Insight and recovery from psychosis in chronic schizophrenia and schizoaffective disorder patients

Thomas E. Smith*, James W. Hull, Jonathan D. Huppert, Steven M. Silverstein, Donna T. Anthony, Joel F. McClough

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


Impaired insight is an important contributing factor to poor treatment response and outcome in schizophrenia. Prior studies have attempted to identify the illness characteristics that underlie these deficits, with conflicting results regarding associations with symptoms and neurocognitive deficits. These inconsistencies may be a function of a number of methodological issues, which were addressed in this study. In a prospective, longitudinal study, 50 individuals with schizophrenia or schizoaffective disorder underwent baseline assessments upon discharge from an acute inpatient unit, and again at a 6-month follow-up. Unawareness of positive and negative symptoms were studied separately, with analyses focusing on changes in insight over time as well as associations with disorganized symptoms, depression, and card sorting deficits. Subjects showed greater insight for negative symptoms than for positive symptoms. Insight for positive symptoms improved only slightly over the follow-up period, while negative symptom awareness did not change. Insight for negative symptoms showed modest associations with card sorting deficits, while awareness for positive symptoms showed stronger associations with thought disorder, depression, and card sorting deficits. Awareness for positive symptoms in schizophrenia may be distinct from awareness of negative symptoms. Clinicians should also be aware of the multidetermined nature of impaired insight, and future research should aim to isolate distinct mechanisms that give rise to these deficits.

Original languageAmerican English
Pages (from-to)169-176
Number of pages8
JournalJournal of Psychiatric Research
Issue number2
StatePublished - 2004
Externally publishedYes

Bibliographical note

Funding Information:
This research was supported by National Institute of Mental Health grant MH 01359 to Dr. Smith, and by funds established in The New York Community Trust by DeWitt-Wallace. The authors wish to thank Lorna Starkey and Elaine Kalweit for valuable assistance with the project.


  • Disorganized symptoms
  • Executive deficits
  • Insight
  • Negative symptoms
  • Positive symptoms
  • Schizophrenia


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