Table 2.
Longitudinal Studies Investigating the Impact of Insight on Adherence
| Study | Design | Participants | Measures | Results |
| McEvoy et al58 | Acute episode at baseline, follow-up after 30 d and between 2.5 and 3.5 y | 52 patients with schizophrenia (DSM-III criteria) | Insight: ITAQ | There was a trend for patients with more insight to be more compliant 30 d after discharge. |
| Outcome: phone calls to aftercare clinicians about the patient's outpatient care compliance (appointments and medication) | ||||
| Buchanan59 | Assessment at discharge, follow-up at 1 and 2 y | 61 patients with schizophrenia (Research Diagnostic Criteria) | Insight: Attitude Questionnaire | A “future-positive” view was associated with outpatient attendance and drug treatment compliance at 1 y but not at 2-y follow-up |
| Outcome: records of out-patient compliance (attended appointments) and medication compliance (urinary drug testing) | ||||
| Cuffel et al36 | Assessment at discharge, 6-mo follow-up | 89 patients with schizophrenia (Structured Clinical Interview for DSM, SCID) | Insight: AII | No significant association between baseline awareness and service use/medication adherence during the follow-up period |
| Outcome: compliance self-reports and interviews with collaterals | ||||
| Coldham et al46 | Outpatient at baseline, 1-y follow-up | 143 outpatients with schizophrenia or schizophreniform disorder (SCID) | Insight: PANSS | The nonadherent group had significant poorer insight at both assessments. In a logistic regression analyses, controlling for age, family involvement, premorbid functioning, and cannabis use, insight was not significant. |
| Outcome: scale to rate adherence | ||||
| Novak-Grubik and Tavcar60 | Assessment during inpatient treatment and at 1-y follow-up | 56 patients with schizophrenia, schizophreniform, or schizoaffective disorder (ICD-10) | Insight: PANSS | In a multivariate Cox regression analyses, poor insight at discharge predicted noncompliance with outpatient treatment (OR = 2.00, R2 = .26, ß = 0.69). |
| Outcome: attendance of appointments and medication compliance assessed as self-report and/or reports from key-relatives | ||||
| Tait et al61 | Acute psychosis at baseline, 3- and 6-mo follow-up | 42 patients (at third follow-up) with schizophrenia | Insight: IS | No significant correlation between insight at 3-mo follow-up and service engagement at 6-mo follow-up. |
| Outcome: Service Engagement Scale | ||||
| Byerly et al62 | Outpatient at baseline, trial of compliance therapy, follow-up assessment at 5 mo | 30 patients with schizophrenia or schizoaffective disorder (DSM-IV) | Insight: SAI | In the hierarchical linear model, insight was the only baseline characteristic associated with greater adherence during the follow-up period. |
| Outcome: Medication Event Monitoring, clinical ratings, Medication Adherence Rating Scale | ||||
| Yen et al48 | In remission at baseline, 1-y follow-up | 74 patients with schizophrenia (DSM-IV) | Insight: SAI, SAI-E | Insight correlated positively (r = .24) with medication adherence at index interview but not at 1-y follow-up. |
| Outcome: Medication Adherence Behavior Scale | ||||
| Kamali et al63 | Inpatient at baseline, 6-mo follow-up | N = 60 | Insight: PANSS | Reduced insight is a strong predictor of nonadherence in patients who do not abuse alcohol or other drugs and a weaker but significant predictor in the sample as a whole. |
| First-episode schizophrenia or schizophreniform disorder (SCID) | Outcome: Compliance Interview |
Note: Abbreviations are explained in footnote to table 1. DSM-III, Diagnostic and Statistical Manual for Mental Disorders, Third Edition; ICD-10, International Classification of Diseases, 10th Revision; DSM-IV, Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, SAI-E Schedule for Assessing the 3 components of insight-Expanded Version.