Video on Anosognosia (Lack of Insight) on Mental Illness

Scope of the Problem
Poor and partial-adherence to treatment presents staggering obstacles to recovery. It is associated with a poorer course of illness, increased involuntary hospitalizations, suicide, poorer subsequent response to treatment, estrangement and discord with caregivers and providers, criminal behavior, and failure to reach optimal levels of recovery. In light of the tremendous advances made in the treatment of schizophrenia and bipolar disorder, the tragedy of both untreated, and inadequately treated, mental illness is compounded. The urgency to implement strategies that optimize adherence and recovery has never been greater.
Non-adherence rates in schizophrenia and bipolar disorder continue to hover around 50% while partial adherence rates are even higher (75%). Considering that millions of people either flat out refuse to participate in treatment, or if they do, practice only partial-adherence, the "real-world" effectiveness of both the older, and more promising newer treatments, is abysmal.
Deficits in insight (a.k.a. "anosognosia" see DSM IV-TR, American Psychiatric Association Press, 2000, page 304) are very common. Not surprisingly, anosognosia predicts poor and partial-adherence. After all, who would want to take medication for an illness they did not believe they had? Research shows that poor insight is among the top predictors of poor adherence, far more predictive than the person's experience of side effects. Although recent innovations in drugs used to treat these disorders have addressed many of the limitations of traditional antipsychotic medications (e.g., severity of side effects, aspects of cognitive dysfunction), they still do not deal with the problem of poor adherence to treatment.

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