Table 1.
Scales That Assess Insight in Schizophrenia, Sorted by Date of Publication
| Scale | Dimensions | Psychometric properties |
| Attitude Questionnaire24 | Eleven aspects of attitude: illness positive or negative, integrate or isolate illness, blame self, blame family, blame events, insight positive or negative, future positive or negative | Reliability and validity: only scale intercorrelations are described. Positive and negative attitudes toward illness correlate significantly (r = −.62) and positive attitudes correlate significantly with integrate scores, a positive attitude toward the future and a high value for insight in solving present problems. |
| Insight Instrument25 | Beliefs about symptoms, awareness of illness and causes of hospitalization, feeling of vulnerability to recurrences, and beliefs about treatment benefit | Reliability: Cronbach alpha = .91 |
| ITAQ26 | Questions address the recognition of mental illness, the need for hospital care, and the need to take medication | Validity: significant correlation (r = .85) of ITAQ scores with open interview to assess insight. ITAQ is highly correlated with the SAI (r = .82) and the PANSS insight item (r = .90)27; factor analysis: PCA extracted one factor. |
| SAI23,28 | Assesses 3 components of insight: awareness of illness, the capacity to relabel psychotic experiences as abnormal, and treatment compliance | Validity: total insight is highly correlated with insight in the PSE (r = .72) and moderately with the total PSE Score (r = −.31). All components correlate with each other and with insight in the PSE (r = .58–.60). Correlations with PANSS insight (r = .88) and ITAQ (r = .82) are high27; factor structure: a PCA did not support the postulated 3 dimensions but provided a single-factor solution accounting for 60.2% of the variance. |
| Marková and Berrios Insight Scale29 | Questions address hospitalization, mental illness, perception of being ill, changes in self, control over situation, perception of environment, wish to understand situation. In the revised scale, items on hospitalization and medication were deleted and more emphasis laid on awareness of changes and relationship to the environment. | Validity: Sanz et al27 found associations with other insight scales (SAI, PANSS, ITAQ) to be low to moderate, ranging from r = .34–.55. Factor analysis revealed 5 interpretable factors for the items in group A and 3 factors for group B items; reliability: Cronbach alpha for group A = .71, for group B = .55. |
| Marková and Berrios Insight Scale—revised (self-report)30 | For the revised form Cronbach alpha is .88, and retest reliability (assessed by 10 patients repeating the assessment 1 d later) is r = .65. | |
| SUMD31 | Separate assessment of present and past insight into mental disorder (item 1), social consequences (item 2), need for treatment (item 3), and perception of each present symptom and attribution of symptom to disorder (items 4–20). Total: 74 items | Validity: items 1 and 2 for present illness are highly correlated with the insight rating on a mental status examination (r = .88; r = .60); insight in the HDRS (r = .89; r = .80). The correlations for item 3 were moderate (r = .43; r = .62), whereas past awareness revealed lower or insignificant correlations. Present insight is highly correlated with PANSS insight (r = .7332) intra class correlations (ICCs) and ITAQ scores (r = .46 to r = .74)33; reliability: intra class correlations for subscale scores range from 0.52 (past attribution) to 0.90 (current awareness). |
| IS (self-report)34 | Designed to be sensitive to changes in levels of insight and capture the following dimensions of insight: need for treatment, awareness of illness, and relabeling of symptoms as pathological | Validity: high correlations (r = .74–.85) between subscales and total scores of IS and SUMD in a group that completed the IS before being observer rated. In the observer rated, first group associations were low. Insight was rated as lower in the IS as compared with the SUMD35; reliability: Cronbach alpha for total scale = .75, test-retest reliability (1 wk) = .90; factor structure: PCA extracted one factor that accounted for 60% of the variance. |
| AII36 | Assessment of recognition of mental illness (3 questions) and perceived need for psychiatric treatment (4 questions) | Reliability: Cronbach alpha for total scale = .84 (for subscale 1 = .86, for subscale 2 = .75); ICCs for total scale = .79 (for subscale 1 = .81, for subscale 2 = .75). Factor structure: factor analysis revealed 2 factors accounting for 69% of the variance. Factor loadings and intercorrelations only partially support the assumption of the postulated dimensions. |
| SALI37 | Four subscales: treatment acceptance, treatment efficacy awareness, awareness of possibility of recurrence of illness, and own explanation of cause of illness | Validity: the first 3 scales significantly correlated with PANSS insight item (.64–.74) and items assessing insight into positive symptoms (.41–.69). Scales assessing treatment efficacy awareness and possibility of recurrence were significantly correlated with insight into negative symptoms (.55–.58); reliability: Cronbach alpha for complete scale = .85. “Own explanation for illness” revealed negative correlations with the other subscales and was omitted. |
| BABS38 | Assesses delusionality of beliefs (conviction, perception of others views of belief, explanation of differing views, fixity of ideas, attempts to disprove beliefs, insight, delusions of reference) in various disorders | For schizophrenia,39 validity: medium correlation with SUMD in sample of patients with schizophrenia or schizoaffective disorder (.55). No significant correlation with clinicians global insight rating and with scales assessing positive and negative symptoms (BPRS, SANS, SAPS). Reliability: Cronbach alpha for complete scale = .89. |
| SAIQ (self-report)40 | Assesses acknowledgment of illness, acknowledgment of need for psychiatric treatment, and extent of worry about illness and illness-related issues | Factor analysis found 3 factors accounting for 53% of the variance: (1) need for treatment, (2) worry, and (3) presence/outcome of illness. |
| Validity: factor 1 revealed significant associations with the PANSS insight item (r = .58) and the SUMD total (r = .63). Associations were lower but also significant for factor 2 (r = .47; r = .43). Factor 3 was not significantly related to SUMD or PANSS insight; reliability: Cronbach alpha for complete score = .83 and ranged from .72–.86 for the 3 subscales. | ||
| BCIS (self-report)41 | Two components of cognitive insight are assessed: self-reflectiveness (expression of introspection and willingness to acknowledge fallibility) and self-certainty (certainty about beliefs or judgments). | Validity: The Composite Index was correlated (r = −.62) with the SUMD mental disorder item; self-reflectiveness was associated with SUMD delusions (r = −.67). Correlations of self-reflectiveness with IS total score were low (r = .26) and moderate with the IS subscore for awareness of symptoms (r = .36)42; reliability: Cronbach alpha for self-reflectiveness and self-certainty were .67 and .61 for patients with schizophrenia; factor structure: factor analysis supported the 2-factor structure.42 |
Note: ITAQ, Insight and Treatment Attitudes Questionnaire; PSE, Present State Examination; PCA, principal components analysis; SAI, Schedule for Assessing the 3 Components of Insight; PANSS, Positive and Negative Syndrome Scale; SUMD, Scale to Assess Unawareness of Mental Disorder; HDRS, Hamilton Depression Rating Scale; IS, Insight Scale; AII, Awareness of Illness Interview; SALI, Scale to Assess Lack of Insight; BABS, Brown Assessment of Insight Scale; BPRS, Brief Psychiatric Rating Scale; SANS, Scale for the Assessment of Negative Symptoms; SAPS, Scale for the Assessment of Positive Symptoms; SAIQ, Self-Appraisal of Illness Questionnaire; BCIS, Beck Cognitive Insight Scale.