treatment of Poor insight?
Degree of insight may or may not influence a person’s response to an SRI. Many people with poor insight respond well to SRIs when they are willing to take medication. Having said that, poor insight may best predict which patients will be reluctant to commence treatment and those who may be non-compliant.
People with poor insight have an equivalent response to pharmacologic treatment regardless of the SRI agent being used.
There is no evidence that the addition of an antipsychotic is useful for poor insight OCD as first-line intervention, although antipsychotics are a potentially beneficial augmentation strategy for treatment-resistant OCD, this seems to be independent of whether or not the person has poor insight.
Can Exposure and Response Prevention (ERP) be used with poor insight OCD?
Patients with extremely poor insight show a poorer response to ERP. Patients with moderately or mildly poor insight can respond to ERP.
Poor insight OCD patients may have an inability to recognize that the beliefs associated with their obsessions are senseless and this may hinder the learning process that takes place during prolonged and repeated exposures to feared stimuli.
Because of the non-adherence issue with poor insight, cognitive therapy may be more useful initially to challenge the thoughts before using ERP.
Medication should also be started to see if by improving insight the person may then be more amenable to ERP.