Determination and Documentation of Insight in Psychiatric Inpatients

A Crucial and Often Neglected Psychiatric Mental Status Item

By Michael I. Casher, MD and Joshua D. Bess, MD | April 2, 2012

Dr Casher is Director of Adult Inpatient Psychiatry and Clinical Assistant Professor; Dr Bess is Inpatient Attending Psychiatrist and Clinical Instructor in the department of psychiatry at the University of Michigan Medical School, Ann Arbor. They are the coauthors of Manual of Inpatient Psychiatry, published by the Cambridge University Press in 2010 and reviewed in the February 2011 issue of Psychiatric Times. The authors report no conflicts of interest concerning the subject matter of this article.

The self-report aspect is useful, and the scale’s seemingly unwieldy length is somewhat tempered by the simple yes/no question structure. The primary limitation of this scale on an inpatient psychiatric unit is the exclusion of items related to the need for treatment. This one issue consumes more clinical time and energy than any other. While some research studies may be better served by this “clean” approach, daily clinical work must consistently include assessment of the patient’s willingness to adhere to treatment recommendations.

Conclusion

The level of insight is virtually always a crucial issue in hospitalized psychiatric patients. Assessment and documentation of insight is thus an important part of the inpatient psychiatric assessment. This determination should include all the components of insight: awareness of illness and its effects, attribution of symptoms to a mental disorder, perception of need for ongoing treatment, and awareness of the achieved effects of current treatment. Insight can be assessed in the course of a typical evaluation or follow-up interview with augmentation by questions borrowed from any of the validated insight rating scales.

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Determination and Documentation of Insight in Psychiatric Inpatients

A Crucial and Often Neglected Psychiatric Mental Status Item

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