Previous research has focused on measuring awareness in dementia with few attempts to define or clarify this concept, nor explore its meaning to the individual. The present study is preceded by a review of the concepts of insight and awareness, and the different approaches to understanding these drawn from the psychological, neurological and psychiatric literatures. The strengths and limitations of the different and models are discussed and the case for further research in this area is presented. This is followed by a research study that explores the experiences of seven people in the early to moderate stages of dementia. Interpretative phenomenological analysis illuminates some of the psychological factors that contribute to awareness and how these factors impact upon selfconcept. It is suggested that clinicians and services need to pay greater attention to the phenomenological experiences of individuals with dementia. Four superordinate themes emerged which were labelled 1. Relationship with memory 2. Relationship with professionals 3. Emotional experience of memory loss 4. Coping and maximising resources. Each category compares and contrasts individual experiences and suggests that insight may be a complex concept that would be better understood by taking into account the psychological processes that contribute to individual awareness, and their subsequent impact on self-concept. The research paper is followed by a critical review that outlines the strengths and weaknesses of this study, as well as the process issues that arose during the course of the research and the clinical implications.

Introduction: Poor insight is included as a risk factor for violence in risk assessment tools such as the Historical Clinical Risk-Management-20 version 3 (HCR-20v3) yet there is a lack of consensus around the relationship between poor insight and violence in individuals with psychosis. A systematic literature review was therefore carried out to clarify this relationship. Relatedly, a research project aimed to outline the predictive validity of the HCR-20v3 total and sub-scale scores to violence in forensic inpatients. A secondary aim was to understand the predictive ability of 2 dynamic risk factors within the HCR-20v3 clinical sub-scale; insight and positive symptoms, alongside age and history of violence in relation to violence in psychosis. Method: A systematic search of studies investigating insight and violence in patients with psychosis, published between 1980 and 2016 was carried out on relevant databases.17 articles from combined search results of 5694, met the inclusion criteria. These were selected for full-text review and quality grading which was subject to inter-rater reliability. In the research project, the predictive validity of the HCR-20v3 to violence was assessed in N=167 forensic inpatients. A sub-sample of N=135 was then used to investigate insight, positive symptoms, age and history of violence in relation to violence. Data was extracted from case files, with the exception of violence data which was collected prospectively from date of HCR-20v3 publication via DATIX. Results: The systematic review found 8 studies in support of a positive relationship between poor insight and violence, whilst 9 studies did not support this relationship. The majority of better quality studies measured the clinical insight dimension which tended to demonstrate a positive relationship between poor insight and violence. Methodological limitations were apparent across studies. The research project found HCR-20v3 total and clinical and risk-management sub-scale scores to predict violence. The clinical sub-scale was the strongest predictor of violence and physical violence specifically. Sub-sample analysis found positive symptoms and history of violence to significantly predict violence generally whilst only positive symptoms demonstrated prediction of physical violence. Insight and age were not significantly associated with either violence type. Discussion: The systematic review found partial support for a positive relationship between poor insight and violence in psychosis. Future good quality research is required to develop a fuller understanding of this issue. Research project results support the use of the HCR-20v3 in the risk assessment and management of forensic inpatients. They reinforce the usefulness of dynamic risk factors within the clinical sub-scale in particular. In line with the majority of studies within the systematic review however, a relationship between insight and violence in a sub-sample of patients with psychosis was not found. Recommendations are made for the regular re-assessment of dynamic risk factors within the HCR-20v3 clinical sub-scale in order to support patients to reduce their level of risk, with the caveat that future research is still required to support a relationship between insight and violence in this patient group.

