Is there a role for compliance in the assessment of insight in chronic schizophrenia?

Current work on insight focuses on its assessment, a trend that is reflected in the inflation of newly-developed scales. Most scales assess compliance with treatment, recognition and acceptance of mental illness and relabeling of abnormal mental experience as pathological. A handful of studies indicate that compliance is weakly to moderately correlated with awareness of illness and relabelling of symptoms in acute samples. As the parameters of compliance differ between acute and chronic populations, this study investigated the relationship between the three components using the Schedule to Assess the Components of Insight in 78 outpatients with chronic schizophrenia. A weak positive correlation was found between acceptance of illness and relabelling. However, compliance was not reliably related to either the awareness or relabelling component. As the incidence of non-compliance in the present sample did not differ from comparable populations, it appears that non-compliance does not account for these findings. Non-compliance may be viewed as an evaluation of the costs and benefits of treatment on daily living rather than an insight deficit. The lack of a reliable relationship between compliance and insight suggests that the two phenomena should be viewed as distinct constructs and assessed separately in chronic schizophrenia.