Insight is the final heading in the mental state examinations as customarily set out. In schizophrenia, it is very important in management and is one of the main determinants of prognosis. It would be better if the term were replaced by some such phrase as 'patient's attitude to illness and treatment'. It is a complex matter, and questions such as 'does the patient believe he is ill?', and 'will the patient accept treatment?', are key; however, schizophrenic patients are often conflicted about these matters. For example, sometimes they will only come into hospital against their will on a section of the Mental Health Act; nevertheless, once in the hospital, they will seem to accept medication without dispute. Conversely, patients may say that they believe that they are ill, and that they will accept treatment when they leave the hospital; however, once out of the hospital, they refuse the treatment on the grounds that they do not believe that they are ill.

Accordingly, insight in schizophrenia is something of great practical importance. It can only really be assessed by trial and error, as it were, the proof of the pudding being in the eating.

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