[When disease insight is halting. II. The neurobiological underpinnings]

This review examines the neurobiological underpinnings of impaired insight and awareness in psychosis. Crucial mainly dopaminergic pathways are discussed in relation to delusions and hallucinations. Thirty percent of psychotic patients with impaired insight will not respond to traditional neuroleptic drug treatment, and the possibility that multifocal brain etiology might underlie such cases is discussed. It is suggested that severe cases of thought process disorder in psychosis may result from such multifocal processes.