Tereza Petrásková Toušková - Cognitive Disorganisation and Insight in Schizophrenia 1 SUMMARY Conscious awareness is related to brain activities represented as unita- ry, integrated and changeable processes reflecting binding of diverse modalities of basic neural informational processes and their subjective components. According to recent research disturbances of self- awareness and conscious experience have a critical role in pathophysi- ology of schizophrenia, which in early stages of the disease mainly in- clude overactivation of the HPA axis. Together these studies suggest that the processes of disrupted awareness and conscious disintegration in schizophrenia likely might be related and represented by similar dis- ruptions on the brain level, which in principle could be explained by various levels of disturbed connectivity and information disintegration that may negatively affect usual patterns of synchronous activity consti- tuting adaptive integrative functions of consciousness. In this context, a purpose of the theoretical part of the disertation is to describe basic neu- robiological mechanisms underlying integrative processes in the brain with its complementarily related mental activities including self- awareness and insight reflecting interrelated processes between mind and brain that implicate...

From introduction: This study is an attempt to explore and describe phenomenologically a clients total retrospective experience of psychotherapy. The research consistently and radically approaches the phenomenon of the experience of psychotherapy from the clients own perspective and is conceived as a mutual project between researcher and subject. The phenomenological method is used to explicate the subjects qualitative experience of psychotherapy so as not to impose any presuppositions regarding the nature of this experience. At all times the research remains as faithful as possible to the subjects personal account of her therapy experience

In the past decade the healing potential of mindfulness and its practice has gained widespread recognition across various health disciplines and institutions, especially mental health. Past and current research on mindfulness interventions have focused almost exclusively on the beneficial effects for clients. However, there is a serious shortage of research on how mindfulness practice influences therapists and their work. The current study looked specifically at how the influence of mindfulness meditation (MM) was experienced by therapists in the context of their work. An interpretive description methodology was used to guide the research process. Semi-structured in-depth interviews were conducted with six therapists who practiced MM regularly. A thematic analysis of interview transcripts highlighted commonalities and differences among participants’ perceptions of the influence of MM on their work. Eleven themes emerged from the data analysis. Thematic findings were considered in relation to key issues in psychotherapy, master therapist traits and other contemporary qualitative research addressing the influence of MM on practitioners. The results are discussed with an emphasis on the practical implications for future research, therapist training and clinical practice. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Failure to acknowledge their mental illness occurs in approximately half of all psychotic patients. Interest has been recently been refocused on insight (i.e., awareness of mental illness), and its associations with treatment compliance and better prognosis. Researchers have called into question the traditional factor structure of insight, instead viewing and defining it as a multidimensional and continuous construct. While factor analytic research has suggested that insight is an independent feature of psychotic disorders rather than a secondary manifestation of psychotic symptoms, several factor analytic studies have identified only one higher-order factor. Furthermore, a significant amount of the research literature has assessed insight or analyzed its relationships using only a single insight score. The current study evaluated the structural model of insight and assessed the associations between the different proposed dimensions of insight and psychotic symptoms. One hundred and six participants recruited from both inpatient and outpatient settings with a diagnosis of schizophrenia, schizoaffective disorder, psychotic disorder NOS, or bipolar disorder with psychotic features were rated on David's Schedule for Assessing Insight-Expanded Version (SAI-E), Birchwood's Insight Scale (IS), and the Brief Psychiatric Rating Scale (BPRS) or the Positive and Negative Syndrome Scale (PANSS). Structural equation modeling (SEM) was utilized to provide stringent, confirmatory statistical tests of the hypothetical factor models while accounting for measurement error. Principal findings from the current study were that the three factor model of insight was supported and that the insight factors were meaningfully correlated to the two symptom factors. Moreover, the three factor insight model provided significantly better fit than a single factor model of insight.

