[Perception and insight of illness in schizophrenic patients]

A review of prevalence and causes of low insight in schizophrenic patient as well as of possible interventions. Low insight was found in 20-80% of cases. The complex phenomenon 'lack of insight' is caused by a common pathway of different psychopathological and adaptive processes: psychotic reality distortion, psychotic resistance ('denial') and the expression of neurobiological deficits ('anosognosia'), respectively. Step by step, the subjective awareness and the individual causal model of the patient have to be adopted to the medical disorder model ('vulnerability-stress-coping concept') to achieve a functional understanding of the disorder that is optional for good cooperation between patient, relatives and professional carers. Thereby, a strengthening of the negative self-image and of the weakened autonomy should be given special attention to prevent hopeless-suicidal developments.