King's College London

TY - JOUR

T1 - Insight is a useful construct in clinical assessments if used wisely

AU - David, Anthony

AU - Ariyo, Kevin

N1 - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2020

Y1 - 2020

N2 - Medical ethicist, Guidry-Grimes has critically reviewed the concept of insight, voicing concerns that it lacks consensus as to its components and that it undermines patient perspectives. We respond by briefly summarising research over the last 30 years that she overlooks which has helped establish the clinical validity of the construct. This includes the adoption of standardised assessment tools-at least in research-and longitudinal and cross-sectional studies quantifying associations with psychopathological, clinical and cognitive measures. We also make the distinction between the current standards for assessing decision-making capacity leading to, where appropriate, involuntary treatment in clinical and medico-legal settings which in most legislations do not include insight assessments, and anecdotal reports of the use and misuse of 'lack of insight' as a proxy for more comprehensive evaluation. We conclude by encouraging a broader view of insight akin to self-knowledge.

AB - Medical ethicist, Guidry-Grimes has critically reviewed the concept of insight, voicing concerns that it lacks consensus as to its components and that it undermines patient perspectives. We respond by briefly summarising research over the last 30 years that she overlooks which has helped establish the clinical validity of the construct. This includes the adoption of standardised assessment tools-at least in research-and longitudinal and cross-sectional studies quantifying associations with psychopathological, clinical and cognitive measures. We also make the distinction between the current standards for assessing decision-making capacity leading to, where appropriate, involuntary treatment in clinical and medico-legal settings which in most legislations do not include insight assessments, and anecdotal reports of the use and misuse of 'lack of insight' as a proxy for more comprehensive evaluation. We conclude by encouraging a broader view of insight akin to self-knowledge.

KW - capacity

KW - decision-making

KW - involuntary civil commitment

KW - mentally ill and disabled persons

KW - psychiatry

UR - http://www.scopus.com/inward/record.url?scp=85083396610&partnerID=8YFLogxK

U2 - 10.1136/medethics-2020-106128

DO - 10.1136/medethics-2020-106128

M3 - Article

C2 - 32273295

JO - Journal of Medical Ethics

JF - Journal of Medical Ethics

SN - 0306-6800

M1 - 32273295

ER -