I’m an early career clinician in a community-based program for people with SMI, and didn’t receive any training on the concept of anosognosia/lack of insight (I found the term on my own). This term basically means that some people with psychosis don’t perceive their condition, even when they are not having psychotic symptoms.

Example: a person believes demons are attacking them. This makes them very distressed and they can’t function. They go on antipsychotics and these experiences go away, and the person feels better (they say the medication makes them feel calmer) but they still do not acknowledge that they were having delusions/hallucinations. They might not be able to have a conversation about what they experienced with the demons; it’s like that information is fuzzy to them. It’s pretty easy for someone like this to go off medication because they don’t have a clear sense of why they went on it.

I haven’t done a deep dive yet, but the websites I’ve found give ranges between 20-50% of people with schizophrenia. This fits what I see in my job. Some people are very self-aware of their delusions/hallucinations, some people are aware when not in an episode, and some people are never very aware of it. It makes a big difference in their prognosis and the best way to approach them.

This seems like an oddly under-acknowledged feature of psychotic disorders, both in the way SMI programs are designed, and in the way laypeople talk about medication and treatment. I definitely don’t think everyone with psychosis needs to be on antipsychotics or needs a particular type of treatment–including people with anosognosia–but it is apparent that some people aren’t making an informed decision because they can’t perceive all the information.

Thoughts on why this isn’t discussed more? Or experiences working with it?

Originally posted by u/throwawayswstuff on Reddit.

Top comment by u/charliebrownbluth

I don’t have a lot of experience working with it but rather with clients who have family members with SMI. I highly recommend the “LEAP” method for working with patients with poor insight.