Insight in psychosis: a systematic review - the constructs of insight in psychosis and their measurement & An exploration of current practices in the assessment and intervention of insight in psychosis within Scotland’s Forensic Mental Health Services: clinical psychologists’ perspective
Slack, Tom Gavin Hume
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Poor insight has clinical significance as a predictor of non-adherence to treatment, increased number of relapses, hospitalisations, recovery and risk of violence. Empirical research has led to advances in the redefinition, knowledge and understanding of insight in psychosis. However, the use of a wide range of definitions and measures has created difficulties in interpreting research findings, without clarifying the concepts being measured and evaluating the quality of their associated assessment tool. Therefore, the aim of the first piece of work, a Systematic Review (SR), was to identify and describe the constructs of insight in psychosis and their assessment tools and briefly evaluate their psychometric properties. Insight in psychosis is particularly relevant to Forensic Mental Health Services, given its link with offending behaviour and risk to others. However, outside of those provided by risk appraisal tools, there are no current guidelines that specifically target the assessment, or intervention, of insight. Therefore, the second piece of work, a research project (RP), aimed to explore current practices, as described by experienced clinicians. The SR identified twelve assessment tools and fourteen papers for detailed analysis. Twelve theoretical constructs were identified, the most prominent being awareness of mental illness and awareness of the need for treatment. Other prominent theoretical constructs included awareness of negative consequences of illness and awareness of generic or specific symptoms. However, few of the subscales associated with each theoretical construct were supported by empirical evidence. Further work to clarify aspects of insight that are important areas for intervention, along with the provision of data to support these, should continue to be a focus for on-going research. The RP was a qualitative design using Thematic Analysis. Data was collected by semi-structured interviews from 11 qualified Clinical Psychologists working in Forensic Mental Health Services across Scotland. The RP identified three overarching themes. The first “risk related” illustrated the influence of risk to other when assessing and treating patients. The second “holistic approach” illustrated that insight or mental illness was rarely looked at in isolation. The third theme “no specific or satisfactory unified approach” illustrated the diversity of the conceptualising, assessment and treatment of insight. Opportunities exist to develop a more uniformed approach and to introduce or develop outcome measures for interventions.