contrast, identification of an individual insightful patient with his or her illness can lead to demoralisation and worsen the prognosis. Thus, it is not illness insight as such which is of the utmost importance, but the individual handling of insight and what the patient makes of it. Therapy noncompliance, partial compliance or insufficient adherence to therapy is also frequent and again, it is not a constant variable, but fluctuates over time. On the whole, patients without insight have worse adherence to therapy. Improvement of insight and therapy adherence belongs to the important therapeutic goals. Patients with mental disorders are able to learn and to get information. In spite of this fact it can prove problematic to increase insight and ameliorate therapy adherence psychotherapeutically. Repeated bi-directional information exchange and participative decision making on the basis of openness, reliability and mutual respect are necessary. Keywords: insight; compliance; adherence; psychopathology; psychotherapy