Illness Awareness Fluctuates With Schizophrenia, But May Not Affect Outcomes

schizophrenia diagnosis
schizophrenia diagnosis
In this study of older patients with schizophrenia, investigators examined the temporal fluctuations that occur with awareness of mental illness, and related factors that influence illness awareness.

The results of a study published in the American Journal of Geriatric Psychiatry suggest that for many older patients with schizophrenia, illness awareness (IA) may have a limited effect on long-term clinical and social outcomes.

Between 50% and 80% of individuals with schizophrenia lack insight into their disease, but this is not a constant characteristic, and may be influenced by a variety of clinical and social factors. Some evidence shows that insight into the illness may be affected by the decline in cognitive function and increase in physical illness that often accompanies the aging process.

Carl I. Cohen, MD, State University of New York Distinguished Service Professor and director, Division of Geriatric Psychiatry, State University of New York Downstate Medical Center, Brooklyn, New York, and colleagues analyzed a sample of 103 community-dwelling individuals age ≥55 years with early-onset schizophrenia during a mean follow-up of 53 months to determine IA, how IA changed over time, and the factors associated with IA.

The researchers found considerable variability in IA, with 23% of individuals in the sample population transitioning between presence and absence of IA, whereas 62% of persons were consistently aware of the illness and 15% never had IA. Approximately 75% of the study population acknowledged having schizophrenia at baseline. Fewer negative symptoms at baseline, as well as higher cognitive functioning, younger age, higher educational levels, and the presence of more physical comorbidities, showed a significant correlation with higher rates of IA at follow-up, as indicated by stepwise multiple regression analysis. Increased age, cognitive functioning, and physical disorders had additive, independent effects on IA.

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One of the more surprising findings of the study was that IA had little long-term effect on clinical, treatment, and social variables. Because these individuals were all in long-term outpatient treatment, this may have reduced the effect, but the researchers suggested that as the result of these findings, focusing on IA enhancement might not be an effective use of clinical resources.


Cohen CI, Mani A, Ghezelaiagh B. A longitudinal study of illness awareness in older adults with schizophrenia [published online October 21, 2018]. Am J Geriatr Psychiatry.