Insight and treatment adherence in serious mental illness, namely psychotic disorders, are well recognized as strong predictors of prognosis; several psychometric instruments have been developed for their evaluation.

To analyze the relation between self and hetero-evaluated insight and treatment attitudes in a clinical sample of psychiatric patients, besides assessing it's clinical correlates and relevance.

60 patients with serious mental illness (schizophrenia and bipolar disorder with psychotic features) were assessed using the Portuguese versions of the ‘Insight Scale' (IS), ‘Medication Adherence Rating Scale’ (MARS) and ‘Insight and Treatment Attitudes Questionnaire’ (ITAQ). General psychopathology and functioning scales were also applied, such as the BPRS, BDI-II and FAST. Relevant sociodemographic and clinical variables were also obtained. Statistical analysis was conducted using SPSS version 19.

Self-reported insight using the IS was not correlated with the insight subscale of the ITAQ, a hetero-evaluation instrument. Similarly, we found no correlation regarding attitudes to treatment when comparing self-report (MARS) and hetero- evaluation (treatment attitudes subscale of the ITAQ). Nonetheless, patients with a history of medication non-compliance and worse clinical outcomes had significantly lower (p< .05) scores in hetero-evaluation measures of insight and treatment attitudes (ITAQ), yet exhibited no differences in the self-evaluation measures of those dimensions.

Insight and treatment attitudes assessments can be valuable in clinical practice, contributing to decisions in both in- and outpatient settings involving treatment planning and level of monitoring. Clinician-rated instruments are probably more reliable, with clearer prognostic relevance.