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With the dramatic increase and continued growth of digital information, developing Visual Analytic systems that support human cognition and insight generation are more necessary than ever before, but there is currently no content-agnostic method for measuring or com- paring how well a system facilitates analysis. Researchers in industry and academia are developing advanced tools that offer automated data analysis combined with support for human sense-making; tools for a wide variety of sense-making tasks are freely available. Now, the pressing question is: which tool works best, and for what? We show that using Shannon's entropy and self-information measures will provide a measure of the complexity reduction that results from an analyst's actions while sorting the information. Further, we demonstrate that reduced complexity can be linked to the knowledge gained. This is important, because a metric for objectively evaluating the success of current systems in generating insights would establish a standard that future tools could build on. This work could help guide researchers and developers in making the next generation of analytic tools, and in the age of big data the effect of such tools could potentially impact everyone. / Master of Science / With the dramatic increase and continued growth of digital information, developing systems that enables humans to make sense of all the data are more necessary than ever before, but there is currently no one-size-fits-all method for measuring or comparing how well a system helps people gain such insight. Rather than trying to pin down a definition of what insight is, we instead look at complexity reduction—with the intuition that, before we can make sense of complex data, we must somehow simplify it in a meaningful way. We show that using Shannon’s entropy and self-information values will provide a measure of the complexity reduction that results from an analyst’s actions while sorting information, and further demonstrate that reduced complexity can be linked to the knowledge gained. This work is important, because a metric for objectively evaluating the success of current systems in generating insights would establish a standard that future tools could build on. This work could help guide researchers and developers in making the next generation of analytic tools, and in the age of big data the effect of such tools could potentially impact everyone.

Many psychotic patients fail to admit they are mentally ill. The current study evaluated the associations between insight, specific symptoms, and neurocognitive impairments. Thirty-three acute inpatients with a schizophrenia, schizoaffective disorder, or psychotic disorder NOS diagnosis were rated on the SAIE, Birchwood's IS, and the BPRS. Neurocognitive assessments of attention and frontal lobe functioning were also conducted. Stepwise multiple regression analyses found composites representing delusions, disorganization, and anxiety/depression, as well as CPT-IP shapes hit rate, served as significant predictors of total insight or the specific insight dimensions. At least for acute patients, symptoms tended to have stronger relationships with and were more regularly predictive of insight than neurocognitive measures, though the attentional task associated with right hemisphere functioning, contributed significantly.

