Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches

Abstract

Many individuals with schizophrenia are unaware of the symptoms and consequences of their illness. Unawareness of schizophrenia is linked to poorer adherence to treatment and is a risk factor for a range of poorer outcomes. Paradoxically, the achievement of awareness may lead to depression, low self-esteem and possibly a higher risk of suicide. To explore these issues, this article reviews emerging literature on the correlates of unawareness of illness in schizophrenia, describes advances in how to address unawareness of illness in a treatment setting and discusses newly developing ways of conceptualizing insight. A plan for further research is presented, along with an outline for the development of methodologies to assess awareness of illness as a narrative phenomenon, which calls on a range of neurocognitive and metacognitive capacities, and which must deal with the social stigma linked with mental illness.