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Insight in Psychiatry and Neurology

State of the Art, and Hypotheses

Landi, Paola MD; Marazziti, Donatella MD; Rutigliano, Grazia MD; Dell’Osso, Liliana MD

doi: 10.1097/HRP.0000000000000083

In spite of the increasing number of studies on insight in psychiatry and also in neurology and psychology, its nature is still elusive. It encompasses at least three fundamental characteristics: the awareness of suffering from an illness, an understanding of the cause and source of this suffering, and an acknowledgment of the need for treatment. As such, insight is fundamental for patients’ management, prognosis, and treatment. Not surprisingly, the majority of available data, which have been gathered on schizophrenia, show a relationship between low insight and poorer outcomes. For mood disorders, however, insight is associated with less positive results. For other psychiatric disorders, insight has rarely been investigated. In neurology, the impaired ability to recognize the presence of sensory, perceptual, motor, affective, or cognitive functioning—referred to as anosognosia—has been related to damage of specific brain regions. This article provides a comprehensive review of insight in different psychiatric and neurological disorders, with a special focus on brain areas and neurotransmitters that serve as the substrate for this complex phenomenon.

From the Dipartimento di Medicina Clinica e Sperimentale, University of Pisa.

Original manuscript received 30 July 2014, accepted for publication subject to revision 23 October 2014; revised manuscript received 19 November 2014.

Correspondence: Grazia Rutigliano, MD, Dipartimento di Medicina Clinica e Sperimentale, University of Pisa, Via Roma 67, 56100 Pisa, Italy. Email:

© 2016 President and Fellows of Harvard College
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