Poster
69
(#69) Diminished illness awareness in schizophrenia: Aligning science and lived experience
Psych Congress 2025
Abstract: Diminished insight in schizophrenia is linked to lower treatment engagement and poorer outcomes. In addition, definitions of insight and terms used to describe the concept vary across stakeholders. Despite reflecting distinct mechanisms and meanings, terms such as "lack of insight," "anosognosia," and "denial" are often conflated. This can complicate treatment planning and lead to misinterpretation of treatment refusal.
Individuals diagnosed with schizophrenia may reject psychiatric labels (therefore, potentially being labeled with "lack of insight") for personal, cultural, or identity-based reasons. Caregivers often understand lack of insight as biologically driven and can perceive it as deeply consequential to their loved one's prognosis. Researchers have described lack of insight in varying ways, many from a biological perspective.
We conducted a targeted literature review to better understand the conceptualization of lack of insight in the scientific literature and to update a multidimensional framework of insight in schizophrenia. Five core dimensions were identified and mapped to biological, cognitive, and contextual drivers. Causal pathways include environmental and experiential models, brain-based differences, neurocognition and social cognition, and metacognition and self-assessment.
This updated model of lack of insight in schizophrenia aims to accommodate all stakeholder perspectives and begin to create a unified understanding and lexicon. More lived experience research is needed to create a truly comprehensive model that is grounded in neuroscience and informed by lived realities. This can guide better communication, reduce conflict, and clarify care pathways to support more effective and person-centered care.
Short Description: An updated insight model for schizophrenia is presented that integrates conceptualizations from the scientific literature. Six dimensions of insight are identified and mapped to explanatory mechanisms. While this model supports clearer communication and more individualized care, it also calls for a more comprehensive framework that reflects both diagnosed and caregiver viewpoints.
Name of Sponsoring Organization(s): N/A
Individuals diagnosed with schizophrenia may reject psychiatric labels (therefore, potentially being labeled with "lack of insight") for personal, cultural, or identity-based reasons. Caregivers often understand lack of insight as biologically driven and can perceive it as deeply consequential to their loved one's prognosis. Researchers have described lack of insight in varying ways, many from a biological perspective.
We conducted a targeted literature review to better understand the conceptualization of lack of insight in the scientific literature and to update a multidimensional framework of insight in schizophrenia. Five core dimensions were identified and mapped to biological, cognitive, and contextual drivers. Causal pathways include environmental and experiential models, brain-based differences, neurocognition and social cognition, and metacognition and self-assessment.
This updated model of lack of insight in schizophrenia aims to accommodate all stakeholder perspectives and begin to create a unified understanding and lexicon. More lived experience research is needed to create a truly comprehensive model that is grounded in neuroscience and informed by lived realities. This can guide better communication, reduce conflict, and clarify care pathways to support more effective and person-centered care.
Short Description: An updated insight model for schizophrenia is presented that integrates conceptualizations from the scientific literature. Six dimensions of insight are identified and mapped to explanatory mechanisms. While this model supports clearer communication and more individualized care, it also calls for a more comprehensive framework that reflects both diagnosed and caregiver viewpoints.
Name of Sponsoring Organization(s): N/A