Dans la partie introductive (Partie A), le Chapitre 1 présente la schizophrénie et la prise en compte encore rare de la qualité de vie subjective dans cette population. La fiabilité de l’appréciation subjective de la qualité de vie a longtemps été critiquée compte tenu des fréquents troubles de l’insight relevés dans cette population. Ce chapitre souligne un paradoxe, où, d’un côté, les politiques d’empowerment encouragent l’intégration du sujet comme acteur de sa prise en charge, alors que, d’un autre côté, les troubles de l’insight peuvent limiter voire empêcher l’engagement thérapeutique.Le Chapitres II et III présentent les conceptualisations classiques de l’insight clinique dans la schizophrénie (définitions, évaluations, modélisations). Parmi les modélisations classiques, les prédicteurs sont essentiellement personnels (ex. ressources cognitives) et cliniques (symptômes). Les travaux ont progressivement intégré des variables modératrices ou médiatrices, n’ayant pas toujours relevé de relation directe entre ces facteurs classiques et l’insight. Cependant, les modélisations tiennent essentiellement compte des capacités propres au sujet, en omettant de relever le processus éminemment interactif en jeu dans l’insight ou dans son évaluation. Le Chapitre IV présente les études ayant porté sur les relations entre insight et certains indicateurs centraux du soin. Ce chapitre permet de situer le débat encore vif autour de la balance potentielle bénéfices/coûts d’une intervention thérapeutique centrée sur l’insight. Là encore, les résultats des études demeurent contradictoires. Ils laissent supposer que les facteurs interpersonnels pourraient apporter des informations cruciales pour préciser les conditions d’une intervention centrée sur l’insight. Le Chapitre V décrit les quelques études internationales sur l’insight ayant inclus des facteurs interpersonnels. Seules les caractéristiques personnelles impliquées dans les relations interpersonnelles (cognition sociale) ont été étudiées comme variables explicatives de l’insight. Les caractéristiques de l’environnement proche impliquées dans les relations interpersonnelles ont été partiellement interrogées afin d’expliquer les relations insight-corrélats cliniques. Plus rares encore sont les études ayant porté sur les variables interpersonnelles expliquant les relations insight et qualité de vie subjective. Le Chapitre VI présente les deux objectifs de cette thèse. Dans le cadre d’une étude transversale, il s’agissait d’explorer la pertinence de l’inclusion de facteurs interpersonnels i) dans les modèles explicatifs de l’insight, et ceci selon le mode auto ou hétéro-évaluatif ; ii) dans l’explication des relations insight et qualité de vie subjective. La Partie B décrit en détail la méthode utilisée, avec la procédure et les différentes analyses réalisées afin d’explorer ces questions. La Partie C présente les caractéristiques de l’échantillon constitué et les résultats significatifs aux différentes analyses conduites, en les resituant face aux recherches internationales. Les facteurs interpersonnels permettent d’améliorer la qualité des modèles classiques de l’insight, quelle que soit la méthode d’évaluation (auto versus hétéro-évaluation). Cependant, les facteurs interpersonnels isolés sont différents pour chacune de ces méthodes. Enfin, les résultats suggèrent que certains facteurs interpersonnels modèrent la relation insight-qualité de vie subjective. La Partie D discute les résultats principaux de cette thèse, en insistant sur les limites de la recherche et les perspectives qu’elles ouvrent en conséquence. Quatre points d’intervention spécifique autour de l’insight sont développés, chacun propre à considérer et intégrer les facteurs interpersonnels comme leviers thérapeutiques. / In the Part A, the Chapter 1 presents schizophrenia and the subjective quality of life, rarely considered in this population. The reliability of subjective quality of life assessment has been frequently criticized because of the frequent lack of insight in schizophrenia. This chapter highlights the following paradox. On one hand, the empowerment policies induce the consideration of the subject as playing an active role with regard to the treatment that they receive, whereas, on the other hand, the lack of insight can limit or prevent therapeutic engagement. Chapters II and III present classical conceptualizations of clinical insight in schizophrenia (definition, assessment, models). Among the classical models, predictors of insight have been mostly investigated in terms of personal (e.g. cognitive resources) and clinical factors (symptoms). These studies have gradually integrated moderating or mediating factors since data about linear relationships between insight and classical factors were inconsistent. However, models are essentially based on the subject abilities, without taking into account the interactional process involved in insight. The Chapter IV presents studies investigating associations between insight and clinical outcomes. This chapter highlights the debate still active on the cost/benefit potential balance of a therapeutic intervention focused on insight. Here again, consensus is lacking. Interpersonal factors might also give crucial information to define more thoroughly the conditions of interventions focused on insight. The Chapter V describes the few international studies dealing with insight and interpersonal factors. Only personal characteristics involved in interpersonal relationships (e.g. social cognition) have been studied as predictors of insight. The close environment characteristics that are involved in interpersonal relationships have been partially questioned in order to explain relationships between insight and clinical outcomes. Very few studies have been focused on interpersonal variables that could explain relationships between insight and subjective quality of life. The Chapter VI presents the two main objectives of this work. Through a cross-sectional study, we explored whether including interpersonal factors i) in explanatory models of insight, ii) in explanation of relationships between insight and subjective quality of life could be relevant. The Part B gives details about the method, the procedure and the different analyses that have been conducted in order to explore these questions. The Part C presents sample characteristics and significant results of analyses. These results are compared to those of international research. Interpersonal factors significantly improved the quality of classical insight models, whatever the assessment method (self-reported versus expert-rated insight). However, depending on the assessment method, distinct interpersonal factors were identified. Finally, results suggest that several interpersonal factors moderate the relationships between insight and subjective quality of life. Finally, the Part D discusses the main results of this work, insisting on the limits of the present research and giving some perspectives for future research. Four points for clinical interventions on insight are developed, each integrating interpersonal factors as therapeutic lever.