INSIGHT AND JUDGMENT-1.pptx

Insight

1. INSIGHT AND JUDG e MENT Dr. Anuradha Patel 1 st year resident Department of psychiatry

2. Definitions Insight : conscious recognition of one’s own condition. In psychiatry, it refers to conscious awareness and understanding of one’s own psychodynamics and symptoms of maladaptive behavior. Judgement : mental act of comparing or evaluating choices within the framework of given set of values for the purpose of electing a course of action. synopsis of psychiatry 12 th edition.

3. Insight and judgment are interrelated. The ability to make sound decision / judgment presupposes an adequate level of insight. A variable amount of insight precedes the formulation of an opinion or judgment. Insight judgement decision action Paula T. Trzepacz and robert baker

4. insight Insight begins with one’s own feelings, thoughts and reactions to other people or situations. After this, insight requires comparison of how one feels and thinks about an issue or problem with what other people feel and think . This permits conscious awareness of one’s conformity or nonconformity with societal norms. Not an indicator of severity of illness A person with psychosis may have good insight while a person with mild anxiety disorder may have little or no insight. Paula T. Trzepacz and robert baker and synopsis

5. grades of insight GRADE 1 : complete denial of illness GRADE 2 : slight awareness of being sick and needing help but denying it at the same time GRADE 3 : awareness of being sick but blaming it on others, on external events, on organic factors. GRADE 4 : awareness that illness is caused by something unknown in the patient synopsis 10 th edition

6. GRADE 5 : INTELLECTUAL INSIGHT : admission that patient is ill and that symptoms or failures in social adjustment are caused by the pt’s own particular irrational feelings or disturbances without applying this knowledge to future experiences GRADE 6 : TRUE EMOTIONAL INSIGHT : emotional awareness of motives and feelings within the pt and the important persons in his/her life which can lead to basic changes in behavior synopsis 10 th edition

7. factors influencing insight Cultural factors General intelligence and knowledge Stigma Symptomatology Personality traits Predominant defense mechanism Mental status examination(2014)retrieved February 28, 2014 from http://www.amdc.edu.pk

8. All mental illnesses will alter the patient’s world view and capacity to cope with circumstances. Assessment of insight measures the awareness of this change by patient and his ability to adapt to the change. It is the understanding of the individual about his own state of health, capacity and worth; It also relates this assessment of internal state to other people and the world outside. David regards insight as composed of 3 distinct, overlapping dimensions, namely the recognition of morbid psychological change, labelling of this change as deriving from mental illness and understanding that this change requires treatment . sims symtomps in the mind

9. Insight is a complex construct. Adequate insight is usually vital for compliance with ongoing treatment. Insight may fluctuate with stress( e.g. usually insightful but frightened pt with acute MI may deny seriousness of chest pain & try to leave emergency room ) or current severity of mental illness (E. g. the patient who does not realize, when manic, that his hypersexual behavior at church is inappropriate). Paula T. Trzepacz and robert baker

10. Possible questions for patient What brings you here today? What seems to be the problem? What do you think is causing your problem? How do you understand your problem? Are you aware of phenomenon others have observed? If so, do you recognize the phenomenon as abnormal? If so, do you consider that they are caused by mental illness? If so, do you think you need treatment? Mental status examination(2014)retrieved February 28, 2014 from http://www.amdc.edu.pk

11. judgement Judgement is a thought that expresses a view of reality. ( sims ) Judgement involves weighing and comparing the relative values of different aspects of an issue. The ability to make sound judgement requires intact cognition, capacity to conceptualize, ability to consider long term effects and possible adverse outcomes. Any impairment of these functions diminishes the quality of the resultant judgement . Paula T. Trzepacz and robert baker

12. Determining whether a particular judgement is sound is situation dependant. E.g. killing other people is considered immoral , an exception is made for soldier in battle. To assess whether judgement is disturbed or not, one need to measure it against objective fact. ( sims ) Assessment of faulty judgement is not made solely on the basis of that particular belief or argument but on taking the whole of patient’s behavior and opinions into account.( sims ) The level of judgement may or may not correlate to the level of insight. A patient may have no insight into his/her illness but have good judgement . (synopsis)

13. Assessment of judgement In MSE, judgement can be assessed by: 1) social judgement 2) test judgement

14. Social judgement It includes basic knowledge of social situations, knowledge of responses in such situations and ability apply the correct response personally when faced with a actual social situation. It is observed during hospital stay, interview session and history of informants who have witnessed the patient’s actual performance in day to day events. Mental status examination(2014)retrieved February 28, 2014 from http://www.amdc.edu.pk

15. Test judgement It is assessed by asking the patient what he/she would do in certain test situations E.g. what would you do in case of a house on a fire? what is the thing to do if you find an envelop in the street that is sealed, stamped and addressed? If you were in a crowded movie theater and you were the first one to notice a fire , what would you do?

16. Examples of disorders whose symptoms may contribute to impaired insight and judgement Drugs and alcohol dependence Depression Mania Anxiety disorders Dementia Delirium Attention deficit disorder Impulse control disorders Conversion disorder OCD Psychosis Personality disorders Central nervous system disorders Paula T. Trzepacz and robert baker

17. Phenomenon of loss of insight and disturbed judgement are also observed in lesions of hypothalmo -parietal areas of right side of brain and lesions of more central part of optic radiation. In this phenomenon, pt is unaware of paresis of limb or one side of body. Such pt when asked about their paretic limb may say that limb is alright. When asked to move paralytic limb they may move other limb and insist that they have moved paralytic limb. a guide to clinical psychiatry by namboodiri and john

18. Insight Self appraisal and self esteem Understanding of current circumstances Ability to describe personal, psychological and physical status Judgement Appraisal of major social relationships Understanding of personal roles and responsibilities

19. Thank you