Insight in schizophrenia - a double-edged sword?

Lack of insight is defined as a loss of ability to distinguish that one's unusual and unreal experiences should be the symptoms of the psychiatric disorder requiring treatment. Lack of insight may be considered as a core symptom of schizophrenia. The concept of insight has been regarded for a long time as necessary for treatment, which improves adherence and makes a better prognosis. Increased insight in schizophrenia has been associated not only with benefits, but also bring trouble in the form of self-stigma, low self-esteem, reduced patient's hope, diminished quality of life, and increased suicidality. Therefore, insight should be managed with sensitive monitoring of the risk factors, and be gradual, carefully supported by the encouragement of hope and confidence to managing everyday life.