Am J Psychiatry 1993; 150:1649-1653
Copyright © 1993 by American Psychiatric Association
Use of psychopathology vignettes by patients with schizophrenia or schizoaffective disorder and by mental health professionals to judge patients' insight
JP McEvoy, NR Schooler, E Friedman, S Steingard and M Allen
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh.
OBJECTIVE: The goal of this study was to clarify more precisely where
patients with psychotic disorders and the mental health professionals who
care for them disagree regarding whether the patient is ill or needs
treatment. METHOD: The authors prepared brief vignettes in everyday
descriptive language that provided examples of the classical positive and
negative psychopathological features of schizophrenia. Fifteen men and 11
women diagnosed as having schizophrenia or schizoaffective disorder and one
physician used these vignettes as a common frame of reference to rate 1)
the degree to which the patients demonstrated the features described in
each vignette and 2) the degree to which the features signified the
presence of mental illness. RESULTS: Disagreements between the physician's
and patients' ratings, indicating deficits in insight, were associated with
the recognition of the presence of conceptual disorganization,
avolition-apathy, and affective blunting in the patients by the physician
but not the patients and with the conceptualization of hallucinatory
behavior and suspiciousness as signs of mental illness by the physician but
not the patients. CONCLUSIONS: The authors conclude that the failure to
acknowledge conceptual disorganization, avolition-apathy, and affective
blunting and the failure to view hallucinatory behavior and suspiciousness
as signs of mental illness, which proved to be additive in this study,
contribute to deficits in insight.
