Commentary: "Exploring the "Insight Paradox" in Treatment Resistant Schizophrenia: Correlations Between Dimensions of Insight and Depressive Symptoms in Patients Receiving Clozapine".

Abstract

Insight into the symptoms of almost all mental illnesses is a cornerstone directly related to adherence to therapy and treatment outcome. The critical awareness or non-awareness of the mental illness is a reason to take into account the guidelines for carrying out therapeu-tic interventions for individual patients. One fundamental concern is whether we should consider insight as a qualitative phenomenon or as a phenomenon in the continuum? On the other hand, insight in patients with mental disorders in general is an approach that can be questioned in the context of Freud's concept: “The ego is not master of its own house”. 1 This view calls into question whether we are critical of our own experiences and behavior at all. In patients with schizophrenia as well as in patients with bipolar depression, insight is impaired. 2 Previous research indicates that during the life cycle it is U-shaped. In the early years or at first psychotic episode, it is mostly absent, improving over time until it wors-ens again with advancing age. 1 This form can be explained on the one hand as a gradient dynamic of adaptation of patients to life with psychotic symptoms and on the other hand as an attempt to adapt to the social environment. Dönmezler and associates confirm this trend in their research. Their research may also indirectly explain adaptation to the environment with compliance to treatment as associated with patient functioning. 2 Other research suggests that patients with schizophrenia who have better understanding of their illness are more likely to experience depressive symptoms. It may well be explained with the disease insight which leads to greater awareness of the negative consequences of the disease, such as social isolation, stigma, and reduced quality of life 3,4 In addition, there have been reported better insight in patients with schizophrenia who are more likely to recognize and report symptoms of depression. Most probably illness insight contributes to the ability to recognize changes in mood and behavior. 5,6,7 Disruption of insight in schizophrenia can hardly be comprehended as a single-component phenomenon, since schizophrenia is a complex heterogeneous disorder with its individual evolution and patho-plastic development, whereby the assessment of impaired insight as a gradual phenomenon should also