Insight et interventions psychoéducationnelles dans la schizophrénie

Poor insight is consistently present in schizophrenia and is among the most discriminating symptoms for differentiating schizophrenia from other mental disorders. Patients are unable to see the most obvious symptoms of their illness, despite the fact that their family members can recognize thought disorder, mania or hallucinations. Results suggest that lack of insight is a part of the disorder itself, rather than an adaptive strategy. Poor insight in schizophrenia has been described as a lack of awareness of suffering from an illness, of the symptoms of the illness, of the consequences of the disorder, and of the need for treatment. Similarly to some negative symptoms lack of insight predisposes to an increased number of relapses and hospitalizations, to deteriorating social skills and quality of social relationships, and to a worsening course of illness. Unawareness is among the best predictions of non-adherence to treatment. Patients do not want to take medicine for an illness they do not think they have. The ways in which patients think about their illness experiences have been associated with a variety of behaviours and emotional responses. In schizophrenia, the study of beliefs about mental illness has generally been centered on people's interpretations of experiences and how these interpretations contribute to the development and maintenance of symptoms. There are less studies of other beliefs such as the causes of the experience, beliefs about treatment, consequences, and how long the illness is likely to last. The need to understand the way in which a patient appraises his/her own experiences has been recognized. People who integrated their experiences more fully, accepting that they had experienced a psychotic episode, actually showed higher levels of depression. This may reflect the demoralization and stigma that patients associate with mental illness. Many clinicians believe that lack of insight is very often a consequence of denial, a defensive mechanism. Terms such as defensive denial, and lack of insight often reflect underlying conceptual differences. Psychoeducational interventions were developed to increase patients' knowledge of, and awareness about their illness, there is a focus on knowledge. Education is a process by which a patient gains understanding through learning. Patients have a right to an accurate and complete knowledge regarding their illness and treatment. The assumption is that this increased knowledge and insight will enab