Assessing insight in schizophrenia: East meetsWest

BackgroundLack of insight has been observed in people with schizophrenia acrosscultures but assessment of insight must take into account prevailingillness models.AimsTo determine whether culturally specific and Western biomedicalinterpretations of insight and psychosis can be reconciled.MethodPatients with schizophrenia (n=131) were assessed duringtheir first contact with psychiatric services in Vellore, South India.Patients' explanatory models, psychopathology and insight wereinvestigated using a standard schedule translated into Tamil.ResultsSupernatural explanations of symptoms were frequent. Some insightdimensions were weakly associated (inversely) with severity of symptomswhereas preserved insight was associated with anxiety, help-seeking andperception of change. Willingness to attribute symptoms to disease, inothers and in one's self, but not to supernatural forces was stronglyassociated with insight.ConclusionsThe relationship between insight, awareness of illness and other clinicalvariables is similar in South India to elsewhere. However, the assessmentof insight might have failed to capture locally accepted explanatoryframeworks. An inclusive conceptual model which emphasises help-seekingis recommended.